Clinical Services Auditor (LVN/ LPN) CALIFORNIA

The ideal candidate must live in  California and some minimal travel will be required. 

 

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 standards
    • May 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.

 

Pay Range:  $21.82 – $42.55 an hour*

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

 

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.

 

 

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