**KNOWLEDGE/SKILLS/ABILITIES** Oversees an auditing team responsible monthly auditing of HCS staff. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals and Grievances experience and a clinical background. The candidate must have strong organization skills, proficient knowledge of MS Excel, self-driven and experience identifying areas for process enhancement. Further details to be discussed during our interview process. This is a remote position. Work hours: Monday- Friday: 8:00am -5:00pm. Michigan RN license preferred. + Functions as a hands-on supervisor, providing direction and guidance to the auditing team to ensure implementation of activities that align with Molina auditing policy and protocols + Assists Manager with data for team member performance reviews + Provides employee development and recognition; and assists with selection, orientation and mentoring of new staff. + Works with the Manager to ensure adequate staffing and production levels are maintained + Performs monthly auditing of registered nurse and other clinical functions in Utilization Management (UM), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), and/or Disease Management (DM) and monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed. + Audits for clinical gaps in care from a medical and/or behavioral perspective to ensure member needs are being met. + Assesses registered nurses and other clinical staff regarding appropriate clinical decision-making. + Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to staff and 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 with all communications. + Adheres to departmental standards, policies, protocols. + Maintains detailed records of auditing results. + Assists HCS training team with developing training materials or job aids as needed to address findings in audit results. + Meets minimum production standards + May conduct staff trainings as needed + Communicates with QA supervisor/manager about issues identified and works collaboratively to resolve/correct them.. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN) Program and an Associate's or bachelor’s degree in Nursing. Michigan unrestricted license preferred. **Required Experience** + Minimum two years UM, CM, MAT, HM, DM, and/or managed care experience. + Proficient knowledge of Molina workflows. + Required License, Certification, Association + Active, unrestricted State Registered Nurse (RN) License in good standing. + Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings. **Preferred Education** Bachelor's Degree in Nursing **Preferred Experience** + 3-5 years in case management, disease management, managed care or medical or behavioral health settings. + One year of auditing/ clinical review experience. + More than one-year supervisory experience. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $69,779 - $155,508 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.