Nurse Auditor: Delegation Oversight & Compliance

AltaMed Health Services Corp; 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 plan

Flexible Spending Accounts

Career development opportunities

Paid Time Off

Job summary

AltaMed Health Services Corp. seeks a Delegation Oversight Nurse Auditor to perform audits ensuring delegates comply with health plan requirements and regulatory standards.

The role involves rapid corrective actions and coaching to improve overall compliance within AHN medical services. The ideal candidate holds an active California nursing license and has at least 3 years in managed care, with 2 years in UM and 1 year in delegation oversight audit responsibilities.

Qualifications

• Current and active, unrestricted California Nurse license (RN or LVN).
• Minimum of 3 years of experience in managed care.
• Minimum of 2 years Utilization Management experience.
• Minimum of 1 year of delegation oversight audit experience.

Responsibilities

• Perform delegation oversight auditing to ensure delegates comply with upstream health plan contractual requirements and regulatory standards.
• Provide consultation and coaching to improve compliance across delegates and sub-delegates.
• Report findings and recommendations to AHN Medical Services Delegation Oversight leadership.

Skills

Nurse license

Managed care experience

Utilization Management

Delegation oversight

Regulatory knowledge

Job description

AltaMed Health Services Corp. seeks a Delegation Oversight Nurse Auditor to perform audits ensuring delegates comply with health plan requirements and regulatory standards.

The role involves rapid corrective actions and coaching to improve overall compliance within AHN medical services. The ideal candidate holds an active California nursing license and has at least 3 years in managed care, with 2 years in UM and 1 year in delegation oversight audit responsibilities.