Nurse Auditor: Delegation Oversight & Compliance

Careerwebsite; Montebello, Northern (CA, KY); Hybrid; USD 69,000 - 82,000; Full time

Benefits offered by this job

Medical Insurance

Dental & Vision Insurance

Retirement 403(b)

Paid Time Off

CME Days

Tuition Reimbursement

Tail Coverage

Employee Discounts

Job summary

AltaMed Health Services Corp. in Montebello, CA seeks a Nurse Auditor, Delegation Oversight, to perform audits ensuring delegates meet upstream health plan contractual requirements and NCQA/state/federal standards.

The role reports to AHN leadership and provides coaching to improve overall compliance. California RN/LVN license, 3+ years in managed care, and UM experience are required.

Qualifications

• Active California nursing license (RN or LVN) required.
• At least 3 years of managed care experience.
• Minimum 2 years of Utilization Management experience.
• At least 1 year in delegation oversight audit (or 2+ years UM in lead role).
• Working knowledge of state and federal regulations.
• Experience with Medicare/Medicaid programs.
• BLS certification or higher required.

Responsibilities

• Perform delegation oversight audits to ensure compliance with upstream health plan requirements.
• Provide guidance to improve delegate and sub-delegate regulatory compliance.
• Report to AHN Medical Services Delegation Oversight leadership and advise on improvements.

Skills

Nurse license (RN/LVN)

Managed care

Utilization Management

Delegation oversight

Regulations

Medicare/Medicaid

BLS

Job description

AltaMed Health Services Corp. in Montebello, CA seeks a Nurse Auditor, Delegation Oversight, to perform audits ensuring delegates meet upstream health plan contractual requirements and NCQA/state/federal standards.

The role reports to AHN leadership and provides coaching to improve overall compliance. California RN/LVN license, 3+ years in managed care, and UM experience are required.