Delegation Oversight Nurse Remote based in CA (Must have a CA License)

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.

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.

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. 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.