Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Remote · Omaha, Nebraska, United States
Job Summary
Auditor, Healthcare Services (RN) supporting Molina’s Medicaid Team with remote flexibility for candidates residing in Nebraska. Responsibilities include conducting audits of care management, member assessments, behavioral health, and other clinical areas to ensure compliance with NCQA, CMS, and state/federal guidelines; identifying gaps in care and ensuring appropriate clinical decision-making; generating and communicating monthly audit outcomes to leadership; maintaining HIPAA confidentiality; and assisting in training materials to address audit findings. Requires an active RN license, 2+ years healthcare experience (1 year in care management/managed care), and strong Excel/PowerPoint skills. Hours are Mon–Fri 8AM–5PM in local time; position emphasizes quality, cost-effective member care aligned with regulatory standards.
Required Qualifications
- Registered Nurse (RN) license active in state of practice
- 2+ years healthcare experience with 1 year in care management or managed care (or equivalent education/experience)
- strong attention to detail and organizational skills
- analytical and problem-solving skills
- ability to work in cross-functional team and independently
- excellent verbal and written communication
- Microsoft Office proficiency
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