Delegation Operations Nurse Auditor - RN, Senior (Oncology)

Your Role

The Delegation Oversight team is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS, DHCS, LA Care and DMHC requirements including delegation standards and requirements contained in the delegation agreement. The Delegation Operations Nurse Auditor- RN - Senior will report to the Manager of UMDO. In this role you will assist in maintaining continuous quality improvement in the 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 RN license required

• Bachelors of Science in Nursing or advanced degree preferred

• Requires 5 years of prior relevant experience

• Requires 2 years of oncology experience

• Experience in auditing of claims, credentialing and/or re-credentialing preferred.

• Requires strong analytical and problem-solving skills

• Strong working knowledge of regulatory standards and regulations preferred

• Ability to solve complex issues and identify solutions preferred

• Desired knowledge of accreditation entities and their requirements

• Ability to work independently

• Excellent verbal and written communication skill and interpersonal skills

• Computer ease & literacy with Word, Excel, Power Point Skills preferred