RN LTSS Audit Specialist - Risk & Quality

Molina Healthcare, Inc.; Wauwatosa (WI); Presencial; USD 70.000 - 90.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive benefits

Descripción de la vacante

Molina Healthcare, Inc. is seeking an experienced RN LTSS Auditor to support clinical auditing for long-term services and supports.

The role focuses on risk-focused audits, trend analysis, and ensuring documentation and escalation follow established Molina procedures. You will review care management records, LTSS, HCBS, and utilization management activities to identify health and safety risks, validate data quality, and report findings to leadership.

Formación

• At least 3 years of healthcare experience, preferably in care management, utilization management, and/or managed care, and at least 2 years of LTSS, quality improvement, audit, and/or member health and safety activities.
• Registered Nurse (RN). License must be active and unrestricted in state of practice.
• Experience working with data, reports, or audit results to identify trends, outliers, and opportunities for improvement.
• Strong analytical and problem-solving skills.
• Strong attention to detail and organizational skills.
• Ability to work in a cross-functional, professional environment.
• Ability to work on a team and independently.
• Strong verbal and written communication skills.
• Microsoft Office suite proficiency.
• Microsoft Excel proficiency, including organizing, reconciling, filtering, and analyzing data.
• In some states, a bachelor's degree in a health care related field may be required (dependent upon state/contractual requirements).

Responsabilidades

• Conduits retrospective, concurrent, and targeted audits of care management records, assessments, member-centered plans, and related documentation.
• Reviews LTSS, HCBS, care management, and utilization management activities to ensure risk identification across the care continuum.
• Facilitates reviews to ensure risks are identified, mitigated, documented, and escalated when needed.
• Identifies trends related to residential placement, HCBS service delivery, critical incidents, and care coordination.
• Analyzes audit results and internal metrics to identify recurring or emerging risks.
• Verifies data quality and maintains traceability of findings to source documentation.
• Reports outcomes and communicates findings to leadership.
• Documents findings, risk level, recommended action, owner, due date, status, escalation, and evidence.
• Conducts follow-up reviews to verify corrective actions.
• Ensures auditing approaches follow Molina standards in method and tools.
• Maintains HIPAA-compliant confidentiality and professional behavior.
• Maintains detailed records of auditing results.
• Assists with training materials to address audit findings.
• Meets minimum production standards related to non-clinical auditing.
• May conduct staff training as needed.
• Communicates issues to Quality and Healthcare Services leadership for resolution.

Conocimientos

Auditing

Data analysis

RN license

Excel proficiency

Communication

Detail-oriented

Educación

Bachelor's degree in healthcare

Herramientas

MS Office

Microsoft Excel

Descripción del empleo

Molina Healthcare, Inc. is seeking an experienced RN LTSS Auditor to support clinical auditing for long-term services and supports.

The role focuses on risk-focused audits, trend analysis, and ensuring documentation and escalation follow established Molina procedures. You will review care management records, LTSS, HCBS, and utilization management activities to identify health and safety risks, validate data quality, and report findings to leadership.