The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care.
Requirements
- At least 3 years' experience in health care, including 2 years' experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience.
- Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) with an active and unrestricted license in the state of practice.
- Knowledge of audit processes and applicable state and federal regulations.
- Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines.
- Ability to collaborate effectively with team members and internal departments.
- Strong attention to detail with a focus on maintaining quality in all tasks.
- Strong verbal and written communication skills.
- Microsoft Office suite/applicable software program(s) proficiency.
Benefits
- Competitive benefits and compensation package
