This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid ...
This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid ...
At NorthBay Health as a Registered Nurse in the Emergency Department you will provide safe ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
At NorthBay Health as a Registered Nurse in the Emergency Department you will provide safe ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
At NorthBay Health the Registered Nurse on the Perioperative Unit you will provide safe, effective ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
At NorthBay Health the Registered Nurse on the Perioperative Unit you will provide safe, effective ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Long Beach, CA · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid ...
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Long Beach, CA · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid ...
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Long Beach, CA · On-site +1
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid ...
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Long Beach, CA · On-site +1
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in Nebraska. Opportunity for a Registered Nurse who has a US license in good standing to join our Medicaid ...
Utilization Management Nurse I, RN
Huntington Beach, CA · Remote
$34.98 - $42.85/hr
Remote in California only Are you ready to make a lasting impact and transform the healthcare space ... Job Summary The UM Nurse I - RN performs clinical review of authorization requests to determine ...
Utilization Management Nurse I, RN
Huntington Beach, CA · Remote
$34.98 - $42.85/hr
Remote in California only Are you ready to make a lasting impact and transform the healthcare space ... Job Summary The UM Nurse I - RN performs clinical review of authorization requests to determine ...
Home health Nurse
Palm Springs, CA · Remote
$31.25 - $40.25/hr
Registered Nurse (RN) - Home Health Care Our agency's mission is to provide professional and ... Company Cell phone This is a remote position.
Home health Nurse
Palm Springs, CA · Remote
$31.25 - $40.25/hr
Registered Nurse (RN) - Home Health Care Our agency's mission is to provide professional and ... Company Cell phone This is a remote position.
Care Manager, LTSS (RN)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
***Remote and field travel in Dane County for member visits*** Job Summary Provides support for care ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...
Care Manager, LTSS (RN)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
***Remote and field travel in Dane County for member visits*** Job Summary Provides support for care ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...
Care Manager, LTSS (RN)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
***Remote with travel throughout Jackson, La Crosse, & Monroe Counties, WI*** Job Summary Provides ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...
Care Manager, LTSS (RN)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
***Remote with travel throughout Jackson, La Crosse, & Monroe Counties, WI*** Job Summary Provides ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...
Care Manager, LTSS (RN)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
***Remote with travel throughout Dane County, Wi for member visits*** Job Summary Provides support for ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...
Care Manager, LTSS (RN)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
***Remote with travel throughout Dane County, Wi for member visits*** Job Summary Provides support for ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is ... Position is eligible for telecommuting/remote work location upon completing the necessary steps and ...
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is ... Position is eligible for telecommuting/remote work location upon completing the necessary steps and ...
Provider Quality Review Nurse, RN
Rancho Cucamonga, CA · On-site +1
$91K - $120K/yr
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is ... Position is eligible for telecommuting/remote work location upon completing the necessary steps and ...
Provider Quality Review Nurse, RN
Rancho Cucamonga, CA · On-site +1
$91K - $120K/yr
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is ... Position is eligible for telecommuting/remote work location upon completing the necessary steps and ...
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is ... Position is eligible for telecommuting/remote work location upon completing the necessary steps and ...
Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is ... Position is eligible for telecommuting/remote work location upon completing the necessary steps and ...
Lead Customer Solution Center Appeals and Grievances RN
Los Angeles, CA · Remote
$132K - $163K/yr
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Lead Customer Solution Center Appeals and Grievances RN
Los Angeles, CA · Remote
$132K - $163K/yr
Job Summary The Lead Appeals and Grievances RN is responsible for assisting with the development of ... holidays, a hybrid remote schedule, and occasional flexibility in hours/shift in critical ...
Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ... Current California RN license required. * Certified Nurse Operating Room required. * Certification ...
Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ... Current California RN license required. * Certified Nurse Operating Room required. * Certification ...
Appeals and Grievances Nurse Specialist RN II
Los Angeles, CA · Remote
$115K - $142K/yr
Job Summary The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides ... remote schedule, occasional flexibility in hours/shift in critical situations and work on-call. ...
