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    "ExternalDescriptionStr": "<p>JOB DESCRIPTION Job Summary</p>\n<p>Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.&nbsp;<br><br>\n &nbsp;</p>\n<p>Essential Job Duties</p>\n<p><br>\n • 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 Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed.&nbsp;<br>\n • Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.&nbsp;<br>\n • Assesses clinical staff regarding appropriate clinical decision-making.&nbsp;<br>\n • Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.&nbsp;<br>\n • Ensures auditing approaches follow a Molina standard in approach and tool use.&nbsp;<br>\n • Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications.&nbsp;<br>\n • Adheres to departmental standards, policies and protocols.&nbsp;<br>\n • Maintains detailed records of auditing results.&nbsp;<br>\n • Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results.&nbsp;<br>\n • Meets minimum production standards related to clinical auditing.&nbsp;<br>\n • May conduct staff trainings as needed. •&nbsp;Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.&nbsp;<br><br>\n &nbsp;</p>\n<p>Required Qualifications</p>\n<p><br>\n • 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.&nbsp;<br>\n • Registered Nurse (RN). License must be active and restricted in state of practice.&nbsp;<br>\n • Strong attention to detail and organizational skills.&nbsp;<br>\n • Strong analytical and problem-solving skills.&nbsp;<br>\n • Ability to work in a cross-functional, professional environment.&nbsp;<br>\n • Ability to work on a team and independently.&nbsp;<br>\n • Excellent verbal and written communication skills.&nbsp;<br>\n • Microsoft Office suite/applicable software program(s) proficiency.&nbsp;<br><br>\n &nbsp;</p>\n<p>Preferred Qualifications</p>\n<p><br>\n • Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.</p>\n<p>#PJCorp</p>\n<p>#LI-AC1<br><br>\n To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.&nbsp;<br><br>\n Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V</p>",
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