Delegation Oversight Nurse - Hybrid
Description
Job Title: Delegation Oversight Nurse - Hybrid
Department: Health Services - DO & Quality Mgmt
About the Role:
We are currently seeking a highly motivated Delegation Oversight (DO) Nurse. This role will report to a Manager - Delegation Oversight. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.
What You'll Do:
- Support the oversight of all delegated activities to ensure compliance with Health Plan, DHCS, DMHC, CMS, and NCQA requirements
- Assist with Corrective Action Plans (CAPS) issued by Health Plan to verify the deficiencies and confirm action plans are sufficient and complete.
- Assist Health Services staff to improve processes so they are compliant with all the health plan requirements and update P&Ps as needed
- Supplement thorough preparation of documentation (Road Maps), reports and any other information needed for Health Plan and regulatory audits related to delegation oversight
- Serve as a subject matter expert in interpreting compliance and regulatory requirements and ensuring overall areas are operational and in compliance with Health Plan, State, federal and NCQA standards or requirements
- Support pre-delegation audits, annual audits, required reporting and ongoing reporting of performance for delegated activities
- Collaborate with Utilization Management, Case Management as needed for audit related activities
- Actively participate in collaborative team environment to educate, coordinate activities, and resolve unique problems with recommended course to action with internal and external partners
- Recommends, issues, and monitors implementation of approved CAPs
- Assist with Corrective Action Plans (CAPS) issued by Health Plan to verify the deficiencies and confirm action plans are sufficient and complete.
- Subject Matter Expert and resource for medical group Delegation Oversight
- Ensures timely completion of assigned audits, monitoring, and projects
- Support health plan UM audit reports to the IPA UM and Compliance Committees
Qualifications:
- Current California RN or LVN license
- 3+ years of clinical experience or managed care experience
- 2+ years of UM/CM delegation oversight audit experience with a Health Plan or MSO
- Knowledge of various Health Plan, DMHC, DHCS, CMS, and NCQA requirements
You're great fit for this role if:
- Strong organizational skills, detail oriented, and sound decision-making skills required
- Exceptional follow-through abilities to track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed timely
- Ability to manage multiple projects of varying complexity, priority levels and deadlines
- Highly motivated and able to work with multiple teams simultaneously
Who We Are:
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 12,000 physicians to provide care for over 1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Our Values:
- Patients First
- Empowering Entrepreneurial Provider and Care Teams
- Operate with Integrity & Deliver Excellence
- Be Innovative
- Work as One Team
Environmental Job Requirements and Working Conditions:
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754.
- The total compensation target pay range for this role is between $35.00 - $44.00 per hour. The salary range represents our national target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
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