Auditor, Clinical Services (RN) Remote

Molina Healthcare; Long Beach (CA); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization seeks a Remote Clinical Auditor to enhance compliance and quality assurance. Responsibilities include monitoring clinical staff, conducting audits, and preparing for regulatory reviews. Ideal candidates hold an RN license and possess experience in case management or similar fields, aiming for a supportive growth environment.

Benefits

Competitive benefits and compensation

Flexibility in work location

Opportunities for career advancement

Qualifications

• Minimum 2 years of experience in Utilization Management, Case Management.
• Proficient knowledge of relevant workflows.
• Active RN license in good standing required.

Responsibilities

• Perform monthly clinical function audits in Utilization Management.
• Monitor compliance with regulatory requirements.
• Prepare for regulatory audits by conducting file reviews.

Skills

Clinical Auditing

Compliance Monitoring

Feedback Provision

Education

RN Program Completion

Associate's/Bachelor's Degree in Nursing

Bachelor's/Master's Degree in a Related Field

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Remote position offering flexibility in work location
- Opportunity for career advancement and growth within the organization
- Competitive benefits and compensation package
- Chance to contribute to compliance and quality assurance in healthcare
- Supportive work environment focused on continuous improvement

What to Expect (Job Responsibilities):
- Perform monthly auditing of clinical functions in Utilization Management, Case Management, and related areas
- Monitor compliance of clinical staff with regulatory requirements and internal standards
- Assess clinical staff decision-making and provide feedback
- Prepare for regulatory audits by conducting file reviews and participating as a subject matter expert
- Maintain detailed records of auditing results and assist in developing training materials

What is Required (Qualifications):
- Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's degree in Nursing, or a Bachelor's or Master's degree in a related field
- Minimum of two years of experience in Utilization Management, Case Management, or similar areas
- Proficient knowledge of workflows relevant to the employer
- Valid driver's license with a good driving record and reliable transportation
- Active and unrestricted RN license in good standing

How to Stand Out (Preferred Qualifications):
- 3-5 years of experience in case management, disease management, or utilization management in managed care or healthcare settings
- Two years of clinical auditing/review experience

#HealthcareServices #ClinicalAuditing #RemoteWork #CareerGrowth #QualityAssurance

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About the company

Molina Healthcare is a managed care company headquartered in Long Beach, California, United States.

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