Delegation Operations Nurse Auditor - LVN, Experienced

Your Role

The Delegation Oversight Utilization Management team is responsible for the organization, tracking and data entry of IPA Utilization Management audits, issues, complaints and monitoring. Identifies root cause of the problem and maintains monthly reporting that track and compare patterns of delegated entities. The Delegation Operations Nurse Auditor-LVN-Experienced will report to the Manager of UMDO. In this role you will be assist in maintaining continuous quality improvement in the Utilization Management Delegation Oversight Clinical Audit ensuring that departmental and organizational goals are accomplished through oversight and facilitating Utilization Management compliance of the Plan Partners.

Your Knowledge and Experience

• Current CA LVN License

• Bachelors of Science in Nursing or advanced degree preferred

• Requires at least 3 years of prior relevant experience in auditing of claims, credentialing, or recredentialing

• Experience in auditing utilization management or prior out-patient authorization review preferred

• Desired knowledge of accreditation entities and their requirements
• Ability to work independently
• Excellent verbal and written communication skills and interpersonal skills
• Computer ease & literacy with Word, Excel, Power Point Skills