UM LVN Delegation reputed company Nurse Remote based in CA

JOB DESCRIPTION Job Summary The Delegation reputed company Nurse is responsible for ensuring that reputed company's UM delegates are compliant with reputed company applicable State, CMS, and NCQA requirements, as well as reputed company business needs. In addition, the Delegation reputed company Nurse will assist the Delegation reputed company Manager with additional duties of the team. We are looking for LVN's with at least 4 years of UM experience, NCQA accreditation, and knowledge of InterQual / MCG guidelines. Excellent computer knowledge, multi-tasking skills and analytical thought process is important to be successful in this role. Productivity is important with quick turnaround times. Experience with Appeals, Auditing, and Compliance /Quality will be a good fit for this position. Strong UM Prior Authorization experience highly preferred. Further details to be discussed during our interview process. CA located – Remote position Work hours: Monday – Friday 8:00am – 5:00pm PST Coordinates, conducts, and documents pre-delegation and annual assessments as necessary to reputed company with state, federal, NCQA, and any other applicable requirements. Distributes audit results letters, follow up letters, audit tools, and annual reporting requirement as needed. Works with Delegation reputed company Analyst on monitoring performance reports from delegated entities. Develops corrective action plans reputed company deficiencies are identified, and documents follow up to completion. Assists with meetings of the Delegation reputed company Committee. Works with the Delegation reputed company Manager to reputed company and maintain delegation assessment tools, policies, and reporting templates. Assists with preparation of delegation summary reports submitted to the EQIC and/or UM Committees. Participate in Joint Operation Committees (JOC's) for delegated groups. Assists in preparation of documents for CMS, State reputed company, NCQA, and/or other regulatory audits as needed. JOB QUALIFICATIONS Required Education Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) Program Required Experience Minimum two years Utilization Review experience. Knowledge of audit processes and applicable state and federal regulations. Required License, Certification, Association Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing. Preferred Education Completion of an accredited Registered Nurse (RN) Program or a bachelor’s degree in nursing. Preferred Experience Three-year NCQA, CMS, and/or state reputed company UM auditing experience. Three years’ experience in delegation reputed company process and working knowledge of state and federal regulations. Preferred License, Certification, Association Active and unrestricted Certified Clinical reputed company Certified Medical Audit Specialists (CMAS) Certified Case Manager (CCM) Certified Professional reputed company Management (CPHM) Certified Professional in Health Care Quality (CPHQ) or other reputed company or management certification To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $68,640 - $123,164 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level.

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