Molina Healthcare
Overview
As a Delegation Oversight Nurse, you will play a crucial role in enhancing the quality of healthcare delivery. This position supports quality improvement activities by overseeing delegated tasks to ensure adherence to standards set forth by the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), and state Medicaid requirements. Your contributions will help shape strategies for delivering quality and cost-effective care to our members.
This remote role requires an unrestricted LVN licensure and calls for individuals who are technologically proficient, self-directed, and have a proven ability to work independently from home. Experience in Care Management and Waiver Service Auditing is highly desirable.
Work hours:
Monday - Friday 8:00am - 4:00pm Essential Job Duties Coordinate, conduct, and document pre-delegation and annual assessments to comply with NCQA and applicable federal and state guidelines. Effectively distribute audit results, follow-up communications, and annual reporting requirements. Collaborate with analytics teams to monitor performance reports from delegated entities. Develop and implement corrective action plans (CAPs) for any identified deficiencies, ensuring thorough documentation and follow-up to resolution. Assist in delegation oversight committee meetings, contributing your insights and expertise. Work alongside leadership to create and maintain assessment tools, policies, and reporting templates. Contribute to the preparation of summary reports for the Eastern US Quality Improvement Collaborative (EQIC) and utilization management committees. Participate in joint operation committees (JOCs) for delegated groups as needed. Help prepare documentation for CMS, state Medicaid, NCQA, and other regulatory audits. Required Qualifications A minimum of 3 years of healthcare experience, including 2 years in a managed care environment focused on utilization reviews, or an equivalent combination of education and experience. Active and unrestricted Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in the state of practice. Solid understanding of audit processes and relevant state and federal regulations. Able to perform effectively in a fast-paced environment, ensuring accuracy while meeting deadlines. Proven ability to collaborate seamlessly with team members and different departments. Exceptional attention to detail, committed to maintaining high-quality standards. Strong verbal and written communication skills. Proficient in Microsoft Office suite and other relevant software applications. Preferred Qualifications Registered Nurse (RN) license, active and unrestricted in the state of practice. Certifications such as Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), or Certified Professional in Healthcare Quality (CPHQ). If you are currently a Molina employee and wish to apply for this position, please do so through the Internal Job Board. Molina Healthcare provides a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range:
$77,969 - $128,519 / ANNUAL *Actual compensation may vary based on geographic location, work experience, education, and skill level.
Monday - Friday 8:00am - 4:00pm Essential Job Duties Coordinate, conduct, and document pre-delegation and annual assessments to comply with NCQA and applicable federal and state guidelines. Effectively distribute audit results, follow-up communications, and annual reporting requirements. Collaborate with analytics teams to monitor performance reports from delegated entities. Develop and implement corrective action plans (CAPs) for any identified deficiencies, ensuring thorough documentation and follow-up to resolution. Assist in delegation oversight committee meetings, contributing your insights and expertise. Work alongside leadership to create and maintain assessment tools, policies, and reporting templates. Contribute to the preparation of summary reports for the Eastern US Quality Improvement Collaborative (EQIC) and utilization management committees. Participate in joint operation committees (JOCs) for delegated groups as needed. Help prepare documentation for CMS, state Medicaid, NCQA, and other regulatory audits. Required Qualifications A minimum of 3 years of healthcare experience, including 2 years in a managed care environment focused on utilization reviews, or an equivalent combination of education and experience. Active and unrestricted Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in the state of practice. Solid understanding of audit processes and relevant state and federal regulations. Able to perform effectively in a fast-paced environment, ensuring accuracy while meeting deadlines. Proven ability to collaborate seamlessly with team members and different departments. Exceptional attention to detail, committed to maintaining high-quality standards. Strong verbal and written communication skills. Proficient in Microsoft Office suite and other relevant software applications. Preferred Qualifications Registered Nurse (RN) license, active and unrestricted in the state of practice. Certifications such as Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional in Healthcare Management (CPHM), or Certified Professional in Healthcare Quality (CPHQ). If you are currently a Molina employee and wish to apply for this position, please do so through the Internal Job Board. Molina Healthcare provides a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range:
$77,969 - $128,519 / ANNUAL *Actual compensation may vary based on geographic location, work experience, education, and skill level.