RN Delegation Oversight & UM Auditor

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 89,000 - 142,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Job summary

L.A. Care Health Plan seeks an RN II for Delegation Oversight Clinical Audit to ensure delegates comply with Utilization Management regulatory requirements and internal standards. You will work with Plan Partners, PPGs and external bodies to strengthen compliance and drive quality improvements.

Requires RN with clinical auditing experience; strong regulatory knowledge, communication, and analytical skills; location in Los Angeles expected.

Qualifications

• RN with clinical auditing/UM experience preferred.
• Strong knowledge of HIPAA and regulatory standards.
• Excellent communication and analytical skills.

Responsibilities

• Ensure delegate compliance with UM policies, procedures and audit tools.
• Prepare for internal and external audits and monitor progress.
• Provide coaching to improve compliance across Plan Partners and PPGs.

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (Preferred)

Registed Nurse (RN)

Job description

L.A. Care Health Plan seeks an RN II for Delegation Oversight Clinical Audit to ensure delegates comply with Utilization Management regulatory requirements and internal standards. You will work with Plan Partners, PPGs and external bodies to strengthen compliance and drive quality improvements.

Requires RN with clinical auditing experience; strong regulatory knowledge, communication, and analytical skills; location in Los Angeles expected.