We are seeking a highly skilled and experienced Delegation Oversight Nurse (LVN) to join our Utilization Management team. As a key member of our team, you will play a critical role in ensuring compliance with state, federal, and regulatory requirements, as well as driving business growth and excellence. This is a remote-based opportunity located in California, offering a competitive salary range of $68,640 - $123,164 per year.
Job Summary:
The Delegation Oversight Nurse will be responsible for conducting pre-delegation and annual assessments, monitoring performance reports, and developing corrective action plans to ensure compliance with applicable requirements. You will work closely with the Delegation Oversight Manager and Analyst to drive delegation oversight processes, develop policies and reporting templates, and prepare reports for regulatory audits. If you have a strong background in Utilization Management, excellent analytical and communication skills, and experience with InterQual/MCG guidelines, we encourage you to apply.
Key Responsibilities:
- Conduct pre-delegation and annual assessments to ensure compliance with state, federal, and regulatory requirements
- Monitor performance reports from delegated entities and develop corrective action plans as needed
- Collaborate with the Delegation Oversight Manager and Analyst to drive delegation oversight processes
- Develop and maintain delegation assessment tools, policies, and reporting templates
- Prepare reports for regulatory audits, including CMS, State Medicaid, and NCQA
- Participate in Joint Operation Committees (JOCs) for delegated groups
Requirements:
- Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program
- Minimum 2 years of Utilization Review experience
- Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing
- Knowledge of audit processes and applicable state and federal regulations
Preferred Qualifications:
- Completion of an accredited Registered Nurse (RN) Program or a bachelor's degree in nursing
- 3+ years of NCQA, CMS, and/or state Medicaid UM auditing experience
- 3+ years of experience in delegation oversight process and working knowledge of state and federal regulations
- Certified Clinical Coder, Certified Medical Audit Specialists (CMAS), Certified Case Manager (CCM), or other healthcare/management certification
What We Offer:
- Competitive salary range of $68,640 - $123,164 per year
- Comprehensive benefits package
- Opportunity to work with a leading healthcare organization
- Remote-based work arrangement
How to Apply:
If you are a motivated and experienced Delegation Oversight Nurse (LVN) looking for a new challenge, please apply through our website. We are an Equal Opportunity Employer (EOE) M/F/D/V.
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