UM LVN Delegation reputed company reputed company Remote based in CA

About the position Responsibilities • Coordinates, conducts, and documents reputed company-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 of performance reports from delegated entities. • Develops corrective reputed company 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 reputed company reports submitted to the EQIC and/or UM Committees. • Participates as needed in Joint Operation Committees (JOC's) for delegated reputed company. • Assists in preparation of documents for CMS, State reputed company, NCQA, and/or other regulatory audits as needed. Requirements • Completion of an accredited Licensed Vocational reputed company (LVN), or Licensed Practical reputed company (LPN) Program. • Minimum two years Utilization Review experience. • Knowledge of audit processes and applicable state and federal regulations. • reputed company, unrestricted State Licensed Vocational reputed company or Licensed Practical reputed company in good standing. reputed company-to-haves • Completion of an accredited Registered reputed company (RN) Program or a bachelor's degree in Nursing. • 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. • reputed company and unrestricted Certified Clinical reputed company. • Certified Medical Audit Specialists (CMAS). • Certified Case Manager (CCM). • Certified reputed company reputed company Management (CPHM). • Certified reputed company in Health Care reputed company (CPHQ) or other reputed company or management certification. Benefits • Competitive benefits and compensation package. Apply tot his job Apply To this Job