Delegation Oversight Clinical Auditor RN II

RN Job: Delegation Oversight Clinical Auditor RN II Shift: Full Time Pay Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Job ID: 13052 Location: Los Angeles, 90017 Job Description The Delegation Oversight Clinical Auditor RN II is responsible for ensuring that delegates contracted to perform Utilization Management (UM) functions on behalf of L.A. Care (LAC) are in compliance with all UM regulatory requirements and new legislation through the maintenance of required policies/procedures/workflows/processes/audit tools necessary to meet the requirements. This position utilizes a rapid team approach for needed improvements identified through external audits of delegated entities. This position assists in maintaining continuous quality improvement in the Delegation Oversight Clinical Audit unit ensuring that departmental/divisional and organizational goals are accomplished through overseeing and facilitating compliance of the Plan Partners, Participating Provider Groups (PPG), Specialty Health Plans (SHP), and contracted provider network as managed by the Delegation Oversight Department. This position is responsible, as part of the oversight team, for ensuring compliance of the Plan Partners and/or Participating Physician Groups (PPG) to regulatory, contractual and L.A. Care requirements. This position is responsible for performing annual and focused audits. This position also acts as a liaison between the Plan Partners and PPGs and L.A. Care Health Plan regarding UM issues. The position assists in improving access and utilization performance of Plan Partners and PPGs by being a resource for best practices and providing continuous feedback. Additionally, th... Education Required Associate's Degree in Nursing Preferred Bachelor's Degree in Nursing Experience Required At least 7 years in a clinical setting with at least 3 years in a managed care setting in Utilization Management/Case Management. #J-18808-Ljbffr Working Nurse