Delegation Oversight Nurse (LPN) - Must Reside in California
On-site · Redlands, California, United States
Job Summary
Oversee delegation oversight quality improvement activities and coordinate pre-delegation and annual assessments to ensure compliance with NCQA, CMS, state Medicaid and other regulatory requirements. Prepare and distribute audit results, follow-up correspondence, and annual reporting; monitor performance reports from delegated entities; develop and implement corrective action plans; support delegation oversight committee activities; assist in developing tools, policies, and templates; contribute to delegation summary reports for EQIC and utilization management committees; participate in joint operation committees and assist with CMS/state audits as needed.
Required Qualifications
- Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN); active and unrestricted in state of practice
- At least 3 years experience in health care, including 2 years experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience
- Knowledge of audit processes and applicable state and federal regulations
- Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines
- Ability to collaborate effectively with team members and internal departments
- Strong attention to detail with a focus on maintaining quality in all tasks
- Strong verbal and written communication skills
- Microsoft Office suite/applicable software program(s) proficiency
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