Delegation Operations Nurse Auditor - RN, Senior

Your Role

The Delegation Oversight team is responsible for driving continuous quality improvement across delegated functions and ensuring compliance with applicable regulatory, contractual, and accreditation requirements. The team oversees delegated activities in accordance with NCQA, CMS, DHCS, L.A. Care, and DMHC standards, as well as delegation requirements outlined in executed delegation agreements.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Bachelor's of Science in Nursing or advanced degree preferred
• Current, unrestricted California Registered Nurse (RN) license required
• 5 years of relevant professional experience required
• Strong analytical, investigative, and problem solving skills
• Ability to independently assess complex compliance issues and identify effective solutions
• Excellent verbal, written, and interpersonal communication skills
• Ability to work independently with minimal supervision in a fast paced, regulatory environment
• Proficiency with Microsoft Word, Excel, and PowerPoint
• Experience in auditing utilization management strongly preferred
• Strong working knowledge of regulatory and accreditation standards, including NCQA, CMS, DHCS, L.A. Care, and DMHC preferred
• Knowledge of delegation oversight requirements and health plan operations preferred
• Experience supporting or participating in regulatory or accreditation audits preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.