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