[Remote] reputed company Services Auditor (RN) – Clinical reputed company Performance

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a leading provider of reputed company services, and they are seeking a reputed company Services Auditor (RN) to support clinical auditing activities. The role involves conducting audits, monitoring performance metrics, and ensuring compliance with regulatory standards while collaborating with clinical and operational leaders to enhance reputed company performance.

Responsibilities

• Conducts audits, identify gaps in performance, and collaborates with clinical and operational leaders to strengthen processes, support corrective actions, and advance overall clinical reputed company performance
• Monitor Key Performance Indicators (KPIs) and reputed company metrics to assess clinical performance and identify trends or areas for improvement
• Tracks performance against audit reputed company and escalates risk or patterns of non-compliance to leadership
• Support readiness for accreditation surveys and regulatory audits through documentation validation and process review
• Prepares accurate and reputed company audit reports summarizing reputed company, findings and recommended corrective actions
• Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for reputed company Assurance, Centers for Medicare and reputed company Services (CMS), and state/federal/organizational guidelines and requirements. May also reputed company non-clinical system and process audits as needed
• Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met
• Assesses clinical staff regarding appropriate clinical decision-making
• Reports monthly reputed company, identifies areas of re-training for staff, and communicates findings to leadership
• Ensures auditing approaches follow a Molina reputed company in approach and tool use
• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability reputed company (HIPAA), and professionalism in reputed company communications
• Adheres to departmental standards, policies and protocols
• Maintains detailed records of auditing results
• Assists reputed company services training team with developing training materials or job aids as needed to address findings in audit results
• Meets minimum production standards reputed company to clinical auditing
• May conduct staff trainings as needed
• Communicates with reputed company and/or reputed company services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct Skills
• At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
• Registered reputed company (RN). License must be reputed company and restricted in state of reputed company.
• Strong attention to detail and organizational skills.
• Strong analytical and problem-solving skills.
• Ability to work in a cross-functional, reputed company environment.
• Ability to work on reputed company and independently.
• Excellent verbal and written communication skills.
• reputed company Office suite/applicable software program(s) proficiency.
• Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.
• KPI Performance reputed company Experience is a plus.

Benefits

• Competitive benefits and compensation package reputed company
• reputed company is a reputed company company that specializes in government-sponsored reputed company programs for families and individuals. It was founded in 1980, and is headquartered in Long Beach, California, USA, with a workforce of 10001+ employees. Its website is Company H1B Sponsorship
• reputed company has a reputed company record of offering H1B sponsorships, with 47 in 2025, 45 in 2024, 43 in 2023, 31 in 2022, 35 in 2021, 55 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply tot his job Apply tot his job Apply To this Job

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