*****California residents preferred.** ****Out of state candidates must be licensed for CA and must be willing to support PACIFIC TIME ZONE business hours.** **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. + 15% travel required. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program **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 Experience** More than one-year managed care experience. One year of UM, CM, DM auditing experience. 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. Pay Range: $27.61 - $53.83 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.