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Loyola University Chicago Marcella Niehoff School of Nursing
Chicago, Illinois
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University of Illinois Chicago College of Nursing
Chicago, Illinois
University of Illinois Chicago College of Nursing
Chicago, Illinois
University of Illinois Chicago College of Nursing
Chicago, Illinois
Planned Parenthood of Southern New England
Providence, Rhode Island
University of Massachusetts Dartmouth
Dartmouth, Massachusetts
IRIS SDPC (RN) - TMG (Dane County, WI) (Fieldwork/Hybrid) (No Holidays, No Weekends, No After Hours)
Molina Healthcare
Madison, Wisconsin
Molina Healthcare
Milwaukee, Wisconsin
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Remote Auditor, Clinical Services - RN preferred
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). Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed. Assesses clinical staff regarding appropriate decision-making. Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership. Ensures auditing approaches follow a Molina standard in approach and tool use. Assists in preparation for regulatory audits by performing file review
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