Delegation Oversight Nurse, LVN (Remote) in Rancho Cucamonga, CA
Delegation Oversight Nurse, LVN (Remote) - Inland Empire Health Plan - Rancho Cucamonga, CA - work from home job
Company: Inland Empire Health Plan
Job description: Job Requisition ID: 9880
Position Summary/Position
Under the direction of the department leadership, the Delegation Oversight Nurse, LVN is responsible for oversight of clinical operations for the delegated IPA and subcontracted providers. In this capacity, the Delegation Oversight Nurse, LVN works directly with IEHP and delegated IPA Administrators, Medical Directors, and IPA staff to ensure accurate and timely dissemination of all IEHP and mandated Regulatory requirements to all IPA and subcontracted providers.
Major Functions (Duties and Responsibilities)
1. Serve as liaison to delegated IPA and subcontracted providers to assist with interpreting IEHP Policies and Procedures and referral processes as they apply to IEHP Members.
2. Serve as a regulatory resource person and trainer to IPAs staff regarding IEHP and regulatory requirements, standards, and forms. Assist other medical services departments and staff within the organization in regards to delegated medical services activities as required.
3. Attend Joint Operations Meetings (JOM) between delegated IPA and IEHP. Responsible for documentation, formatting, and dissemination of minutes, as required.
4. Oversight of IPA activity through monthly collection and tracking of data/reports. Collaborate with IEHP Medical Director regarding IPA and subcontracted providers deficiencies and non-compliance issues identified during the monthly audits. Timely follow-up and completion of necessary follow-up action that may include, educational letters, training, corrective action plan (CAP), concurrent review, and any additional audits, etc.
5. Conduct comprehensive monthly IPA denial and care management file audits and annual Medical Management audits, prepare and report results to the IPA and IEHP.
6. Work with the IEHPs Provider Services Dept. to schedule regulatory audits.
7. Active participation in both internal and external meetings, such as, Delegation Oversight, Utilization Management Subcommittee, Denial Related Grievance Review, and in other internal and external meetings as assigned, including preparation, and presenting of reports as required.
8. Assist in the development of internal Medical Management Policy and Procedure Manuals.
9. Maintain comprehensive files for all IPA/Delegate correspondence and monitoring activities.
Experience Qualifications
Three (3) or more years of utilization and case management experience in an HMO and IPA setting with in-depth knowledge of all aspects of managed care operations.
Education Qualifications
High school diploma or GED required.
Professional Certification
Professional Licenses
Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required.
Drivers License Required
Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.
Knowledge Requirement
Knowledge in NCQA standards, DHCS, CMS, and DHMC regulatory requirements.
Skills Requirement
Must have excellent communication skills and able to maintain positive relationships with internal and external contacts at all levels. Must possess high level of organizational skills to maintain accurate records and documentation.
Abilities Requirement
Self-starter and able to work independently.
Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
A reasonable salary expectation is between $61,422.40 and $78,312.00, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as Great Place to Work. With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, were ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Expected salary: $61422.4 - 78312 per year
Location: Rancho Cucamonga, CA
Job date: Wed, 02 Aug 2023 22:47:07 GMT
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Company: Inland Empire Health Plan
Job description: Job Requisition ID: 9880
Position Summary/Position
Under the direction of the department leadership, the Delegation Oversight Nurse, LVN is responsible for oversight of clinical operations for the delegated IPA and subcontracted providers. In this capacity, the Delegation Oversight Nurse, LVN works directly with IEHP and delegated IPA Administrators, Medical Directors, and IPA staff to ensure accurate and timely dissemination of all IEHP and mandated Regulatory requirements to all IPA and subcontracted providers.
Major Functions (Duties and Responsibilities)
1. Serve as liaison to delegated IPA and subcontracted providers to assist with interpreting IEHP Policies and Procedures and referral processes as they apply to IEHP Members.
2. Serve as a regulatory resource person and trainer to IPAs staff regarding IEHP and regulatory requirements, standards, and forms. Assist other medical services departments and staff within the organization in regards to delegated medical services activities as required.
3. Attend Joint Operations Meetings (JOM) between delegated IPA and IEHP. Responsible for documentation, formatting, and dissemination of minutes, as required.
4. Oversight of IPA activity through monthly collection and tracking of data/reports. Collaborate with IEHP Medical Director regarding IPA and subcontracted providers deficiencies and non-compliance issues identified during the monthly audits. Timely follow-up and completion of necessary follow-up action that may include, educational letters, training, corrective action plan (CAP), concurrent review, and any additional audits, etc.
5. Conduct comprehensive monthly IPA denial and care management file audits and annual Medical Management audits, prepare and report results to the IPA and IEHP.
6. Work with the IEHPs Provider Services Dept. to schedule regulatory audits.
7. Active participation in both internal and external meetings, such as, Delegation Oversight, Utilization Management Subcommittee, Denial Related Grievance Review, and in other internal and external meetings as assigned, including preparation, and presenting of reports as required.
8. Assist in the development of internal Medical Management Policy and Procedure Manuals.
9. Maintain comprehensive files for all IPA/Delegate correspondence and monitoring activities.
Experience Qualifications
Three (3) or more years of utilization and case management experience in an HMO and IPA setting with in-depth knowledge of all aspects of managed care operations.
Education Qualifications
High school diploma or GED required.
Professional Certification
Professional Licenses
Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required.
Drivers License Required
Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.
Knowledge Requirement
Knowledge in NCQA standards, DHCS, CMS, and DHMC regulatory requirements.
Skills Requirement
Must have excellent communication skills and able to maintain positive relationships with internal and external contacts at all levels. Must possess high level of organizational skills to maintain accurate records and documentation.
Abilities Requirement
Self-starter and able to work independently.
Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
A reasonable salary expectation is between $61,422.40 and $78,312.00, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as Great Place to Work. With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, were ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Expected salary: $61422.4 - 78312 per year
Location: Rancho Cucamonga, CA
Job date: Wed, 02 Aug 2023 22:47:07 GMT
Apply for the job now!
Apply Now