Healthcare Services Auditor (RN) (New York)

JOB DESCRIPTION Job SummaryProvides 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 u2022 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. u2022 Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met. u2022 Assesses clinical staff regarding appropriate clinical decision-making. u2022 Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership. u2022 Ensures auditing approaches follow a Molina standard in approach and tool use. u2022 Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications. u2022 Adheres to departmental standards, policies and protocols. u2022 Maintains detailed records of auditing results. u2022 Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results. u2022 Meets minimum production standards related to clinical auditing. u2022 May conduct staff trainings as needed. u2022 Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct. Required Qualifications u2022 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. u2022 Registered Nurse (RN). License must be active and unrestricted in state of practice. u2022 Strong attention to detail and organizational skills. u2022 Strong analytical and problem-solving skills. u2022 Ability to work in a cross-functional, professional environment. u2022 Ability to work on a team and independently. u2022 Excellent verbal and written communication skills. u2022 Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications u2022 Utilization management, 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: $29.05 - $67.97 / HOURLY Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-10-20