UM Delegation Oversight - Remote

About the role

Under the general direction of the Delegation Oversight Manager, this position is responsible for coordinating all components of Health Plan Delegation Oversight audits and performing internal quality reviews for Case Management and Utilization Management. The role offers the flexibility to work remotely from anywhere within the U.S. Hours for the role are Monday through Friday, 8AM–5PM.

Responsibilities

• Prepares and submits pre-audit documentation as outlined on Health Plan audit tools
• Communicates with Health Plan auditors related to audit documents and processes
• Communicates and collaborates across the organization to gather necessary documentation to meet audit requirements
• Facilitates onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence
• Participates in performance improvement activities
• Conducts comprehensive internal audit of the end-to-end utilization management process
• Conducts focused internal audits of a specific element or process change based on identified trends or new process implementation

Required Qualifications

• Graduation from an accredited Licensed Vocational/Practical Nurse program or completion of vocational nursing program through the CA Board of Nursing
• Current LVN/LPN license
• 2+ years of clinical experience working as an LVN/LPN
• 1+ years of utilization management experience, especially Prior Authorization

Preferred Qualifications

• 3+ years of experience working as an LVN/LPN
• 2+ years of care management, utilization review, or discharge planning experience
• Experience in an HMO or experience in a Managed Care setting
• Knowledge of requirements for Medicare, Medi-Cal, and Commercial lines of business

Pay

The hourly pay for this role will range from $20 to $36 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)