Delegation Oversight Nurse Remote based in CA (Must have a CA License)
Molina Healthcare Everett, Washington; Albany, New York; New York; Idaho; Utah; Texas; Nebraska; Iowa; Florida; Michigan; New Mexico; Georgia; Ohio; Kentucky; Wisconsin; Washington; Chandler, Arizona; West Valley City, Utah; Nampa, Idaho; New York, New York; Lincoln, Nebraska; Houston, Texas; Tacoma, Washington; Dallas, Texas; Santa Fe, New Mexico; Idaho Falls, Idaho; Kearney, Nebraska; Cleveland, Ohio; Sioux City, Iowa; Augusta, Georgia; Miami, Florida; Cincinnati, Ohio; Madison, Wisconsin; Columbus, Georgia; Kenosha, Wisconsin; Tampa, Florida; Syracuse, New York; Green Bay, Wisconsin; Macon, Georgia; Buffalo, New York; Fort Worth, Texas; Orem, Utah; Seattle, Washington; Iowa City, Iowa; Ann Arbor, Michigan; Yonkers, New York; Rochester, New York; Savannah, Georgia; Covington, Kentucky; Akron, Ohio; Columbus, Ohio; Omaha, Nebraska; Meridian, Idaho; Racine, Wisconsin; Boise, Idaho; Layton, Utah; Phoenix, Arizona; Austin, Texas; Louisville, Kentucky; Sterling Heights, Michigan; Salt Lake City, Utah; Bellevue, Washington; San Antonio, Texas; St. Petersburg, Florida; Lexington-Fayette, Kentucky; Rio Rancho, New Mexico; Albuquerque, New Mexico; Roswell, New Mexico; Provo, Utah; Tucson, Arizona; Milwaukee, Wisconsin; Vancouver, Washington; Detroit, Michigan; Owensboro, Kentucky; Orlando, Florida; Cedar Rapids, Iowa; Davenport, Iowa; Warren, Michigan; Atlanta, Georgia; Grand Island, Nebraska; Caldwell, Idaho; Des Moines, Iowa; Bellevue, Nebraska; Spokane, Washington; Las Cruces, New Mexico; Mesa, Arizona; Dayton, Ohio; Bowling Green, Kentucky; Jacksonville, Florida; Scottsdale, Arizona; Grand Rapids, Michigan Job ID 2030307JOB DESCRIPTION
Job Summary
Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requirements contained in the delegation agreement.
KNOWLEDGE/SKILLS/ABILITIES
The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the team. This includes, but is not limited to:
- Coordinates, conducts, and documents pre-delegation and annual assessments as necessary to comply 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 Oversight Analyst on monitoring of performance reports from delegated entities.
- Develops corrective action plans when deficiencies are identified, and documents follow up to completion.
- Assists with meetings of the Delegation Oversight Committee.
- Works with the Delegation Oversight Manager to develop and maintain delegation assessment tools, policies, and reporting templates.
- Assists with preparation of delegation summary reports submitted to the EQIC and/or UM Committees.
- Participates as needed in Joint Operation Committees (JOC's) for delegated groups.
- Assists in preparation of documents for CMS, State Medicaid, NCQA, and/or other regulatory audits as needed.
JOB QUALIFICATIONS
Required Education
Completion of an accredited Licensed Vocational Nurse (LVN), or Licensed Practical Nurse (LPN) Program
Required Experience
- Minimum two years Utilization Review experience.Â
- Knowledge of audit processes and applicable state and federal regulations.
Required License, Certification, Association
Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing.
Preferred Education
Completion of an accredited Registered Nurse (RN) Program or a bachelor’s degree in Nursing.
Preferred Experience
- Three-year NCQA, CMS, and/or state Medicaid UM auditing experience.
- Three years’ experience in delegation oversight process and working knowledge of state and federal regulations.
