Lvn Jobs in Indio, TX

About The Position

Requirements

• Current CA LVN License
• Requires at least 3 years of prior relevant auditing experience in utilization management or prior out-patient authorization review preferred
• Ability to work independently
• Excellent verbal and written communication skills and interpersonal skills
• Computer ease & literacy with Word, Excel, Power Point

Nice To Haves

• Certificate/diploma in vocational nursing required or advanced degree preferred
• Desired knowledge of accreditation entities and their requirements

Responsibilities

• Be responsible for overseeing policy and procedure review and completing limited and less complex full desk or onsite Pre-delegation, Annual or follow-up audits /assessments of delegated entities, including vendors, in support of the regulatory and NCQA requirements.
• Act as the auditor in charge on small and less complex audits, with supervision, of Sr. management and other delegated non-clinical areas through to corrective action plan oversight.
• Research, investigate and oversee delegated entity’s compliance with reporting requirements by tracking the receipt and evaluating the completeness of reports.
• Educate the delegated entities and vendors on area of expertise including but not limited to claims payment management, credentialing management, financial solvency, and system controls.
• Collaborate on regulatory audits, findings responses or enforcements by regulatory agencies.
• Responsible for writing Corrective Action Plans and comprehensive summaries
• Responsible for reviewing criteria on denial letters
• Responsible for handling multiple audits and able to prioritize workflow