RN Healthcare Services Auditor

Temporary

Job Summary
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. Knowledge/Skills/Abilities
* Performs monthly auditing of registered nurse functions in Healthcare Services and Nurse Advice for compliance with CMS, NCQA, URAC, State and Federal requirements.
* Coaches registered nurses in appropriate clinical decision-making.
* Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to staff and leadership.
* Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications.
* Adheres to departmental standards, policies, protocols.
* Maintains detailed records of auditing results
* Assists HCS training team with developing training materials or job aids as needed to address findings in audit results
* Communicate with the Supervisor and Manager of QA Issues identified and works collaboratively to resolve/correct issues.
* 5 – 15% local travel may be required.

Job Qualifications

Required Education
Completion of an accredited Registered Nurse (RN) Program and an Associate’s or Bachelor’s Degree in Nursing.

Required Experience
Minimum two years UM, CM, and/or managed care experience.

Proficient knowledge of Molina workflows.

Required License, Certification, Association
Active, unrestricted State Registered Nursing (RN) license in good standing.

Must have valid driver’s license with good driving record and be able to drive within applicable state or locality with reliable transportation.

Preferred Education
Bachelor’s Degree in Nursing

Preferred Experience
3-5 years in case management, disease management, managed care or medical or behavioral health settings.

Preferred License, Certification, Association
N/A

To all current Molina employees: If you are interested in applying for this position, please apply through the Intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package.

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.