Nurse Auditor, Delegation Oversight
About The Position
The Delegation Oversight Nurse Auditor is responsible for performing delegation oversight auditing activities to ensure delegates comply with upstream health plan contractual requirements. This also includes NCQA, federal, and state regulations and standards. This position utilizes a rapid team approach for needed improvements identified through audits and monitoring activities. The oversight responsibility of this position includes reporting to AltaMed Health Network (AHN) Medical Services Delegation Oversight leadership and providing consultation/instructional/coaching recommendations to improve overall compliance of delegates and sub-delegates with regulatory entities and standards.
Requirements
- Current and active, unrestricted California Nurse license, LVN.
- A minimum of 3 years of experience in managed care is required.
- Minimum of 2 years Utilization Management experience required.
- Minimum of 1 year of delegation oversight (D) audit experience required. Instead of delegation oversight experience, we will consider candidates with 2+ years of UM experience, preferably in a lead and/or supervisory role.
- Working knowledge of state and federal regulations.
- Knowledge and experience with Medicare/Medicaid programs.
- A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.
Responsibilities
- Performing delegation oversight auditing activities to ensure delegates comply with upstream health plan contractual requirements, NCQA, federal, and state regulations and standards.
- Utilizing a rapid team approach for needed improvements identified through audits and monitoring activities.
- Reporting to AltaMed Health Network (AHN) Medical Services Delegation Oversight leadership.
- Providing consultation/instructional/coaching recommendations to improve overall compliance of delegates and sub-delegates with regulatory entities and standards.
Benefits
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
