UM LVN Delegation reputed company reputed company Remote based in CA
JOB reputed companyJob reputed company
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, andknowledge 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
- 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 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.
- Participate 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.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Licensed Vocational reputed company (LVN), or Licensed Practical reputed company (LPN) Program
Required Experience
- Minimum two years Utilization Review experience.
- Knowledge of audit processes and applicable state and federal regulations.
Required License, Certification, Association
reputed company, unrestricted State Licensed Vocational reputed company or Licensed Practical reputed company in good standing.
Preferred Education
Completion of an accredited Registered reputed company (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
- 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
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.
Originally posted on Himalayas
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