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 ...
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 ...
Remote Complex Care Registered Nurse- South Bay San Diego Residents Only (Active CA RN License Requi
San Diego, CA · On-site +1
The Remote Complex Care RN (CCM RN) serves as the clinical center of the Care Anywhere pod - owning the member journey, coordinating care across disciplines, and ensuring the highest-acuity Medicare ...
Remote Complex Care Registered Nurse- South Bay San Diego Residents Only (Active CA RN License Requi
San Diego, CA · On-site +1
The Remote Complex Care RN (CCM RN) serves as the clinical center of the Care Anywhere pod - owning the member journey, coordinating care across disciplines, and ensuring the highest-acuity Medicare ...
Remote Complex Care Registered Nurse- South Bay San Diego Residents Only (Active CA RN License Re...
San Diego, CA · Remote
The Remote Complex Care RN (CCM RN) serves as the clinical center of the Care Anywhere pod - owning the member journey, coordinating care across disciplines, and ensuring the highest-acuity Medicare ...
Remote Complex Care Registered Nurse- South Bay San Diego Residents Only (Active CA RN License Re...
San Diego, CA · Remote
The Remote Complex Care RN (CCM RN) serves as the clinical center of the Care Anywhere pod - owning the member journey, coordinating care across disciplines, and ensuring the highest-acuity Medicare ...
The RN, utilizing Jean Watson's Theory of Caring Relationship Based Care, and NorthBay ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
New
The RN, utilizing Jean Watson's Theory of Caring Relationship Based Care, and NorthBay ... Remote Work Disclosure NorthBay Health is primarily an onsite organization due to the nature of ...
New
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 ...
(RN)Care Manager - Nevada Based
Long Beach, CA · Remote
$27.73 - $54.06/hr
This role is primarily remote but may include some local field travel. The target area for this ... Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ...
(RN)Care Manager - Nevada Based
Long Beach, CA · Remote
$27.73 - $54.06/hr
This role is primarily remote but may include some local field travel. The target area for this ... Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may ...
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 ...
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 ...
Care Manager, LTSS (RN)
Long Beach, CA · On-site +1
$26.41 - $51.49/hr
***Remote and will travel throughout the Southwest and Western regions of Wisconsin for member ... 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 will travel throughout the Southwest and Western regions of Wisconsin for member ... 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 St. Croix County, WI for member visits*** 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 St. Croix County, WI for member visits*** 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
This is a remote position with substantial field work and productivity is important. Preferred ... 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
This is a remote position with substantial field work and productivity is important. Preferred ... RNs may conduct medication reconciliation as needed. • 25-40% estimated local travel may be ...
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
Lead 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 ...
Lead 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 Primary Care Provider (NP/PA)
Round Mountain, CA · Remote
$101K - $138K/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 · Remote
$101K - $138K/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 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 ...
Registered Nurses (Data labelling and training) Type: Contract Compensation: $60-$80/hour Location: Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ...
Quick apply
Registered Nurses (Data labelling and training) Type: Contract Compensation: $60-$80/hour Location: Remote Role Responsibilities * Review and assess clinical documentation for accuracy, completeness ...
RN Case Manager - Remote California
Anaheim, CA · On-site +1
Position in this function is responsible for providing professional nursing care by assessing, planning, implementing, and evaluating the care of patients under the supervision of a clinician or RN, ...
RN Case Manager - Remote California
Anaheim, CA · On-site +1
Position in this function is responsible for providing professional nursing care by assessing, planning, implementing, and evaluating the care of patients under the supervision of a clinician or RN, ...
(RN) Remote Care Review Clinician - Utilization Review
Long Beach, CA · On-site +1
$25.08 - $51.49/hr
SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and ...
(RN) Remote Care Review Clinician - Utilization Review
Long Beach, CA · On-site +1
$25.08 - $51.49/hr
SC Single state or Compact RN License. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and ...
Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single state or Compact RN License. Ability to prioritize and manage multiple deadlines. Excellent ...
Registered Nurse (RN). License must be active and unrestricted in state of practice. SC Single state or Compact RN License. Ability to prioritize and manage multiple deadlines. Excellent ...
Remote Rn Ibclc information
What is the difference between Remote Rn Ibclc vs Remote Rn Certified Diabetes Educator?
| Aspect | Remote Rn Ibclc | Remote Rn Certified Diabetes Educator |
|---|---|---|
| Certifications | RN license, IBCLC certification | RN license, Certified Diabetes Educator (CDE) |
| Work Environment | Healthcare facilities, telehealth, clinics | Diabetes management programs, telehealth, clinics |
| Industry Usage | Maternal and infant health, lactation consulting | Chronic disease management, diabetes education |
Both roles require an RN license, but the Remote Rn Ibclc focuses on lactation consulting, while the Remote Rn Certified Diabetes Educator specializes in diabetes management. Their work environments often overlap in telehealth settings, but their certifications and patient focus differ significantly.
Auditor, Healthcare Services (RN) (Remote) Must Live In Nebraska
Long Beach, CA • Remote
Full-time
Re-posted 8 days ago
Molina Healthcare rating
8.1
Based on 193 frontline employees who took The Breakroom Quiz
133rd of 281 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
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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.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Long Beach, CA, US
Year founded
1980