Delegation Oversight Nurse Remote based in CA (Must have a CA License)

ClickJobs.io; Lehi (UT); Remote; USD 77,000 - 129,000; Full time

Job summary

A leading healthcare organization is seeking a Delegation Oversight Nurse to ensure compliance with NCQA, CMS, and State Medicaid requirements. This remote role involves overseeing delegated activities, conducting assessments, and developing corrective action plans. Ideal candidates will have experience in Utilization Review and hold an active LVN or LPN license. The position offers competitive benefits and opportunities for professional growth.

Benefits

Competitive benefits

Qualifications

• Minimum two years of Utilization Review experience.
• Knowledge of audit processes and applicable regulations.

Responsibilities

• Oversees delegated activities to ensure compliance with NCQA, CMS, and State Medicaid requirements.
• Coordinates and documents pre-delegation and annual assessments.

Skills

Utilization Review

Audit Processes

Education

Completion of an accredited LVN or LPN program

Completion of an accredited RN program or a bachelor’s degree in Nursing

Job description

Delegation Oversight Nurse Remote based in CA (Must have a CA License)

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Job Summary

Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS, and State Medicaid requirements, including delegation standards and requirements contained in the delegation agreement.

Job Description

Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS, and State Medicaid requirements, including delegation standards and requirements contained in the delegation agreement.

Knowledge/Skills/Abilities

The Delegation Oversight Nurse ensures Molina Healthcare's UM delegates comply with all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare's business needs. The nurse will assist the Delegation Oversight Manager with additional team duties, including:

• Coordinating, conducting, and documenting pre-delegation and annual assessments to meet state, federal, NCQA, and other requirements.
• Distributing audit results letters, follow-up letters, audit tools, and annual reports.
• Monitoring performance reports from delegated entities in collaboration with the Delegation Oversight Analyst.
• Developing corrective action plans for deficiencies and following up until resolution.
• Assisting with Delegation Oversight Committee meetings.
• Helping develop and maintain delegation assessment tools, policies, and reporting templates with the Delegation Oversight Manager.
• Preparing delegation summary reports for the EQIC and/or UM Committees.
• Participating in Joint Operation Committees (JOCs) for delegated groups as needed.
• Preparing documents for CMS, State Medicaid, NCQA, and other regulatory audits.

Job Qualifications

Required Education

Completion of an accredited LVN or LPN program.

Required Experience

• Minimum two years of Utilization Review experience.
• Knowledge of audit processes and applicable regulations.

Required License, Certification, Association

Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse license in good standing.

Preferred Education

Completion of an accredited RN program or a bachelor’s degree in Nursing.

Preferred Experience

• Three years of NCQA, CMS, and/or state Medicaid UM auditing experience.
• Three years of delegation oversight experience with knowledge of relevant regulations.

Preferred License, Certification, Association

• Active and unrestricted certifications such as Certified Clinical Coder, CMAS, CCM, CPHQ, or other healthcare management certifications.

Interested Molina employees should apply via the intranet. Molina Healthcare offers competitive benefits. We are an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $128,519 annually. Actual compensation may vary based on location, experience, and education.