Molina Healthcare · 5 hours ago
Auditor, Healthcare Services - Must reside in Michagan, remote position
United States
Full-time
Remote
Entry, Mid Level
$26.41/hr - $51.49/hr
2+ years expMolina Healthcare is a leading provider in healthcare services, and they are seeking an Auditor for their clinical auditing activities. The role involves performing audits in various clinical areas, ensuring compliance with regulatory requirements, and contributing to the quality of member care.
Health CareHospitalMedical
Responsibilities
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
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
Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications
Adheres to departmental standards, policies and protocols
Maintains detailed records of auditing results
Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results
Meets minimum production standards related to clinical auditing
May conduct staff trainings as needed
Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct
Qualification
Required
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
RN or Social Worker Clinical licensure and/or certification required in the State of Michigan, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in State of Michagan
Strong attention to detail and organizational skills
Strong analytical and problem-solving skills
Ability to work in a cross-functional, professional environment
Ability to work on a team and independently
Excellent verbal and written communication skills
Microsoft Office suite/applicable software program(s) proficiency
Preferred
Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience
Benefits
Competitive benefits and compensation package
Company
Molina Healthcare
Molina Healthcare is a healthcare company that specializes in government-sponsored healthcare programs for families and individuals.
10001+ employees
H1B Sponsorship
Molina Healthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (56)
2024 (45)
2023 (43)
2022 (31)
2021 (35)
2020 (55)
Funding
Current Stage
Public CompanyTotal Funding
$2.35B2025-11-17Post Ipo Debt· $850M
2024-11-13Post Ipo Debt· $750M
2021-11-16Post Ipo Debt· $750M
Leadership Team
Dave Reynolds
Executive Vice President, Health Plans & Medicaid Chief Operating Officer
Debbie Simkins
Vice President, Office of the CIO
Recent News
2026-01-17
Company data provided by crunchbase