Auditor, Healthcare Services - reside in Michagan, remote position

Position: Auditor, Healthcare Services - Must reside in Michagan, remote position
JOB DESCRIPTION

Job Summary

Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential

Job Duties

- Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed.

- Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.

- Ensures auditing approaches follow a Molina standard in approach and tool use.

- Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications.

- Adheres to departmental standards, policies and protocols.

- Maintains detailed records of auditing results.

- Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results.

- Meets minimum production standards related to clinical auditing.

- May conduct staff trainings as needed.

- Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.

Required Qualifications

- At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.

- RN or Social Worker Clinical licensure and/or certification required in the State of Michigan, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in State of Michagan.

- Strong attention to detail and organizational skills.

- Strong analytical and problem-solving skills.

- Ability to work in a cross-functional, professional environment.

- Ability to work on a team and independently.

- Excellent verbal and written communication skills.

- Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

- Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.

To all current Molina employees:
If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $51.49 / HOURLY

* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.