Healthcare Services Auditor (RN) (New York)

JOB DESCRIPTION Job SummaryProvides 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.

care from a medical and / or behavioral health perspective to ensure

member needs are being met.

staff regarding appropriate clinical

decision-making.

identifies areas of re-training for staff, and communicates

findings to leadership.

approaches follow a Molina standard in approach and tool

use.

compliance with the Health Insurance Portability and Accountability

Act (HIPAA), and professionalism in all

communications.

standards, policies and protocols.

detailed records of auditing results.

healthcare services training team with developing training

materials or job aids as needed to address findings in audit

results.

related to clinical auditing.

trainings as needed.

healthcare services leadership regarding issues identified, and

works collaboratively to subsequently

resolve / correct.

Required

Qualifications

experience, with at least 1 year experience in utilization

management, care management, and / or managed care, or equivalent

combination of relevant education and experience.

Registered Nurse (RN). License must be active and unrestricted in

state of practice.

organizational skills.

problem-solving skills.

cross-functional, professional environment.

Ability to work on a team and independently.

Excellent verbal and written communication

skills.

software program(s)

proficiency.

Preferred

Qualifications

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 : $29.05 - $67.97 / HOURLY

vary from posting based on geographic location, work experience,

education and / or skill level.