RN / LVN / LPN Remote Monitoring Nurse

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.

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.

Monday - Friday 8 : 00am – 4 : 00pm

Remote position

Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements.

Works with delegation oversight analytics representatives on monitoring performance reports from delegated entities.

Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. Works with delegation oversight leadership to develop 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 Medicaid Services (CMS), state Medicaid, National Committee for Quality Assurance (NCQA) and / or other regulatory audits as needed.

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). Strong attention to detail with a focus on maintaining quality in all tasks.

Microsoft Office suite / applicable software program(s) proficiency.

Registered Nurse (RN). Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ).

Molina Healthcare offers 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 from posting based on geographic location, work experience, education and / or skill level.