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Clinical Services Auditor (LVN/ LPN) : Travel required in Southern California San Diego, Califo[...]

Company: Molina Healthcare
Location: Riverside
Posted on: March 19, 2023

Job Description:

Clinical Services Auditor (LVN/ LPN) : Travel required in Southern CaliforniaWe are seeking LVN Nurse Auditorsfor this role, THIS POSITION REQUIRES 50% TRAVEL BY CAR (2 - 3 days a week in the field),throughout the area that you are responsible for. The qualified candidate MUST BE LOCATED IN SOUTHERN CALIFORNIA.Travel will include but may notbe limited to San Diego County, San Bernardino County or Riverside County. Multiple openings will be available. A clean DMV driving record, proof of auto insurance, and reliable transportation is required. Mileage will be reimbursed. Position will be based from your remote home office in California.KNOWLEDGE/SKILLS/ABILITIES

  • Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed.
  • Audits for clinical gaps in care from a medical and/or behavioral perspective to ensure member needs are being met.
  • Assesses clinical staff regarding appropriate clinical decision-making.
  • Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings leadership.
  • Ensures auditing approaches follow a Molina standard in approach and tool use.
  • Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and professionalism with all communications.
  • Adheres to departmental standards, policies, protocols.
  • Maintains detailed records of auditing results.
  • Assists HCS training team with developing training materials or job aids as needed to address findings in audit results.
    • Meets minimum production standards
    • May conduct staff trainings as needed
    • Communicates with QA supervisor/manager about issues identified and works collaboratively to resolve/correct them.JOB QUALIFICATIONSRequired EducationCompletion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program and/or Associate's or bachelor's degree in Health related field.Required Experience
      • Minimum two years UM, CM, MAT, HM, DM, and/or managed care experience.
      • Proficient knowledge of Molina workflows.Required License, Certification, Association
        • Active, unrestricted State Licensed Vocational Nurse or Practical Nurse (LVN or LPN) in good standing.
        • Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.Preferred ExperienceMore than one-year managed care experience. One year of UM, CM, DM auditing experience.*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.About UsMolina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Sign up to receive automatic notices when jobs that match your interests are posted.

Keywords: Molina Healthcare, Riverside , Clinical Services Auditor (LVN/ LPN) : Travel required in Southern California San Diego, Califo[...], Healthcare , Riverside, California

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