Auditor, Clinical Services
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... 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 ... auditing approaches follow a Molina standard in approach and tool use. • Maintains member ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Participates in denial prevention, denial management, auditing activities, and performance ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Participates in denial prevention, denial management, auditing activities, and performance ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Participates in denial prevention, denial management, auditing activities, and performance ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Participates in denial prevention, denial management, auditing activities, and performance ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Participates in denial prevention, denial management, auditing activities, and performance ...
Day Shift Description: The Utilization Review (UR) Coordinator collaborates with a ... Participates in denial prevention, denial management, auditing activities, and performance ...
... analysis and auditing. They will also be responsible for end user adoption of best practice ... Knowledge and understanding of Utilization Management, Quality Management, Care Management, and/or ...
... analysis and auditing. They will also be responsible for end user adoption of best practice ... Knowledge and understanding of Utilization Management, Quality Management, Care Management, and/or ...
... analysis and auditing. They will also be responsible for end user adoption of best practice ... Knowledge and understanding of Utilization Management, Quality Management, Care Management, and/or ...
... analysis and auditing. They will also be responsible for end user adoption of best practice ... Knowledge and understanding of Utilization Management, Quality Management, Care Management, and/or ...
... analysis and auditing. They will also be responsible for end user adoption of best practice ... Knowledge and understanding of Utilization Management, Quality Management, Care Management, and/or ...
... analysis and auditing. They will also be responsible for end user adoption of best practice ... Knowledge and understanding of Utilization Management, Quality Management, Care Management, and/or ...
Auditor, Healthcare Services (Remote in MI)
Long Beach, CA · Remote
$26.41 - $51.49/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, Healthcare Services (Remote in MI)
Long Beach, CA · Remote
$26.41 - $51.49/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 ...
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 ...
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 ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... auditing approaches follow a Molina standard in approach and tool use. • Maintains member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · On-site +1
$26.41 - $51.49/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... auditing approaches follow a Molina standard in approach and tool use. • Maintains member ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · Remote
$26.41 - $51.49/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... auditing approaches follow a Molina standard in approach and tool use. • Maintains member ...
Auditor, Healthcare Services (Remote in MI)
Detroit, MI · Remote
$26.41 - $51.49/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... auditing approaches follow a Molina standard in approach and tool use. • Maintains member ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
... management and other clinical cost reduction Utilization Manager Medical Chart Auditor Completes retrospective medical necessity reviews for compliance with regulatory or payor-specific guidelines ...
Compliance Auditor
Tampa, FL · On-site
Job Title: Compliance Auditor Are you an experienced Compliance Auditor looking for a new ... Assists management with the collection of data and performs audits of utilization management ...
Compliance Auditor
Tampa, FL · On-site
Job Title: Compliance Auditor Are you an experienced Compliance Auditor looking for a new ... Assists management with the collection of data and performs audits of utilization management ...
Directs education, training, and auditing of all clinical services and operational staff ... Master's degree preferred. * 8 years progressive experience in managed care utilization management ...
Directs education, training, and auditing of all clinical services and operational staff ... Master's degree preferred. * 8 years progressive experience in managed care utilization management ...
Delegation Operations Nurse Auditor - LVN, Experienced
Redding, CA · On-site
$29.25 - $39.25/hr
Your Role The Delegation Oversight Utilization Management team is responsible for the organization ... The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this ...
Delegation Operations Nurse Auditor - LVN, Experienced
Redding, CA · On-site
$29.25 - $39.25/hr
Your Role The Delegation Oversight Utilization Management team is responsible for the organization ... The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this ...
Delegation Operations Nurse Auditor - LVN, Experienced
Rancho Cordova, CA · On-site
$29.75 - $40/hr
Your Role The Delegation Oversight Utilization Management team is responsible for the organization ... The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this ...
Delegation Operations Nurse Auditor - LVN, Experienced
Rancho Cordova, CA · On-site
$29.75 - $40/hr
Your Role The Delegation Oversight Utilization Management team is responsible for the organization ... The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this ...
