RN II - Delegation Oversight & Utilization Audits

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

Benefits offered by this job

PTO

Tuition Reimbursement

Retirement Plan

Medical/Dental/Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA, seeks a Delegation Oversight Clinical Auditor RN II to ensure delegated UM functions meet regulatory requirements and contractual standards.

You will lead audits, monitor PP/PPG compliance, prepare for external reviews, and provide guidance to improve access and utilization performance across Plan Partners and provider networks. This full-time role requires a California RN license, strong data analysis, and collaboration with Regulatory Affairs and

Qualifications

• At least 7 years in a clinical setting with at least 3 years in a managed care setting in Utilization Management/Case Management.
• Knowledge of Medi-Cal and other HMO & IPA contracts, & payers.
• Ability to manage and organize large volumes of data.
• Knowledge of accreditation entities and their requirements.
• Excellent verbal and written communication skills and interpersonal abilities.

Responsibilities

• Ensure delegates meet UM regulatory requirements and new legislation.
• Prepare internal/ external audits and track progress for UM/PPG compliance.
• Support external reviews with prepared documents and timely responses.
• Identify deficiencies, CAPs, and monitor corrective actions.
• Develop monitoring tools and track progress of PP/PPG compliance.

Skills

Utilization Management

Case Management

Regulatory Compliance

Auditing

RN License

Communication Skills

Data Analysis

Policy Knowledge

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

Word

Excel

PowerPoint

Job description

L.A. Care Health Plan in Los Angeles, CA, seeks a Delegation Oversight Clinical Auditor RN II to ensure delegated UM functions meet regulatory requirements and contractual standards.

You will lead audits, monitor PP/PPG compliance, prepare for external reviews, and provide guidance to improve access and utilization performance across Plan Partners and provider networks. This full-time role requires a California RN license, strong data analysis, and collaboration with Regulatory Affairs and