Remote Auditor, Healthcare Services (RN) – Residency in TX Required

2038646 Summary of highly qualified candidates:

  • Must reside in TX and have an active TX RN license in good standing.
  • Focus of these audits is on the functions of the Utilization Department.
  • Experience in UM with clinical reviews and knowledge of MCG Clinical Criteria is required.
  • Experience with NCQA, EQRO, and HHS ACUR audits, case file preparation and presentation is strongly preferred.
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. 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 unrestricted 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 • 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 - $56.64 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

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. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Job Type Full TimePosting Date 08/03/2026
Back to blog

Other Jobs To Apply

Open Roles for "Darts" Audition Movie

Remote Editor, Children's & YA - Build Publishing Job at Sourcebooks in Napervil

Warehouse Associate (PT or FT flex schedules)

Night Auditor- Hilton Ocala

Warehouse Associate (1st Shift)

Help Desk Analyst - Trenton, NJ(Remote)

Computer-Use Agent Evaluator

Help Desk Analyst - Trenton, NJ(Remote)

Computer-Use Agent Evaluator

Area Manager, Early Career - (2027) - Illinois

Area Manager Intern – Summer 2027 (MO, OH, KY)

HV Administrative Assistant (Remote)

Medical Scribe and Medical Assistant

Remote Video Editor: Social-first Storytelling Pro

Seasonal Store Sales Associate, Levi's®, Citadel Outlets, Commerce, CA

Warehouse Cargo Agents - JFK Airport

Security Operations Center (SOC) Analyst - Remote

Specialty Warehouse Associate

Executive Assistant to the CEO | Bookyourdata

Electrical Apprentice (Comm/Resi)

Area Manager, Early Career (2027) – Ohio

Healthcare Provider- fully remote, flexible schedule, cannabis certifications

CDL A Owner Operator Amazon

Telehealth Follow-Up Nurse (LPN) - Remote! (10:30am - 7:00pm CST Shift)

Data Scientist /data analyst entry level /AI /software programmer(Remote)

Support Analyst - Remote / Telecommute

Remote Weekend Admission Liaison

Warehouse Associate – Cold Storage / Forklift Operator

Remote Client Agent (Work From Home) | Flexible Schedule

Manager - P&C Systems | Remote- United States

HR Business Partner , NASC PXT

Data Entry Clerk Work From Home - Part-Time Focus Group Participants (Up To $750/Week)

Remote 1099 Independent Contractor - Call Center Brand Ambassador - Pandora Jewelry (#OPA)

Night Owl LPN OR RN Needed – Weekly Pay + Flexible Schedule

Entry Level Creative Writer (Home Based) (Creative)

Entry level Job Delta Data Entry Jobs – Remote High Paying Opportunities Job ID- 680 Job ID- 2883

Remote Copywriter for Impactful Campaigns | Flexible Hours

Solutions Architect

Project Manager - Remote

Bilingual Medical Scribe

Bilingual Medical Scribe

Travel Radiology Tech - $1,728 to $1,986 per week in McAllen, TX - Now Hiring

Remote Social Media Manager — AI Gaming Brand Growth

Fully Remote Entry Level

Area Manager II

Verizon FIOS Sales Agent

Robotics Warehouse Associate

Contract Remote English Teacher — U.S. Elementary Schools

Overnight Remote Customer Experience Representative, Robinhood Concierge

Airport Cabin Agent F/T - LGA