Preferred License, Certification, Association
- Active and unrestricted Certified Clinical Coder
- Certified Medical Audit Specialists (CMAS)
- Certified Case Manager (CCM)
- Certified Professional Healthcare Management (CPHM) Certified Professional in Health Care Quality (CPHQ)
- or other healthcare
- or management certification
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $128,519 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 03/04/2025ABOUT OUR LOCATION
View Map- Specialist, Pharmacy Ops Albany New York, Everett Washington, Utah, Florida, Idaho, Wisconsin, Texas, Georgia, Michigan, New Mexico, Kentucky, Washington, Iowa, Nebraska, New York, Ohio, New York New York, Orem Utah, Vancouver Washington, Spokane Washington, Cincinnati Ohio, Savannah Georgia, Madison Wisconsin, Phoenix Arizona, Chandler Arizona, Rio Rancho New Mexico, Covington Kentucky, Lincoln Nebraska, Grand Island Nebraska, Provo Utah, Nampa Idaho, Houston Texas, Des Moines Iowa, Akron Ohio, Bellevue Washington, Tacoma Washington, Seattle Washington, Syracuse New York, Buffalo New York, Augusta Georgia, Caldwell Idaho, Tucson Arizona, Fort Worth Texas, Dayton Ohio, Cleveland Ohio, West Valley City Utah, Grand Rapids Michigan, Sterling Heights Michigan, Rochester New York, Racine Wisconsin, Milwaukee Wisconsin, Boise Idaho, Meridian Idaho, Austin Texas, Owensboro Kentucky, Louisville Kentucky, Omaha Nebraska, Layton Utah, Jacksonville Florida, Orlando Florida, Columbus Ohio, Kenosha Wisconsin, Idaho Falls Idaho, Albuquerque New Mexico, Las Cruces New Mexico, Kearney Nebraska, Iowa City Iowa, Roswell New Mexico, Ann Arbor Michigan, Yonkers New York, Columbus Georgia, Mesa Arizona, Dallas Texas, Bowling Green Kentucky, Bellevue Nebraska, Sioux City Iowa, Davenport Iowa, Cedar Rapids Iowa, Salt Lake City Utah, Detroit Michigan, Tampa Florida, Miami Florida, Macon Georgia, Green Bay Wisconsin, Scottsdale Arizona, Warren Michigan, St. Petersburg Florida, Atlanta Georgia, San Antonio Texas, Santa Fe New Mexico, Lexington-Fayette Kentucky 04/11/2025
- Engineer, Big Data - Databricks/Python/SQL/Power BI - Remote Albany New York, Everett Washington, Georgia, Iowa City Iowa, Caldwell Idaho, Covington Kentucky, Louisville Kentucky, Omaha Nebraska, Lincoln Nebraska, Las Cruces New Mexico, Ohio, Orem Utah, Kenosha Wisconsin, Tucson Arizona, Tampa Florida, Sioux City Iowa, Cedar Rapids Iowa, Nampa Idaho, Kentucky, Grand Island Nebraska, New Mexico, New York New York, New York, Cleveland Ohio, Austin Texas, Miami Florida, Jacksonville Florida, Atlanta Georgia, Macon Georgia, Columbus Georgia, Savannah Georgia, Davenport Iowa, Idaho Falls Idaho, Meridian Idaho, Boise Idaho, Grand Rapids Michigan, Santa Fe New Mexico, Dallas Texas, Salt Lake City Utah, Spokane Washington, Tacoma Washington, Madison Wisconsin, Scottsdale Arizona, Augusta Georgia, Warren Michigan, Nebraska, Fort Worth Texas, Seattle Washington, Racine Wisconsin, Phoenix Arizona, Orlando Florida, Bowling Green Kentucky, Detroit Michigan, Sterling Heights Michigan, Kearney Nebraska, Buffalo New York, Rochester New York, Cincinnati Ohio, Houston Texas, Texas, Utah, Layton Utah, Florida, Iowa, Michigan, Albuquerque New Mexico, Akron Ohio, San Antonio Texas, West Valley City Utah, Washington, Idaho, Wisconsin, St. Petersburg Florida, Des Moines Iowa, Owensboro Kentucky, Ann Arbor Michigan, Syracuse New York, Mesa Arizona, Chandler Arizona, Lexington-Fayette Kentucky, Bellevue Nebraska, Rio Rancho New Mexico, Roswell New Mexico, Yonkers New York, Dayton Ohio, Columbus Ohio, Provo Utah, Vancouver Washington, Bellevue Washington, Green Bay Wisconsin, Milwaukee Wisconsin 03/31/2025
