RN Auditor, Clinical Services remote based in WA

Molina Healthcare; Long Beach (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider is seeking a qualified Registered Nurse for a remote position focused on auditing clinical staff and ensuring compliance. Candidates must have a relevant nursing degree and at least two years of related experience. This role offers opportunities for growth, competitive benefits, and the chance to make a significant impact on patient care.

Benefits

Competitive benefits and compensation package

Opportunities for career advancement

Supportive and collaborative environment

Qualifications

• Minimum two years of experience in Utilization Management, Case Management or related areas.
• Active and unrestricted RN license in good standing.
• Valid driver's license with a good driving record and reliable transportation.

Responsibilities

• Conduct monthly audits of registered nurses and clinical functions.
• Monitor compliance of clinical staff with NCQA, CMS, State, and Federal requirements.
• Assess clinical staff for appropriate decision-making.

Skills

Knowledge of healthcare workflows

Auditing processes

Education

Associate's or Bachelor’s degree in Nursing

Completion of accredited Registered Nurse (RN) Program

Job description

Employer Industry: Healthcare Services

Why Consider this Job Opportunity:

• Remote position available for candidates in Washington State
• Opportunity for career advancement and growth within the organization
• Competitive benefits and compensation package
• Chance to make a positive impact on clinical staff compliance and patient care
• Work in a supportive and collaborative environment

What to Expect (Job Responsibilities):

• Conduct monthly audits of registered nurses and other clinical functions in Utilization Management, Case Management, and other health management areas
• Monitor compliance of clinical staff with NCQA, CMS, State, and Federal requirements
• Assess clinical staff for appropriate decision-making and report findings to leadership
• Assist in preparation for regulatory audits and participate as a subject matter expert
• Maintain detailed records of auditing results and develop training materials as needed

What is Required (Qualifications):

• Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor’s degree in Nursing, or a related field
• Minimum two years of experience in Utilization Management, Case Management, or related areas
• Active and unrestricted RN license in good standing
• Valid driver's license with a good driving record and reliable transportation
• Proficient knowledge of healthcare workflows and auditing processes

How to Stand Out (Preferred Qualifications):

• 3-5 years of experience in case management, disease management, or utilization management within managed care or health settings
• Two years of clinical auditing/review experience
• Familiarity with NCQA standards and state Medicaid contracts

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.

We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.