Delegation Oversight Clinical Auditor Rn Ii

LA Care Health Plan

Los Angeles, CA, US
Base: $88,854 - $142,166; bonus/equity: not specif...
On-site
Utilization management regulatory compliance
Managed care setting experience
Medi-cal and hmo contract knowledge
The role ensures delegates contracted for Utilization Management functions comply with all regulatory requirements and new legislation

Job Summary

  • The role ensures delegates contracted for Utilization Management functions comply with all regulatory requirements and new legislation.
  • This position performs annual, focused, and periodic audits while identifying deficiencies and managing corrective action plans for Plan Partners.
  • L.A. Care offers a comprehensive benefits package including Paid Time Off, Tuition Reimbursement, Retirement Plans, and a Wellness Program.

Matching Summary

The role ensures delegates contracted for Utilization Management functions comply with all regulatory requirements and new legislation.

Salary

Base: $88,854 - $142,166; Bonus/Equity: Not specified; Benefits: PTO, Tuition Reimbursement, Retirement Plans, Medical/Dental/Vision

Skills & Requirements

Must-have

  • Utilization Management regulatory compliance
  • Managed care setting experience
  • Medi-Cal and HMO contract knowledge
  • Annual and focused audit execution
  • Corrective action plan monitoring

Nice-to-have

  • Behavioral health audit program design
  • Inter-rater reliability testing skills
  • Continuous quality improvement initiatives
  • Best practice resource provision
  • Joint operation meeting participation

Key Requirements

  • Active California RN License
  • Associate's Degree in Nursing required
  • 7 years clinical experience minimum
  • 3 years managed care UM/Case Management
  • Knowledge of Medi-Cal and HMO contracts

Work Rights

Not specified

Tailored Resume

Cover Letter