Top 8 Rn Medical Auditor Jobs

Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Molina Healthcare —Omaha, NE
- $27.59 - $56.63 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Analysis skills
- Health insurance
Compliance Auditor
PRECISION HEALTHCARE SPECIALISTS LLC —Fort Myers, FL
- Remote
- Mid-level
- 3 years
- LPN
Quick Apply
Program Integrity Clinical Compliance Auditor
Optum —Boston, MA
- $29 - $52 an hour
- 8 hour shift
- Remote
- 18 years or older
- RN License
- Customer service
- On-the-job training
Delegation Oversight Clinical Auditor RN II
L.A. Care Health Plan —Los Angeles, CA
- $88,854 - $142,166 a year
- Full-time
- Nursing
- RN License
- Computer literacy
- Wellness program
- Health insurance
QA Specialist RN Auditor
CDS Monarch, Inc. —Webster, NY
- $37 - $40 an hour
- Part-time
- 18 years or older
- Nursing
- RN License
Quick Apply
3d
LPN/RN Clinical Auditor
Greenwood Village South —Greenwood, IN
- From $30 an hour
- Weekends as needed
- RN License
- Mid-level
- Analysis skills
- 403(b) matching
- Disability insurance

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Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska

Molina Healthcare -
Omaha, NE

Apply Now

Job Details

Full-time
$27.59 - $56.63 an hour

Benefits

Health insurance

Qualifications

RN License
Spreadsheets
Productivity software
Cross-functional collaboration
Cross-functional communication

Full Job Description

JOB DESCRIPTION

This position will offer remote work flexibility, but the selected candidate must reside in Nebraska.

Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid Team as a Clinical Auditor. The person filling this role will be an instrumental part of the team work to align the Medicaid Team compliance guidelines with those followed by our corporate teams. Knowledge and experience working with NCQA standards is vital to success in this role. The preferred candidate will have 3 – 5 years of experience in a MCO and at least 2 years of clinical auditing and/or review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill sets we are seeking. Hours are Monday – Friday, 8AM – 5PM in your time zone.

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 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.
Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.
Assesses clinical staff regarding appropriate clinical decision-making.
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 care management, and/or managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and restricted in state of practice.
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

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: $27.59 - $56.63 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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Refine Your Search

Rn Medical Auditor jobs

Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska

Compliance Auditor

Program Integrity Clinical Compliance Auditor

Delegation Oversight Clinical Auditor RN II

QA Specialist RN Auditor

LPN/RN Clinical Auditor

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