Employer Industry: Healthcare Services

Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Remote work flexibility within Florida
- Competitive benefits and compensation package
- Supportive work environment that emphasizes compliance and quality assurance
- Chance to contribute to the improvement of healthcare services for Medicaid recipients

What to Expect (Job Responsibilities):
- Perform monthly auditing of registered nurse and clinical functions in Utilization Management (UM), Case Management (CM), and related areas
- Monitor compliance of clinical staff with NCQA, CMS, State, and Federal requirements
- Assess clinical staff for appropriate decision-making and report outcomes to leadership
- Assist in preparation for regulatory audits and participate as a subject matter expert
- Maintain detailed records of auditing results and assist in developing training materials

What is Required (Qualifications):
- Completion of an accredited Registered Nurse (RN) Program and an Associate's or Bachelor's degree in Nursing or a related field
- Minimum two years of experience in UM, CM, MAT, HM, DM, or managed care
- Proficient knowledge of Molina workflows
- Active and unrestricted RN license in good standing
- Valid driver's license with a good driving record and reliable transportation

How to Stand Out (Preferred Qualifications):
- 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

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