$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
Long Beach, CA · On-site +1
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
Long Beach, CA · On-site +1
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
$29.05 - $56.64/hr
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO. Analytical ability to review data and determine ...
Ensures adherence to URAC/NCQA standards, state UM contractual requirements, and CMS audit standards by identifying gaps, mitigating risk, and driving corrective action plans. Primary Job ...
Ensures adherence to URAC/NCQA standards, state UM contractual requirements, and CMS audit standards by identifying gaps, mitigating risk, and driving corrective action plans. Primary Job ...
Ensures adherence to URAC/NCQA standards, state UM contractual requirements, and CMS audit standards by identifying gaps, mitigating risk, and driving corrective action plans. Primary Job ...
Ensures adherence to URAC/NCQA standards, state UM contractual requirements, and CMS audit standards by identifying gaps, mitigating risk, and driving corrective action plans. Primary Job ...
Ensures adherence to URAC/NCQA standards, state UM contractual requirements, and CMS audit standards by identifying gaps, mitigating risk, and driving corrective action plans. Primary Job ...
Ensures adherence to URAC/NCQA standards, state UM contractual requirements, and CMS audit standards by identifying gaps, mitigating risk, and driving corrective action plans. Primary Job ...
Pasadena, CA · On-site
This position assists with NCQA Accreditation preparation and ongoing FDR compliance oversight, ensuring UM operations meet CMS, NCQA, DHCS, DHMC Knox-Keene requirements, and Health Plan standards.
Quick apply
Pasadena, CA · On-site
This position assists with NCQA Accreditation preparation and ongoing FDR compliance oversight, ensuring UM operations meet CMS, NCQA, DHCS, DHMC Knox-Keene requirements, and Health Plan standards.
The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member.
The NCQA Specialist coordinates quality improvement activities and supports various functions within the scope of the Plan quality improvement program, working both independently and as a team member.
Denver, CO · On-site
$108K - $136K/yr
WHAT YOU'LL DO The Sr. Manager, Quality and Delegation serves as a quality liaison to support care management teams in monitoring NCQA performance through the clinical audit process and ensuring ...
Denver, CO · On-site
$108K - $136K/yr
WHAT YOU'LL DO The Sr. Manager, Quality and Delegation serves as a quality liaison to support care management teams in monitoring NCQA performance through the clinical audit process and ensuring ...
Denver, CO · On-site
$31.25 - $41.25/hr
Support NCQA accreditation process by providing subject matter expertise on quality standards (10%) * Work with providers on appropriate coding and documentation for HEDIS Stars and MLR measures.
Denver, CO · On-site
$31.25 - $41.25/hr
Support NCQA accreditation process by providing subject matter expertise on quality standards (10%) * Work with providers on appropriate coding and documentation for HEDIS Stars and MLR measures.
$29.05 - $56.64/hr
Full-time
Posted 21 days ago
8.1
Based on 193 frontline employees who took The Breakroom Quiz
143rd of 277 rated insurance
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. This role supports the New Mexico Turquoise Care Contract.
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
Prior experience in clinical review/auditing of care management.
Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or IPRO.
Analytical ability to review data and determine quality trends.
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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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
