Nurse Auditor, Delegation Oversight

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

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

403(b) Retirement Savings

Flexible Spending Accounts

Paid Time Off & Holidays

CME Days

Tail Coverage (Malpractice)

Tuition Reimbursement

Employee Discounts

Referral Bonus

Pet Care Insurance

Job summary

AltaMed is seeking a Delegation Oversight Nurse Auditor in California to perform oversight audits ensuring delegates meet upstream health plan requirements and NCQA, federal, and state standards. The role includes reporting to AHN leadership and providing coaching to improve overall compliance for delegates and sub-delegates.

Requirements include an active California nurse license (LVN), 3+ years in managed care, 2+ years UM experience, and 1 year in delegation oversight or equivalent leadership

Qualifications

• Unrestricted California nurse license (LVN) and active certification.
• Minimum 3 years managed care experience.
• Minimum 2 years Utilization Management (UM) experience.
• 1 year of delegation oversight or 2+ years UM in lead/supervisory role.
• Working knowledge of federal/state regulations and Medicare/Medicaid programs.

Responsibilities

• Perform delegation oversight auditing to ensure compliance with health plan requirements.
• Provide guidance to improve compliance of delegates and sub-delegates.
• Report findings to AHN Medical Services Delegation Oversight leadership.
• Offer instructional coaching to enhance regulatory adherence.

Skills

UM experience

Delegation oversight

Regulatory knowledge

Medicare/Medicaid knowledge

BLS certification

Education

California RN/LVN license (unrestricted)

BLS certification or higher

Job description

Grow Healthy

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Job Overview

The Delegation Oversight Nurse Auditor is responsible for performing delegation oversight auditing activities to ensure delegates comply with upstream health plan contractual requirements. This also includes NCQA, federal, and state regulations and standards. This position utilizes a rapid team approach for needed improvements identified through audits and monitoring activities. The oversight responsibility of this position includes reporting to AltaMed Health Network (AHN) Medical Services Delegation Oversight leadership and providing consultation/instructional/coaching recommendations to improve overall compliance of delegates and sub-delegates with regulatory entities and standards.

Minimum Requirements

• 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. Instead of delegation oversight experience, we will consider candidates with 2+ years of UM experience, preferably in a lead and/or supervisory role.
• Working knowledge of state and federal regulations.
• Knowledge and experience with Medicare/Medicaid programs.
• A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.

Compensation

$68,640.00 - $82,368.00 annually

Compensation Disclaimer

Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate’s value and the role’s strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

Job Advertisement & Application Compliance Statement

AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.