UM LVN Delegation Oversight Nurse Remote based in CA
About the position Responsibilities • 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 of 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. • Participates as needed 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. Requirements • Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) Program. • Minimum two years Utilization Review experience. • Knowledge of audit processes and applicable state and federal regulations. • Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing. Nice-to-haves • Completion of an accredited Registered Nurse (RN) Program or a bachelor's degree in Nursing. • 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. • 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. Benefits • Competitive benefits and compensation package. Apply tot his job