****REGISTERED NURSE, South Carolina residents in proximity to Cayce, Columbia, or Charleston preferred. Must be licensed for the state of South Carolina. There will be a small percentage of travel for office meetings in Cayce or Charleston SC.** **Work Schedule: EASTERN daytime business hours** **KNOWLEDGE/SKILLS/ABILITIES** + 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). + Monitors key clinical staff for compliance with NCQA, CMS, State and Federal requirements. May also perform non-clinical system and process audits, as needed. + Assesses clinical staff regarding appropriate 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. + Assists in preparation for regulatory audits by performing file review and preparation. + Participates in regulatory audits as subject matter expert and fulfilling different audit team roles as required by management. + 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 Associate's or bachelor’s degree in nursing **Required Experience** + Minimum two years UM (Utilization Management ) and managed care (Medicaid/ Medicare UM reviews) + Proficient knowledge of Molina workflows. + Required License, Certification, Association + Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. + Active and unrestricted license in good standing as applicable + **Preferred Experience** + 3-5 years of experience in case management, disease management or utilization management in managed care, medical or behavioral health settings. + Two years of clinical auditing/review 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: $25.08 - $51.49 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.