Delegation Oversight Nurse (Remote)

Overview

The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs.

In Short

• Coordinates, conducts, and documents pre-delegation and annual assessments.
• Distributes audit results letters and annual reporting requirements.
• Works with Delegation Oversight Analyst on monitoring performance reports.
• Develops corrective action plans for identified deficiencies.
• Assists with meetings of the Delegation Oversight Committee.
• Maintains delegation assessment tools and reporting templates.
• Prepares delegation summary reports for committees.
• Participates in Joint Operation Committees for delegated groups.
• Assists in preparation of documents for regulatory audits.

Requirements

• Completion of an accredited LVN or LPN Program.
• Minimum two years of Utilization Review experience.
• Knowledge of audit processes and regulations.
• Active, unrestricted State LVN or LPN license.
• Preferred: Completion of an accredited RN Program or bachelor’s degree in nursing.
• Preferred: Three years of NCQA, CMS, or state Medicaid UM auditing experience.
• Preferred: Experience in delegation oversight process.
• Preferred: Active and unrestricted healthcare certifications.

Benefits

• Competitive benefits and compensation package.
• Equal Opportunity Employer.