Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Miami, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Miami, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Jacksonville, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Jacksonville, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Tampa, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Tampa, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Long Beach, CA · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Long Beach, CA · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Saint Petersburg, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Saint Petersburg, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Orlando, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Orlando, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Orlando, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Auditor, Clinical Services
Orlando, FL · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Ensures auditing approaches follow a Molina standard in approach and tool use. Maintains member ...
Contract Analyst (Managed care)
Manhattan, NY · On-site
$75K - $91K/yr
... auditing and maintaining of payor and physician contracts in EPSI contract modeler in addition to auditing payor contracts loaded in EPIC patient billing system. 7. Prepares managed care reports with ...
Contract Analyst (Managed care)
Manhattan, NY · On-site
$75K - $91K/yr
... auditing and maintaining of payor and physician contracts in EPSI contract modeler in addition to auditing payor contracts loaded in EPIC patient billing system. 7. Prepares managed care reports with ...
Quality Manager & Lead Auditor (Metal Plating Company) Our client, a leading provider of ... Company Description We are employment specialists who have worked in heath care and managed care ...
Quick apply
Quality Manager & Lead Auditor (Metal Plating Company) Our client, a leading provider of ... Company Description We are employment specialists who have worked in heath care and managed care ...
Contract Analyst (Managed care)
Manhattan, NY · On-site
$70K - $102K/yr
... auditing and maintaining of payor and physician contracts in EPSI contract modeler in addition to auditing payor contracts loaded in EPIC patient billing system. 7. Prepares managed care reports with ...
Contract Analyst (Managed care)
Manhattan, NY · On-site
$70K - $102K/yr
... auditing and maintaining of payor and physician contracts in EPSI contract modeler in addition to auditing payor contracts loaded in EPIC patient billing system. 7. Prepares managed care reports with ...
Contract Analyst (Managed care)
New York, NY · On-site
$75K - $91K/yr
... auditing and maintaining of payor and physician contracts in EPSI contract modeler in addition to auditing payor contracts loaded in EPIC patient billing system. 7. Prepares managed care reports with ...
Contract Analyst (Managed care)
New York, NY · On-site
$75K - $91K/yr
... auditing and maintaining of payor and physician contracts in EPSI contract modeler in addition to auditing payor contracts loaded in EPIC patient billing system. 7. Prepares managed care reports with ...
Internal Auditor
Janesville, WI · On-site
$58K - $94K/yr
Interacts with Operations management regarding trends in order to improve claims processing ... Certified Healthcare Auditor (CHA) * Certified Public Accountant (CPA) * Registered Health ...
Internal Auditor
Janesville, WI · On-site
$58K - $94K/yr
Interacts with Operations management regarding trends in order to improve claims processing ... Certified Healthcare Auditor (CHA) * Certified Public Accountant (CPA) * Registered Health ...
Managed Care Compliance Specialist - REMOTE!
$22 - $28/hr
Auditing * Assist with implementation and ongoing administration of the organizational Compliance ... Understanding of Medicaid Managed Care, healthcare operations, and basic managed care concepts.
Managed Care Compliance Specialist - REMOTE!
$22 - $28/hr
Auditing * Assist with implementation and ongoing administration of the organizational Compliance ... Understanding of Medicaid Managed Care, healthcare operations, and basic managed care concepts.
Managed Care Auditing experience Compliance 360 system knowledge Ability to understand contractual agreements as it pertains to delegation BA or BS required unless 10+ years in managed care ...
Managed Care Auditing experience Compliance 360 system knowledge Ability to understand contractual agreements as it pertains to delegation BA or BS required unless 10+ years in managed care ...
Claims Auditor
$19.55 - $29.75/hr
Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.
Claims Auditor
$19.55 - $29.75/hr
Minimum of five years experience in insurance, medical or managed care environment including two years of claim processing experience required. Previous auditing and/or Amisys experience preferred.
Managed Care Auditor information
See salary details
$10.34 - $13.61
15% of jobs
$14.34 is the 25th percentile. Wages below this are outliers.
