Lincoln, NE · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in ... Essential Job Duties Performs audits in care management, member assessment, behavioral health, and ...
Lincoln, NE · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in ... Essential Job Duties Performs audits in care management, member assessment, behavioral health, and ...
Lincoln, NE · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in ... Essential Job Duties • Performs audits in care management, member assessment, behavioral health ...
Lincoln, NE · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in ... Essential Job Duties • Performs audits in care management, member assessment, behavioral health ...
Omaha, NE · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in ... Essential Job Duties • Performs audits in care management, member assessment, behavioral health ...
Omaha, NE · Remote
$27.59 - $56.63/hr
This position will offer remote work flexibility, but the selected candidate must reside in ... Essential Job Duties • Performs audits in care management, member assessment, behavioral health ...
This role operates at the intersection of technology, finance, procurement, and risk, ensuring ... Ability to travel 0-10%, on average, based on the work you do; this role is predominantly remote ...
This role operates at the intersection of technology, finance, procurement, and risk, ensuring ... Ability to travel 0-10%, on average, based on the work you do; this role is predominantly remote ...
Omaha, NE · Remote
$120K/yr
Collaborates closely with Regional Sales Manager (RSM) to execute a specific and integrated action ... Tris Pharma, Inc. is an Equal Opportunity Employer. #LI-remote
Omaha, NE · Remote
$120K/yr
Collaborates closely with Regional Sales Manager (RSM) to execute a specific and integrated action ... Tris Pharma, Inc. is an Equal Opportunity Employer. #LI-remote
Omaha, NE · On-site +1
$120K/yr
Collaborates closely with Regional Sales Manager (RSM) to execute a specific and integrated action ... Tris Pharma, Inc. is an Equal Opportunity Employer. #LI-remote
Omaha, NE · On-site +1
$120K/yr
Collaborates closely with Regional Sales Manager (RSM) to execute a specific and integrated action ... Tris Pharma, Inc. is an Equal Opportunity Employer. #LI-remote
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... Understand health care goals associated with chronic disease management provided by the practice.
$10/hr
Remote Join our mission to help transform healthcare delivery from reactive, episodic care to ... Understand health care goals associated with chronic disease management provided by the practice.
Omaha, NE · On-site +1
... various healthcare professionals. This position supports the department by sourcing new talent and working with the Account Managers, Sr. Account Managers, and Team Leads to find employment ...
Omaha, NE · On-site +1
... various healthcare professionals. This position supports the department by sourcing new talent and working with the Account Managers, Sr. Account Managers, and Team Leads to find employment ...
Omaha, NE · On-site +1
... various healthcare professionals. This position supports the department by sourcing new talent and working with the Account Managers, Sr. Account Managers, and Team Leads to find employment ...
Omaha, NE · On-site +1
... various healthcare professionals. This position supports the department by sourcing new talent and working with the Account Managers, Sr. Account Managers, and Team Leads to find employment ...
Omaha, NE · Remote
$63K - $95K/yr
This is a remote position, but all candidates must reside in one of the following states: NE, IA ... management to individuals through coordination with the patient, the physician, other health care ...
Omaha, NE · Remote
$63K - $95K/yr
This is a remote position, but all candidates must reside in one of the following states: NE, IA ... management to individuals through coordination with the patient, the physician, other health care ...
Omaha, NE · Remote
$788/wk
... healthcare financing, enterprise risk management and regulatory compliance, data analytics and ... Location This role is ideally based in Seattle, Washington, but remote work within the United ...
Omaha, NE · Remote
$788/wk
... healthcare financing, enterprise risk management and regulatory compliance, data analytics and ... Location This role is ideally based in Seattle, Washington, but remote work within the United ...
Lincoln, NE · Remote
$53K - $88K/yr
... managing relationships with healthcare providers across chronic therapy programs, with a focus on ... Minimal travel (up to ~20%) * Primarily remote with virtual engagement Due to state pay ...
Lincoln, NE · Remote
$53K - $88K/yr
... managing relationships with healthcare providers across chronic therapy programs, with a focus on ... Minimal travel (up to ~20%) * Primarily remote with virtual engagement Due to state pay ...
... healthcare financing, enterprise risk management and regulatory compliance, data analytics and ... This position is fully remote, while occasional travel may be required. Primary Responsibilities:
... healthcare financing, enterprise risk management and regulatory compliance, data analytics and ... This position is fully remote, while occasional travel may be required. Primary Responsibilities:
... Risk Management) to ensure scalable solutions meet governance, auditability, responsible AI, and ... We embrace a remote-first culture through our Flexible Workplace. Most employees hold Home-Flex ...
... Risk Management) to ensure scalable solutions meet governance, auditability, responsible AI, and ... We embrace a remote-first culture through our Flexible Workplace. Most employees hold Home-Flex ...
The ideal candidate will be located US Remote, TX. Position Summary: The Vertical Leader is a ... They manage, coach, and develop a team of Enterprise Account Managers while directly sponsoring and ...
