Delegation Oversight Nurse Auditor

AltaMed Health Services; Montebello (CA); On-site; USD 69,000 - 82,000; Full time

Benefits offered by this job

Medical insurance

Dental & Vision insurance

401(k) matching

Flexible Spending Accounts

Career Advancement & Development

Paid Time Off & Holidays

Paid CME Days

Malpractice tail coverage

Tuition Reimbursement

Employee Discounts

Referral Bonus Program

Pet Care Insurance

Job summary

AltaMed Health Services in Montebello, CA is seeking a Nurse Auditor for Delegation Oversight to perform delegation oversight auditing and ensure delegates meet regulatory contracts and standards. This role requires active CA LVN license and experience in managed care, UM, and delegation oversight.

The position focuses on auditing, reporting, and coaching to improve compliance and performance across delegates and sub-delegates with state, federal, and NCQA standards.

Qualifications

• Current and active, unrestricted California Nurse license, LVN.
• A minimum of 3 years of experience in managed care is required.
• Minimum of 2 years Utilization Management experience required.
• Minimum of 1 year of delegation oversight (D) audit experience required; or 2+ years of UM experience at lead/supervisory level.
• Working knowledge of state and federal regulations.
• Knowledge and experience with Medicare/Medicaid programs.
• A valid BLS certification or higher per AHA/Red Cross guidelines.

Responsibilities

• Perform delegation oversight auditing to ensure compliance with upstream health plan contracts.
• Audit activities to identify improvements and drive compliant practices.
• Report findings to AHN Medical Services Delegation Oversight leadership and provide coaching to delegates.

Skills

Nurse license (LVN)

UM experience

Delegation oversight auditing

Regulatory compliance

Medicare/Medicaid knowledge

BLS certification

Job description

AltaMed Health Services in Montebello, CA is seeking a Nurse Auditor for Delegation Oversight to perform delegation oversight auditing and ensure delegates meet regulatory contracts and standards. This role requires active CA LVN license and experience in managed care, UM, and delegation oversight.

The position focuses on auditing, reporting, and coaching to improve compliance and performance across delegates and sub-delegates with state, federal, and NCQA standards.