$13.61 - $16.89
46% of jobs
$18.63 is the 75th percentile. Wages above this are outliers.
$16.89 - $20.17
26% of jobs
$20.17 - $23.45
7% of jobs
$23.45 - $26.73
1% of jobs
$26.73 - $30
1% of jobs
$30 - $33.28
1% of jobs
$33.28 - $36.56
0% of jobs
$36.56 - $39.84
1% of jobs
$39.84 - $43.12
1% of jobs
$43.12 - $46.39
0% of jobs
$10
$19
$46
How much do managed care auditor jobs pay per hour?
As of Aug 8, 2026, the average hourly pay for managed care auditor in the United States is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $14.42 and $19.23 per hour, depending on experience, location, and employer.
What is the difference between Managed Care Auditor vs Claims Reviewer?
| Aspect | Managed Care Auditor | Claims Reviewer |
|---|---|---|
| Required Credentials | Certifications like CHC, CPC, or relevant healthcare auditing credentials | Often CPC, CCS, or claims processing certifications |
| Work Environment | Healthcare organizations, insurance companies, government agencies | Insurance companies, healthcare providers, third-party administrators |
| Employer & Industry Usage | Used in managed care plans, health insurance, and healthcare compliance | Common in insurance claims processing and reimbursement review |
While both roles involve reviewing healthcare-related documents, Managed Care Auditors focus on evaluating the accuracy and compliance of managed care plans, whereas Claims Reviewers primarily assess individual insurance claims for correctness and eligibility. The roles often overlap in credentials and work environments but differ in scope and focus within the healthcare reimbursement process.
What is a managed care auditor?
A Managed Care Auditor is a professional who reviews and evaluates healthcare claims, billing records, and contracts to ensure compliance with managed care agreements and regulatory requirements. They work for insurance companies, healthcare providers, or third-party organizations to identify errors, prevent fraud, and ensure that reimbursements are accurate. Managed Care Auditors help organizations optimize their processes, reduce costs, and maintain compliance with healthcare laws and policies. Their work plays a crucial role in safeguarding the financial integrity of managed care programs.
What are some common challenges faced by managed care auditors when working with healthcare providers and payers?
Managed Care Auditors often encounter challenges such as navigating complex contract terms, interpreting varying payer requirements, and keeping up with frequent regulatory changes. Coordinating with healthcare providers and insurance companies can also be demanding, as it requires strong communication and negotiation skills to resolve discrepancies. Additionally, Managed Care Auditors must maintain accuracy and attention to detail while analyzing large volumes of medical and financial data, all within tight deadlines.
What are the key skills and qualifications needed to thrive as a managed care auditor?
To thrive as a Managed Care Auditor, you need in-depth knowledge of healthcare compliance, claims auditing, and managed care regulations, often supported by a degree in healthcare administration or a related field. Familiarity with claims processing systems, medical coding software (such as ICD-10 and CPT), and audit management tools is typically required, with certifications like Certified Professional Medical Auditor (CPMA) being advantageous. Attention to detail, analytical thinking, and strong communication skills help auditors identify discrepancies and collaborate with stakeholders. These skills are crucial for ensuring healthcare providers and payers adhere to regulatory standards and optimize financial performance.
More about Managed Care Auditor jobs
What cities are hiring for Managed Care Auditor jobs? Cities with the most Managed Care Auditor job openings:
What states have the most Managed Care Auditor jobs? States with the most job openings for Managed Care Auditor jobs include:
What job categories do people searching Managed Care Auditor jobs look for? The top searched job categories for Managed Care Auditor jobs are:
$29.05 - $56.64/hr
Full-time
Re-posted 7 days ago
Molina Healthcare rating
8.0
Based on 198 frontline employees who took The Breakroom Quiz
163rd of 303 rated insurance
Job description
JOB DESCRIPTION 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.
Registered Nurse (RN). License must be active and restricted 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.
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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
Pay Range: $29.05 - $56.64 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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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