- Rep, MTM Pharmacy Services I Everett Washington, Albany New York, Boise Idaho, Kentucky, Owensboro Kentucky, Covington Kentucky, Michigan, Warren Michigan, Omaha Nebraska, Dallas Texas, Augusta Georgia, Iowa City Iowa, Cedar Rapids Iowa, Meridian Idaho, Lexington-Fayette Kentucky, Nebraska, Rio Rancho New Mexico, Rochester New York, Dayton Ohio, New York New York, Chandler Arizona, Tampa Florida, Georgia, Ohio, Columbus Ohio, Texas, Salt Lake City Utah, Spokane Washington, Wisconsin, Racine Wisconsin, Caldwell Idaho, Louisville Kentucky, Grand Island Nebraska, Las Cruces New Mexico, New Mexico, Akron Ohio, San Antonio Texas, Washington, Madison Wisconsin, Green Bay Wisconsin, Idaho, Bellevue Nebraska, Roswell New Mexico, Cleveland Ohio, Austin Texas, Provo Utah, Utah, Layton Utah, Orem Utah, Vancouver Washington, Tacoma Washington, Kenosha Wisconsin, Tucson Arizona, Florida, Macon Georgia, Idaho Falls Idaho, Ann Arbor Michigan, Santa Fe New Mexico, Cincinnati Ohio, Fort Worth Texas, Houston Texas, West Valley City Utah, Bellevue Washington, Milwaukee Wisconsin, St. Petersburg Florida, Savannah Georgia, Columbus Georgia, Des Moines Iowa, Iowa, Davenport Iowa, Bowling Green Kentucky, Detroit Michigan, Sterling Heights Michigan, Grand Rapids Michigan, Kearney Nebraska, Albuquerque New Mexico, Scottsdale Arizona, Mesa Arizona, Jacksonville Florida, Miami Florida, Nampa Idaho, Lincoln Nebraska, New York, Syracuse New York, Yonkers New York, Buffalo New York, Seattle Washington, Phoenix Arizona, Orlando Florida, Atlanta Georgia, Sioux City Iowa 03/20/2025
- Business Analyst, Tech Config Info Mgmt Albany New York, Everett Washington, Jacksonville Florida, Tampa Florida, Augusta Georgia, Atlanta Georgia, Ohio, Kenosha Wisconsin, Kearney Nebraska, Albuquerque New Mexico, Des Moines Iowa, Meridian Idaho, Miami Florida, St. Petersburg Florida, Orlando Florida, Rio Rancho New Mexico, Santa Fe New Mexico, West Valley City Utah, Layton Utah, Buffalo New York, Tacoma Washington, Cincinnati Ohio, Idaho, Boise Idaho, Grand Rapids Michigan, Ann Arbor Michigan, Iowa City Iowa, Austin Texas, Nebraska, New Mexico, Provo Utah, Seattle Washington, Cleveland Ohio, Nampa Idaho, Owensboro Kentucky, Mesa Arizona, Kentucky, Warren Michigan, Chandler Arizona, Phoenix Arizona, Georgia, Dayton Ohio, Milwaukee Wisconsin, Roswell New Mexico, Syracuse New York, New York New York, Vancouver Washington, Akron Ohio, Bowling Green Kentucky, Sioux City Iowa, Dallas Texas, Green Bay Wisconsin, Racine Wisconsin, Omaha Nebraska, Bellevue Nebraska, Yonkers New York, Rochester New York, Louisville Kentucky, Florida, Savannah Georgia, Cedar Rapids Iowa, Fort Worth Texas, Texas, Madison Wisconsin, Las Cruces New Mexico, Bellevue Washington, Spokane Washington, New York, Iowa, Caldwell Idaho, Idaho Falls Idaho, Lexington-Fayette Kentucky, Sterling Heights Michigan, Michigan, Tucson Arizona, Columbus Georgia, Davenport Iowa, Wisconsin, Lincoln Nebraska, San Antonio Texas, Salt Lake City Utah, Orem Utah, Washington, Covington Kentucky, Detroit Michigan, Scottsdale Arizona, Macon Georgia, Houston Texas, Grand Island Nebraska, Utah, Columbus Ohio 04/11/2025
No recently viewed jobs.
View All JobsNo saved jobs.
View All Jobs