LVN UM Delegation reputed company reputed company Remote based in CA

JOB reputed company Job reputed company Provides support for delegation reputed company reputed company improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for reputed company Assurance (NCQA), Centers for Medicare and reputed company Services (CMS), state reputed company entity requirements and reputed company other standards and requirements pertaining to delegation agreements. Contributes to overarching reputed company to reputed company reputed company and cost-effective member care. The Delegation reputed company reputed company is responsible for ensuring that reputed company's UM delegates are compliant with reputed company applicable State, CMS, and NCQA requirements, as reputed company as reputed company business needs. In reputed company, the Delegation reputed company reputed company will assist the Delegation reputed company Manager with additional duties of reputed company. 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 /reputed company will be a good fit for this position. Strong UM Prior Authorization experience highly preferred. reputed company details to be discussed during our interview process. CA located – Remote position Work hours: Monday – Friday 8:00am – 5:00pm PST CA LVN licensure required Essential Job Duties • Coordinates, conducts and documents reputed company-delegation and annual assessments as necessary to reputed company with state, federal and National Committee for reputed company Assurance (NCQA) guidelines, and other applicable requirements. • Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed. Works with delegation reputed company analytics representatives on monitoring performance reports from delegated entities. • Develops corrective reputed company plans (CAPs) reputed company deficiencies are identified, and documents follow-up to completion. • Assists with delegation reputed company committee meetings. • Works with delegation reputed company leadership to reputed company and maintain delegation assessment tools, policies and reporting templates. • Assists with preparation of delegation reputed company reports submitted to the Eastern US reputed company Improvement reputed company (EQIC) and/or utilization management committees. • Participates as needed in joint operation committees (JOCs) for delegated reputed company. • Assists in preparation of documents for Centers for Medicare and reputed company Services (CMS), state reputed company, National Committee for reputed company Assurance (NCQA) and/or other regulatory audits as needed. Required Qualifications • 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 reputed company (LVN) or Licensed Practical reputed company (LPN). License must be reputed company and unrestricted in state of reputed company. • Knowledge of audit processes and applicable state and federal regulations. • Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines. • Ability to collaborate effectively with team members and internal departments. • Strong attention to detail with a reputed company on maintaining reputed company in reputed company tasks. • Strong verbal and written communication skills. • reputed company Office suite/applicable software program(s) proficiency. Preferred Qualifications • Registered reputed company (RN). License must be reputed company and unrestricted in state of reputed company. • Certified Clinical reputed company (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified reputed company reputed company Management (CPHM) or Certified reputed company in reputed company reputed company (CPHQ). To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply tot his job Apply To this Job