Nebraska Licensed Clinical Auditor

Job Summary

To support the Medicaid Team, the full-time Nebraska Licensed Clinical Auditor will perform clinical audits, ensure compliance with regulatory standards, and contribute to quality member care while working remotely.

Key responsibilities

• Conducts audits in care management and clinical areas to monitor compliance with NCQA, CMS, and state/federal guidelines
• Identifies clinical gaps in care and assesses clinical staff decision-making, reporting outcomes and training needs to leadership
• Maintains detailed records of auditing results and collaborates with the healthcare services training team to develop training materials

Required qualifications

• At least 2 years of healthcare experience, including 1 year in care management or managed care
• Active and unrestricted Registered Nurse (RN) license in Nebraska
• Proficiency in Microsoft Office, particularly Excel and PowerPoint
• Strong analytical skills and attention to detail
• Ability to work effectively in a cross-functional team environment