Clinical Services Auditor (LVN/ LPN): California
KNOWLEDGE / SKILLS / ABILITIES
Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and / or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements.
May also perform non-clinical system and process audits, as needed.
- Audits for clinical gaps in care from a medical and / or behavioral 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 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 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.
Meets minimum production standardsMay conduct staff trainings as needed
- Communicates with QA supervisor / manager about issues identified and works collaboratively to resolve / correct them.
- 15% travel required.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program and / or Associate's or bachelor’s degree in Health related field.
Required Experience
- Minimum two years UM, CM, MAT, HM, DM, and / or managed care experience.
- Proficient knowledge of Molina workflows.
Required License, Certification, Association
- Active, unrestricted State Licensed Vocational Nurse or Practical Nurse (LVN or LPN) 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 Experience
More than one-year managed care experience. One year of UM, CM, DM auditing experience.
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.
Pay Range : $21.6 - $46.81 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission.
Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.
Job Type : Full Time Posting Date : 07 / 23 / 2024
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