UM LVN Delegation Oversight Nurse Remote based in CA

Sauk Prairie Healthcare, Inc.; Los Angeles (CA); Remote; USD 68,000 - 124,000; Full time

Job summary

A leading healthcare organization is looking for a Delegation Oversight Nurse to ensure compliance with state and federal regulations. This remote position requires a Licensed Vocational Nurse with solid experience in utilization management and auditing processes. The ideal candidate will possess excellent analytical skills and a strong background in compliance and quality oversight applicable to healthcare settings.

Qualifications

• LVN with at least 4 years of UM experience required.
• Knowledge of InterQual / MCG guidelines is essential.
• Experience with Appeals, Auditing, and Compliance / Quality will be a good fit.

Responsibilities

• Coordinates and conducts pre-delegation and annual assessments.
• Develops corrective action plans when deficiencies are identified.
• Assists with preparation of documents for regulatory audits.

Skills

Analytical Thought Process

Multi-tasking

Computer Knowledge

Education

Completion of an accredited Licensed Vocational Nurse (LVN) Program

Completion of an accredited Registered Nurse (RN) Program

Tools

Auditing Tools

Job description

You will receive notifications for newjobs withinmiles ofLos Angeles, CA .

Be the first to see new jobsnearLos Angeles, CA!
Enter your email address below to be notified when new jobs are posted.

By creating an alert, you agree to our Terms .You can change your consent settings at any time as outlined in our Terms.

Upload Your Resume

Employers use Nursing Network daily to search for the perfect candidate. Get listed so they can discover you.

UM LVN Delegation Oversight Nurse Remote based in CA New

Job Summary

The

Job Description

Job Summary

The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the team. We are looking for LVN's with at least 4 years of UM experience, NCQA accreditation, and knowledge of InterQual / MCG guidelines. Excellent computer knowledge, multi-tasking skills and analytical thought process is important to be successful in this role. Productivity is important with quick turnaround times. Experience with Appeals, Auditing, and Compliance /Quality will be a good fit for this position. Strong UM Prior Authorization experience highly preferred. Further details to be discussed during our interview process.

CA located – Remote position

Work hours: Monday – Friday 8:00am – 5:00pm PST

• Coordinates, conducts, and documents pre-delegation and annual assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
• Distributes audit results letters, follow up letters, audit tools, and annual reporting requirement as needed.
• Works with Delegation Oversight Analyst on monitoring performance reports from delegated entities.
• Develops corrective action plans when deficiencies are identified, and documents follow up to completion.
• Assists with meetings of the Delegation Oversight Committee.
• Works with the Delegation Oversight Manager to develop and maintain delegation assessment tools, policies, and reporting templates.
• Assists with preparation of delegation summary reports submitted to the EQIC and/or UM Committees.
• Participate in Joint Operation Committees (JOC's) for delegated groups.
• Assists in preparation of documents for CMS, State Medicaid, NCQA, and/or other regulatory audits as needed.
  
  

Job Qualifications

Required Education

Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) Program

Required Experience

• Minimum two years Utilization Review experience.
• Knowledge of audit processes and applicable state and federal regulations.
  
  

Required License, Certification, Association

Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing.

Preferred Education

Completion of an accredited Registered Nurse (RN) Program or a bachelor’s degree in nursing.

Preferred Experience

• Three-year NCQA, CMS, and/or state Medicaid UM auditing experience.
• Three years’ experience in delegation oversight process and working knowledge of state and federal regulations.
  
  

Preferred License, Certification, Association

• Active and unrestricted Certified Clinical Coder
• Certified Medical Audit Specialists (CMAS)
• Certified Case Manager (CCM)
• Certified Professional Healthcare Management (CPHM) Certified Professional in Health Care Quality (CPHQ)
• or other healthcare
• or management certification
  
  

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $68,640 - $123,164 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

You will receive notifications for newjobs withinmiles ofLos Angeles, CA .

Be the first to see new jobsnearLos Angeles, CA!
Enter your email address below to be notified when new jobs are posted.

By creating an alert, you agree to our Terms .You can change your consent settings at any time as outlined in our Terms.

Upload Your Resume

Employers use Nursing Network daily to search for the perfect candidate. Get listed so they can discover you.

You will receive notifications for newjobs withinmiles ofLos Angeles, CA .

Be the first to see newjobsnearLos Angeles, CA!

Enter your email address below to receive notifications for new jobs when they are posted.

By creating an alert, you agree to our Terms .You can change your consent settings at any time as outlined in our Terms.