Appeals and Grievances Nurse Specialist RN II
Los Angeles, CA · Remote
$115K - $142K/yr
Job Summary The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides ... remote schedule, occasional flexibility in hours/shift in critical situations and work on-call. ...
Location: 100% Remote ****FLEXIBLE HOURS (Set your schedule) ***ONLY CALIFORNIA LICENSED We are seeking an experienced and compassionate Nurse Practitioner (NP) licensed in California to conduct ...
Location: 100% Remote ****FLEXIBLE HOURS (Set your schedule) ***ONLY CALIFORNIA LICENSED We are seeking an experienced and compassionate Nurse Practitioner (NP) licensed in California to conduct ...
Location: 100% Remote ****FLEXIBLE HOURS (Set your schedule) ***ONLY CALIFORNIA LICENSED We are seeking an experienced and compassionate Nurse Practitioner (NP) licensed in California to conduct ...
Location: 100% Remote ****FLEXIBLE HOURS (Set your schedule) ***ONLY CALIFORNIA LICENSED We are seeking an experienced and compassionate Nurse Practitioner (NP) licensed in California to conduct ...
Partner with RNs, Community Health Workers, and clinical leadership to close care gaps and ensure ... Fully remote work environment Pair Team is an Equal Opportunity Employer. At Pair Team, we value ...
Quick apply
Partner with RNs, Community Health Workers, and clinical leadership to close care gaps and ensure ... Fully remote work environment Pair Team is an Equal Opportunity Employer. At Pair Team, we value ...
Remote Primary Care Provider (NP/PA)
Round Mountain, CA · On-site +1
$106K - $137K/yr
Remote Primary Care Provider (NP/PA) - Desktop Care Department: Medical Reports To: Chief Medical ... Collaborate closely with RNs, LVNs, MAs, and care coordination teams Telehealth & Patient Care
Remote Primary Care Provider (NP/PA)
Round Mountain, CA · On-site +1
$106K - $137K/yr
Remote Primary Care Provider (NP/PA) - Desktop Care Department: Medical Reports To: Chief Medical ... Collaborate closely with RNs, LVNs, MAs, and care coordination teams Telehealth & Patient Care
Remote Disneyland Rn information
Does Disneyland hire registered Nurses?
What are the key skills and qualifications needed to thrive as a Remote Registered Nurse for Disneyland, and why are they important?
What is a Remote Disneyland RN?
How much do Disney remote jobs pay?
What are some common challenges faced by Remote Disneyland RNs, and how can they effectively address them?
How much do RNs make at Disneyland?
How to make $80,000 a year working from home?
What is the difference between Remote Disneyland Rn vs Remote Pediatric Nurse?
| Aspect | Remote Disneyland Rn | Remote Pediatric Nurse |
|---|---|---|
| Credentials | Registered Nurse (RN) license | Registered Nurse (RN) license, pediatric-specific certifications often preferred |
| Work Environment | Remote, primarily administrative or telehealth settings within Disney healthcare services | Remote, focused on pediatric patient care via telehealth platforms |
| Employer & Industry | Disney, healthcare/entertainment industry | Healthcare providers, hospitals, telehealth companies |
| Common Search/Comparison | Remote Disneyland Rn vs Remote Pediatric Nurse |
Both roles require an RN license and involve remote work, but Remote Disneyland Rn is specific to Disney's healthcare services, often involving entertainment-related health programs, while Remote Pediatric Nurse focuses on providing pediatric care through telehealth for various healthcare providers.
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Molina HealthcareLong Beach, CA • Remote
Full-time
Posted 3 days ago
Molina Healthcare rating
8.0
Based on 192 frontline employees who took The Breakroom Quiz
147th of 261 rated insurance
Job description
JOB DESCRIPTION
This position will offer remote work flexibility, but the selected candidate must reside in Nebraska.
Opportunity for a Registered Nurse 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 NCQA standards 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. Hours are Monday - Friday, 8AM - 5PM in your time zone.
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 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 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
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
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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