REMOTE CLINICAL AUDITOR, COMPLIANCE (RN)

Molina Healthcare

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Molina Healthcare
United States; United States; United States; United States; United States
Job ID 2022676

JOB DESCRIPTION

JOB SUMMARY

Molina Healthcare’s Compliance team supports compliance operations for all Molina product lines enterprise-wide.  It is a centralized corporate function supporting compliance activities at individual state health plans.

Reporting to the Compliance Manager, the Compliance Nurse Auditor is responsible for designing and conducting Compliance Clinical Audits that effectively prevents and/or detects violations of applicable federal, state and local laws, regulations and contracts.  Ensures compliance with established internal control procedures by examining records, reports, operating practices, and documentation.

JOB DUTIES

  • Performs on-going internal compliance clinical audits, regulatory validation audits and ad hoc audits, by developing  audit tools and in some instances, building regulatory matrices.
  • Works with key stakeholders (business areas, compliance officers et. al.) to identify and define audit scopes and criteria and Develop audit objectives, plans, and scope by reviewing available information and conducting research.
  • Completes audit workpapers by documenting audit tests and findings.
  • Appraises adequacy of internal department processes by reviewing cases, documentation, processes and/or other applicable documentation that supports the business.
  • Appraises adequacy of internal control systems by reviewing monitoring and audit tools, key performance indicators, training documents and/or other applicable documentation.
  • Maintains internal control systems by updating audit tools and questionnaires, and recommending new policies and procedures, key performance indicators and corrective actions when appropriate.
  • Communicates audit findings by preparing a final report and discussing findings with the business areas, Compliance Officers and others as appropriate.

REQUIRED EDUCATION:

Registered Nurse

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

1-3 years

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Registered Nurse

PREFERRED EDUCATION:

Bachelor’s degree in health care related area.

PREFERRED EXPERIENCE:

3-5 years experience.

Medicaid & Medicare experience.

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

LVN, LPN or Registered Nurse, R

Pay Range: $49,930 – $99,980 a year*

*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 Us

Molina 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.

Job Type: Full TimePosting Date: 09/21/2023