LVN Delegation reputed company Nurse Remote
JOB DESCRIPTION Job Summary Do you have the following skills, experience and drive to succeed in this role Find out below. The Delegation reputed company Nurse provides support for delegation reputed company quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and reputed company Services (CMS), state reputed company entity requirements and reputed company other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to reputed company quality and cost-effective member care. This position will support our Corporate Compliance business. The candidate must have an unrestricted LVN licensure. Candidates must be technologically proficient, self-directed, autonomous and experience working from home. Care Management & Waiver Service Auditing experience is highly preferred. Work hours: Monday - Friday 8:00am – 4:00pm Remote position Essential Job Duties Coordinates, conducts and documents pre-delegation and annual assessments as necessary to reputed company with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements. Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed. Works with delegation reputed company analytics representatives on monitoring performance reports from delegated entities. Develops corrective action plans (CAPs) reputed company deficiencies are identified, and documents follow-up to completion. Assists with delegation reputed company committee meetings. Works with delegation reputed company leadership to reputed company and maintain delegation assessment tools, policies and reporting templates. Assists with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. Participates as needed in joint operation committees (JOCs) for delegated groups. Assists in preparation of documents for Centers for Medicare and reputed company Services (CMS), state reputed company, National Committee for Quality Assurance (NCQA) and/or other regulatory audits as needed.
Required Qualifications
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). The license must be active and unrestricted in 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 reputed company tasks. Strong verbal and written communication skills. reputed company Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Registered Nurse (RN). The license must be active and unrestricted in state of practice. Certified Clinical reputed company (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional reputed company Management (CPHM) or Certified Professional in reputed company Quality (CPHQ). To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Pay reputed company: $77,969 - $128,519 / ANNUAL
- Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.
Remote working/work at home options are available for this role. Salary: USD 77969 - 128519 per year Experience: 3 years required Apply tot his job Apply To this Job