RN LTSS Audit & Risk Specialist

Molina Healthcare; Wauwatosa (WI); On-site; USD 40,000 - 78,000; Full time

Job summary

Molina Healthcare in the United States seeks an experienced LTSS QA auditor to perform risk-focused audits of care management records, assessing member health and safety and identifying gaps in documentation, escalation, and follow-up. You will contribute to strategies that improve quality and cost-effective member care.

This role emphasizes data-driven reviews, cross-functional collaboration, confidentiality under HIPAA, and timely reporting to leadership.

Qualifications

• 3+ years of healthcare experience, LTSS/utilization management exposure preferred.
• RN license active and unrestricted.
• Experience working with data/reports to identify trends and improvement opportunities.
• Strong analytical and problem‑solving skills.
• Excellent attention to detail and organizational abilities.
• Ability to work cross‑functionally in a professional environment.
• Ability to work both in a team and independently.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office and Excel.

Responsibilities

• Conducts retrospective, concurrent, and targeted audits of care management records and related documents.
• Reviews LTSS/HCBS and utilization activities to identify risks across care continuum.
• Facilitates reviews to ensure risks are identified, mitigated, documented, and escalated when needed.
• Identifies trends affecting residential placement, HCBS delivery, and care coordination.
• Analyzes audit results across units and populations to flag patterns and vulnerabilities.
• Maintains data quality and traceability to source documentation.
• Documents findings with risk level, actions, owners, due dates, and evidence.
• Performs follow‑up reviews to verify corrective actions.

Skills

Analytical skills

Communication skills

Attention to detail

Cross-functional collaboration

Teamwork & independence

Education

RN license (active)

Bachelor’s degree in healthcare

Tools

Microsoft Excel

MS Office

Job description

Molina Healthcare in the United States seeks an experienced LTSS QA auditor to perform risk-focused audits of care management records, assessing member health and safety and identifying gaps in documentation, escalation, and follow-up. You will contribute to strategies that improve quality and cost-effective member care.

This role emphasizes data-driven reviews, cross-functional collaboration, confidentiality under HIPAA, and timely reporting to leadership.