UM LVN Delegation Oversight Nurse Remote based in CA

Lensa; Los Angeles (CA); Remote; USD 68,000 - 124,000; Full time

Job summary

Lensa is seeking a Delegation Oversight Nurse responsible for ensuring compliance with healthcare standards for Molina Healthcare. This remote role requires an LVN with Utilization Management experience, strong analytical skills, and the capability to handle complex audit processes. Join a leading healthcare provider to make a significant impact in the healthcare industry.

Qualifications

• LVN with at least 4 years of UM experience required.
• Active, unrestricted State Licensed Vocational Nurse in good standing.
• Three years’ experience in delegation oversight process preferred.

Responsibilities

• Ensure compliance with State, CMS, and NCQA requirements.
• Conduct and document assessments for compliance.
• Develop corrective action plans for deficiencies.

Skills

Analytical thinking

Multi-tasking

Excellent computer knowledge

Education

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

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

Tools

NCQA accreditation

Job description

UM LVN Delegation Oversight Nurse Remote based in CA

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Pay found in job post

Retrieved from the description.

Base pay range

$68,640.00/yr - $123,164.00/yr

Lensa partners with DirectEmployers to promote this job for Molina Healthcare.

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.
  
  

If you have questions about this posting, please contact [e-mail]

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  IT Services and IT Consulting

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