The ideal candidate will be located US Remote, TX. Position Summary: The Vertical Leader is a ... They manage, coach, and develop a team of Enterprise Account Managers while directly sponsoring and ...
Lincoln, NE · Remote
$53K - $88K/yr
... managing relationships with healthcare providers across chronic therapy programs, with a focus on ... Minimal travel (up to ~20%) * Primarily remote with virtual engagement Due to state pay ...
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Lincoln, NE · Remote
$53K - $88K/yr
... managing relationships with healthcare providers across chronic therapy programs, with a focus on ... Minimal travel (up to ~20%) * Primarily remote with virtual engagement Due to state pay ...
Omaha, NE · Remote
$107K - $156K/yr
... and risk management strategies.Coordinate, collaborate and provide technical guidance to internal ... Health: Comprehensive healthcare plans, wellness incentive program, mental wellbeing support and ...
Omaha, NE · Remote
$107K - $156K/yr
... and risk management strategies.Coordinate, collaborate and provide technical guidance to internal ... Health: Comprehensive healthcare plans, wellness incentive program, mental wellbeing support and ...
Omaha, NE · Remote
$109K - $159K/yr
... and risk management strategies. * Coordinate, collaborate and provide technical guidance to ... Health: Comprehensive healthcare plans, wellness incentive program, mental wellbeing support and ...
Omaha, NE · Remote
$109K - $159K/yr
... and risk management strategies. * Coordinate, collaborate and provide technical guidance to ... Health: Comprehensive healthcare plans, wellness incentive program, mental wellbeing support and ...
Omaha, NE · Remote
$50 - $90/hr
... health biodefense specialist, government biosecurity advisor, or lab director. * Demonstrated ability to develop and review threat scenarios and risk taxonomies with high domain credibility.
Omaha, NE · Remote
$50 - $90/hr
... health biodefense specialist, government biosecurity advisor, or lab director. * Demonstrated ability to develop and review threat scenarios and risk taxonomies with high domain credibility.
Omaha, NE · On-site +1
$106K - $143K/yr
... enterprise risk management. Owning the design, governance, and delivery of our Security Review ... day remote. How you'll help move us forward: * Own the end-to-end design, governance, and ...
Omaha, NE · On-site +1
$106K - $143K/yr
... enterprise risk management. Owning the design, governance, and delivery of our Security Review ... day remote. How you'll help move us forward: * Own the end-to-end design, governance, and ...
$49.1K - $59.4K
4% of jobs
$59.4K - $69.6K
6% of jobs
$69.6K - $79.9K
11% of jobs
$83.8K is the 25th percentile. Wages below this are outliers.
$79.9K - $90.2K
11% of jobs
The median wage is $98.4K / yr.
$90.2K - $100.5K
23% of jobs
$100.5K - $110.7K
13% of jobs
$117.5K is the 75th percentile. Wages above this are outliers.
$110.7K - $121K
12% of jobs
$121K - $131.3K
8% of jobs
$131.3K - $141.5K
6% of jobs
$141.5K - $151.8K
4% of jobs
$151.8K - $162.1K
2% of jobs
$49.1K
$106.4K
$162.1K
A Remote Healthcare Risk Management job involves identifying, assessing, and mitigating risks within healthcare organizations while working remotely. Professionals in this role help ensure patient safety, regulatory compliance, and operational efficiency by analyzing data, developing policies, and implementing risk reduction strategies. They may collaborate with healthcare providers, legal teams, and insurance professionals to address potential liabilities. Strong analytical skills, knowledge of healthcare regulations, and experience in risk management are essential for success in this field.
To thrive in Remote Healthcare Risk Management, you typically need a background in healthcare administration, risk analysis, compliance, and a relevant degree such as nursing, public health, or healthcare management. Familiarity with risk management software, incident reporting systems, HIPAA regulations, and certifications like Certified Professional in Healthcare Risk Management (CPHRM) are highly valuable. Strong analytical thinking, attention to detail, and effective virtual communication skills set candidates apart in this role. These competencies are crucial for identifying, assessing, and mitigating risks in healthcare environments while maintaining regulatory compliance and patient safety—all from a remote setting.
Professionals in Remote Healthcare Risk Management are responsible for identifying potential risks to patient safety, evaluating compliance with healthcare regulations, and developing policies to minimize those risks. On a typical day, their tasks might include reviewing incident reports, analyzing data, conducting virtual training sessions, and collaborating with clinical and administrative teams through video conferencing. They also work closely with legal and compliance departments to ensure all processes adhere to federal, state, and organizational standards. This role requires strong organizational skills, proactive communication, and the ability to manage sensitive information within a remote work environment.
Lincoln, NE • Remote
$27.59 - $56.63/hr
Full-time
Re-posted 5 days ago
8.1
Based on 193 frontline employees who took The Breakroom Quiz
134th of 281 rated insurance
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
Pay Range: $27.59 - $56.63 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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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.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
