ZipRecruiter

Log In

2

Behavioral Health Auditor Remote Jobs in Michigan

Elara Caring

Senior Compliance Auditor - RN

Detroit, MI · Remote

Senior Compliance Auditor - RN (Remote) At Elara Caring, we care where you are and believe the best ... behavioral health. * Audits for trends related to billing compliance and delivers education to ...

Elara Caring

Senior Compliance Auditor - RN

Detroit, MI · Remote

Senior Compliance Auditor - RN (Remote) At Elara Caring, we care where you are and believe the best ... behavioral health. * Audits for trends related to billing compliance and delivers education to ...

Huron Consulting Group

$38.46 - $52.40/hr

We help healthcare organizations build innovation capabilities and accelerate key growth ... Knows, understands, incorporates, and demonstrates Huron's Vision, and Values in behaviors ...

next page

Showing results 1-20

All JobsBehavioral Health Auditor JobsBehavioral Health Auditor Remote JobsBehavioral Health Auditor Remote Jobs in Michigan

Behavioral Health Auditor Remote information

What is a behavioral health auditor?

A Behavioral Health Auditor (Remote) is a professional who reviews and evaluates behavioral health records, billing, and compliance documentation from a remote location. Their primary responsibility is to ensure that healthcare providers follow state, federal, and organizational guidelines in delivering behavioral health services. They check for accuracy in clinical documentation, adherence to coding standards, and the proper use of billing codes. By identifying discrepancies or areas for improvement, they help organizations maintain compliance and improve the quality of care.

What are the key skills and qualifications needed to thrive as a behavioral health auditor?

To thrive as a Behavioral Health Auditor (Remote), you need a strong background in behavioral health care, auditing principles, and regulatory compliance, typically supported by a relevant degree and auditing or clinical licensure. Familiarity with electronic medical records (EMRs), auditing software, and knowledge of standards such as HIPAA and NCQA are essential. Attention to detail, critical thinking, and effective written communication are vital soft skills for evaluating documentation and delivering clear feedback. These skills and qualifications ensure accurate audits, regulatory adherence, and continuous quality improvement in behavioral health organizations.

What are some common challenges faced by behavioral health auditors working remotely, and how can they be addressed?

Behavioral Health Auditors working remotely often encounter challenges such as staying up-to-date with frequently changing regulatory requirements, maintaining clear communication with providers and internal teams, and ensuring data security when handling sensitive patient information. To address these challenges, auditors can participate in regular training sessions, use secure communication platforms, and establish consistent check-ins with team members. Proactively seeking clarification on documentation and fostering a collaborative virtual environment can also help maintain audit accuracy and team cohesion.

What is the difference between Behavioral Health Auditor Remote vs Behavioral Health Claims Reviewer?

AspectBehavioral Health Auditor RemoteBehavioral Health Claims Reviewer
Required CredentialsCertification in auditing or healthcare compliance, relevant licensesKnowledge of insurance policies, basic healthcare certifications
Work EnvironmentRemote, independent auditing tasks, data analysisRemote or onsite review of insurance claims, documentation
Employer & Industry UsageHealthcare organizations, insurance companies, government agenciesInsurance companies, third-party administrators, healthcare providers

Behavioral Health Auditor Remote and Behavioral Health Claims Reviewer roles both involve working with healthcare data remotely. Auditors focus on evaluating compliance and accuracy of behavioral health records, while claims reviewers primarily assess insurance claims for correctness. Both roles require knowledge of healthcare regulations and often share similar certifications, making them comparable in the behavioral health industry.

What are popular job titles related to Behavioral Health Auditor Remote jobs in Michigan?

For Behavioral Health Auditor Remote jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Behavioral Health Auditor Remote jobs in Michigan look for?

The top searched job categories for Behavioral Health Auditor Remote jobs in Michigan are:

What cities in Michigan are hiring for Behavioral Health Auditor Remote jobs?

Cities in Michigan with the most Behavioral Health Auditor Remote job openings:

Behavioral Health Auditor Remote jobs near you
Infographic showing various Behavioral Health Auditor Remote job openings in Michigan as of August 2026, with employment types broken down into 2% As Needed, 72% Full Time, 17% Part Time, 2% Temporary, 6% Contract, and 1% Nights. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Auditor, Healthcare Services (Remote in MI)

Detroit, MI • Remote

Molina Healthcare
Health Care and Social Assistance • 10K+ employees

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

168th of 312 rated insurance

People enjoy working here

Good employer

Recommended by students

Learn more about Molina Healthcareexternal

Full-time

Re-posted 5 days ago

Job description

JOB DESCRIPTION 

This position will offer remote work flexibility, but the selected candidate must reside in Michigan. 

Opportunity for an RN who has a US license in good standing to join our Medicaid Team as a Clinical Auditor.  The person filling this role will be an instrumental part of the team work to align the Medicaid Team compliance guidelines with those followed by our corporate teams.  Knowledge and experience working with Waiver Program is vital to success in this role. 

The preferred candidate will have 3 - 5 years of experience in a MCO and at least 2 years of clinical auditing and/or review experience. Mastery of Microsoft Office, especially Excel, PowerPoint will also be skill sets we are seeking.  Licensure should be an LPC, RN, LLMSW, LMSW, LBSW.

Hours are Monday - Friday, 8:30AM - 5PM EST. 

Job Summary

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. 

Essential Job Duties


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. 
Audits for clinical gaps in care from a medical and/or behavioral health 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 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. 

Required Qualifications

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.

Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.

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 Qualifications


Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.
 

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Molina Healthcare logo

About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

FacebookTwitter

View All Molina Healthcare Jobs

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply