RN II: Clinical Delegation Oversight Auditor

L.A. Care; Lancaster (CA); On-site; USD 8,900 - 142,000; Full time

Benefits offered by this job

Paid Time Off

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA is seeking a Delegation Oversight Clinical Auditor RN II to ensure delegates performing Utilization Management comply with regulatory requirements.

This leadership role supports continuous quality improvement by auditing delegated entities and guiding corrective actions. The position requires an RN with California license and extensive experience in managed care, regulatory knowledge, and strong collaboration across regulatory, compliance and clinical

Qualifications

• RN with active California license.
• Minimum 7 years clinical experience with 3+ years in managed care/utilization management.

Responsibilities

• Ensure delegates meet UM regulatory requirements and new legislation.
• Maintain policies, procedures, workflows, and audit tools for compliance.
• Prepare for internal and external audits and monitor corrective actions.
• Conduct annual and focused audits and identify deficiencies with mitigations.
• Provide training and guidance to Plan Partners and Participating Provider Groups.

Skills

Medi-Cal contracts

Data management

Regulatory knowledge

Communication skills

Regulatory requirements

Independent work

Problem solving

MS Office (Word, Excel, PowerPoint)

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (preferred)

Tools

Word

Excel

PowerPoint

Job description

L.A. Care Health Plan in Los Angeles, CA is seeking a Delegation Oversight Clinical Auditor RN II to ensure delegates performing Utilization Management comply with regulatory requirements.

This leadership role supports continuous quality improvement by auditing delegated entities and guiding corrective actions. The position requires an RN with California license and extensive experience in managed care, regulatory knowledge, and strong collaboration across regulatory, compliance and clinical