Nurse Auditor - Delegation & Compliance Lead

Internationalinsuranceprofessionals; Montebello (CA); Hybrid; USD 69,000 - 82,000; Full time

Benefits offered by this job

Medical, Dental and Vision insurance

403(b) Retirement savings plans with…

Paid Time Off & Holidays

Tuition Reimbursement Program

Career Advancement & Development

Job summary

AltaMed Health Services Corp. in Montebello, CA, seeks a Nurse Auditor, Delegation Oversight to perform delegation oversight audits ensuring delegates meet health plan requirements and NCQA standards. Requires CA LVN license, 3+ years in managed care, and 2+ years in Utilization Management.

You will report to AHN Delegation Oversight leadership and provide coaching to improve compliance across delegates and sub-delegates, with a focus on regulatory adherence.

Qualifications

• Current, active California LVN license.
• 3+ years of managed care experience.
• 2+ years in Utilization Management.
• 1 year of delegation oversight (D) audit experience, or 2+ years UM in lead/supervisory role.
• Working knowledge of state and federal regulations.
• Experience with Medicare/Medicaid programs.
• Valid BLS certification per AHA or Red Cross guidelines.

Responsibilities

• Perform delegation oversight auditing to ensure delegates comply with upstream health plan requirements and NCQA standards.
• Provide consultation, instruction, and coaching to improve overall compliance of delegates and sub-delegates.
• Report findings and coordinate with AltaMed Health Network Leadership for remediation and regulatory alignment.

Skills

Managed care experience

Utilization Management

Delegation oversight audit

Regulatory knowledge

Medicare/Medicaid

BLS certification

California LVN license

Education

California LVN license

Job description

AltaMed Health Services Corp. in Montebello, CA, seeks a Nurse Auditor, Delegation Oversight to perform delegation oversight audits ensuring delegates meet health plan requirements and NCQA standards. Requires CA LVN license, 3+ years in managed care, and 2+ years in Utilization Management.

You will report to AHN Delegation Oversight leadership and provide coaching to improve compliance across delegates and sub-delegates, with a focus on regulatory adherence.