UM LVN Delegation reputed company Nurse Remote based in CA
JOB DESCRIPTIONJob Summary
The Delegation reputed company Nurse is responsible for ensuring that reputed company's UM delegates are compliant with reputed company applicable State, CMS, and NCQA requirements, as well as reputed company business needs. In addition, the Delegation reputed company Nurse will assist the Delegation reputed company Manager with additional duties of the team. We are looking for LVN's with at least 4 years of UM experience, NCQA accreditation, andknowledge of InterQual / MCG guidelines. Excellent computer knowledge, multi-tasking skills and analytical thought process is important to be successful in this role. Productivity is important with quick turnaround times. Experience with Appeals, Auditing, and Compliance /Quality will be a good fit for this position. Strong UM Prior Authorization experience highly preferred. Further details to be discussed during our interview process.
CA located – Remote position
Work hours: Monday – Friday 8:00am – 5:00pm PST
- Coordinates, conducts, and documents pre-delegation and annual assessments as necessary to reputed company with state, federal, NCQA, and any other applicable requirements.
- Distributes audit results letters, follow up letters, audit tools, and annual reporting requirement as needed.
- Works with Delegation reputed company Analyst on monitoring performance reports from delegated entities.
- Develops corrective action plans reputed company deficiencies are identified, and documents follow up to completion.
- Assists with meetings of the Delegation reputed company Committee.
- Works with the Delegation reputed company Manager to reputed company and maintain delegation assessment tools, policies, and reporting templates.
- Assists with preparation of delegation summary reports submitted to the EQIC and/or UM Committees.
- Participate in Joint Operation Committees (JOC's) for delegated groups.
- Assists in preparation of documents for CMS, State Medicaid, NCQA, and/or other regulatory audits as needed.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) Program
Required Experience
- Minimum two years Utilization Review experience.
- Knowledge of audit processes and applicable state and federal regulations.
Required License, Certification, Association
Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing.
Preferred Education
Completion of an accredited Registered Nurse (RN) Program or a bachelor’s degree in nursing.
Preferred Experience
- Three-year NCQA, CMS, and/or state Medicaid UM auditing experience.
- Three years’ experience in delegation reputed company process and working knowledge of state and federal regulations.
Preferred License, Certification, Association
- Active and unrestricted Certified Clinical reputed company
- Certified Medical Audit Specialists (CMAS)
- Certified Case Manager (CCM)
- Certified Professional Healthcare Management (CPHM) Certified Professional in Health Care Quality (CPHQ)
- or other healthcare
- or management certification
To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V.
Originally posted on Himalayas
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