Delegation Operations Nurse Auditor - LVN, Experienced
Long Beach, CA · On-site
$29 - $39/hr
Your Role The Delegation Oversight Utilization Management team is responsible for the organization ... The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this ...
Delegation Operations Nurse Auditor - LVN, Experienced
Long Beach, CA · On-site
$29 - $39/hr
Your Role The Delegation Oversight Utilization Management team is responsible for the organization ... The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this ...
Utilization Management Auditor information
See salary details
$15.63 - $19.08
14% of jobs
$21.93 is the 25th percentile. Wages below this are outliers.
$19.08 - $22.53
14% of jobs
$22.53 - $25.98
17% of jobs
The median wage is $27.88 / hr.
$25.98 - $29.44
11% of jobs
$29.44 - $32.89
8% of jobs
$32.89 - $36.34
6% of jobs
$38.93 is the 75th percentile. Wages above this are outliers.
$36.34 - $39.79
7% of jobs
$39.79 - $43.25
7% of jobs
$43.25 - $46.70
5% of jobs
$46.70 - $50.15
5% of jobs
$50.15 - $53.61
5% of jobs
$15
$31
$53
How much do utilization management auditor jobs pay per hour?
As of Aug 23, 2026, the average hourly pay for utilization management auditor in the United States is $31.94, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $40.62 per hour, depending on experience, location, and employer.
What is a utilization management auditor?
A Utilization Management Auditor is a healthcare professional responsible for reviewing medical records, claims, and utilization data to ensure that healthcare services provided to patients are necessary, appropriate, and comply with established guidelines and policies. They help identify overuse, underuse, or misuse of medical resources and ensure regulatory compliance. Utilization Management Auditors work closely with healthcare providers, insurance companies, and regulatory agencies to improve the quality and cost-effectiveness of patient care.
What are the key skills and qualifications needed to thrive as a utilization management auditor?
To thrive as a Utilization Management Auditor, you need a strong background in healthcare administration, case management, and medical coding, often supported by a clinical degree or certification such as RN, LPN, or RHIA. Familiarity with utilization management software, electronic health records (EHRs), and regulatory standards like CMS guidelines is essential. Analytical thinking, attention to detail, and effective communication are crucial soft skills for identifying compliance issues and collaborating with healthcare teams. These skills ensure accurate audits, regulatory compliance, and optimal resource utilization within healthcare organizations.
What are some common challenges faced by utilization management auditors and how can they be addressed?
Utilization Management Auditors often encounter challenges such as keeping up with constantly changing healthcare regulations and payer requirements, interpreting complex medical documentation, and ensuring compliance with both internal and external policies. To address these challenges, auditors should engage in ongoing professional development, collaborate closely with clinical and administrative teams for accurate information, and make use of robust audit tools and resources. Effective communication and a proactive approach to regulatory changes can help streamline the audit process and maintain high standards of accuracy.
What is the difference between Utilization Management Auditor vs Utilization Review Nurse?
| Aspect | Utilization Management Auditor | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license, certifications like CCM or CUC | Licensed Registered Nurse (RN), often with additional certifications |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinics, insurance companies, often in clinical settings |
| Primary Focus | Auditing and reviewing utilization data for compliance and cost management | Assessing patient care needs and determining appropriate services |
While both roles involve healthcare utilization, the Utilization Management Auditor primarily reviews data for compliance and cost efficiency, whereas the Utilization Review Nurse focuses on patient care assessments. Both require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ.
More about Utilization Management Auditor jobs
What cities are hiring for Utilization Management Auditor jobs?
Cities with the most Utilization Management Auditor job openings:
What states have the most Utilization Management Auditor jobs?
States with the most job openings for Utilization Management Auditor jobs include:
What job categories do people searching Utilization Management Auditor jobs look for?
The top searched job categories for Utilization Management Auditor jobs are:
$29.05 - $56.64/hr
Full-time
Re-posted 22 days ago
Molina Healthcare rating
8.0
Based on 199 frontline employees who took The Breakroom Quiz
167th of 311 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