Job Closed
This listing is no longer active.
Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molina. As an employer, M
Delegation Oversight Nurse
Location
United States
Posted
105 days ago
Salary
0
No structured requirement data.
Job Description
Delegation Oversight Nurse
Molina Healthcare
JOB DESCRIPTION This position is 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. Essential Job Duties 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. We are looking for LVN's with at least 3 years of UM experience, NCQA accreditation and knowledge of InterQual / MCG guidelines. Excellent computer multi-tasking skills and analytical thought process is important to be successful in this role. Productivity is important with turnaround times. Experience with Appeals, Auditing, Prior Authorization, Compliance and Quality will be a good fit for this position. Further details to be discussed during our interview process. CA located – Remote position - 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. Required Qualifications • At least 3 years experience in health care, including 2 years experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience. • Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. • Knowledge of audit processes and applicable state and federal regulations. • Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines. • Ability to collaborate effectively with team members and internal departments. • Strong attention to detail with a focus on maintaining quality in all tasks. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Related Guides
Related Categories
Related Job Pages
More Compliance Jobs
Director, Compliance Officer
KeyrockDigital asset market makers building scalable, self-adaptive technologies to support efficient markets.
• Ensuring compliance with all relevant laws and regulations by developing and implementing the policies and procedures; • Conducting compliance risk assessments and elaborating an annual compliance plan; • Developing and implementing a plan of second-line controls and conducting the tests; • Drafting of compliance points of attention and recommendations to the Board of Directors; • Assessing future business activities to identify potential compliance risks; • Ensuring the firm’s policies and procedures are being communicated effectively to all relevant employees; • Keeping abreast with regulatory changes and maintaining the policies and procedures up to date; • Being responsible for oversight of Keyrock SYC compliance with its AML obligations and acting as a focal point for the firm’s AML activity • Carrying out the duties as per the AML/CTF Framework such as conducting KYC, onboarding customers, ongoing monitoring, reporting of STR/SAR, complaint handling, etc. • Representing the company in all matters of money laundering prevention in the Seychelles • Serving as a subject matter expert on AML/CTF matters, providing guidance and support to the compliance team and other departments; • Conducting regular audits and reviews to ensure compliance with Keyrock’s SYC regulatory obligations; • Serve as a Board Member of Keyrock SYC, with a focus on all compliance related matters. This includes providing strategic guidance on regulatory obligations, overseeing the implementation of compliance frameworks, and ensuring adherence to applicable laws and internal policies across all business activities.
• Perform preparation of document packages for regulatory submissions for new and mature products to ensure alignment and compliance with local and regional registration requirements as well as with company policies from all areas of company as well as internal audits and inspections. • Compile all materials required in submissions, license renewal and annual registrations. • Prepare the necessary copies of international documents, CE Certificates, CFG's and other regulatory documents. • Assist in updating and maintaining Technical files for submission to the Notified Body for changes in manufacturing and/or design. • Maintain the Global RA database for the Corporation. • Provide administrative support to RA Department personnel. • Complete other tasks assigned by management as needed.
• Lead product compliance for radio remote controls (EU & global). • Interpret/apply: EU RED (2014/53/EU), Machinery Regulation (EU) 2023/1230, EMC, LVD / EN 62368‑1, and market approvals (e.g., FCC, IC, MIC, SRRC, ANATEL). • Prepare/maintain Declarations of Conformity (DoC) and technical files. • Support compliance to EN ISO 13849‑1/-2 and contribute to safety concepts (safety functions/architectures, PL/SIL justification, FMEA, FMEDA, MTTFd, DCavg, B10d). • Plan/coordinate/witness testing: RF (EN 300 220 / EN 301 489 / FCC Part 15), EMC, electrical safety, environmental, and functional safety validation.
Expedia Group brands power global travel for everyone, everywhere. We design cutting-edge tech to make travel smoother and more memorable, and we create groundbreaking solutions for our partners. Our diverse, vibrant, and welcoming community is essential in driving our success. Why Join Us? To shape the future of travel, people must come first. Guided by our Values and Leadership Agreements, we foster an open culture where everyone belongs, differences are celebrated and know that when one of us wins, we all win. We provide a full benefits package, including exciting travel perks, generous time-off, parental leave, a flexible work model (with some pretty cool offices), and career development resources, all to fuel our employees' passion for travel and ensure a rewarding career journey. We’re building a more open world. Join us. Compliance Manager In this role, you will: Plan, direct, or coordinate activities of an organization to ensure compliance with ethical or regulatory standards. Support and advise business partners with SOX audit findings, internal operational/compliance audits, and internal/external risk assessments. Support SOX control deficiency assessments and remediation efforts by working directly with control owners to perform impact analysis and control design/operation remediation. Collaborate with internal IT and business stakeholders to identify financial and regulatory risks and develop mitigating control procedures for future state processes and system implementations. Support control environment improvements efforts by identifying opportunities for control efficiencies, process automation, and control consolidation. Track and effectively communicate project and responsibility status with controllership and stakeholder teams. Prepare executive presentation materials. Lead and perform business and technology process risk assessments for top priority areas. Drive compliance excellence for Expedia Group including compliance with company’s policies, external regulations, and established risk management processes. May telecommute. Experience and qualifications: Employer will accept a Bachelor's degree in Accounting, Business Administration, Finance, or related field, followed by 5 years of progressive, post-baccalaureate experience in job offered or in a compliance-related occupation. Position requires: 1. IT General Controls such as Logical Access, Change Management, IT Operations, or Program Development/SDLC; 2. Data governance including frameworks, policies, third-party data risks, and data security and protection; 3. Data privacy compliance including GDPR, CCPA, HIPAA, and other regulations; 4. Developing full project plans, defining timeframe, and prioritizing tasks to achieve project milestones and deliver intended objectives across multiple projects; 5. Enterprise Risk Management frameworks such as ISO 31000 or COSO; 6. Control frameworks such as COBIT or NIST; 7. Understanding of U.S. PCAOB standards and control deficiency evaluation frameworks; 8. Understanding of laws and regulations such as SOX, GDPR, HIPAA, FCPA, PCI-DSS; 9. Understanding of electronic workpapers or GRC and Audit Management systems; 10. Understanding of IAA framework and IT control framework; 11. Risk management principles; 12. Remediation plan development and risk mitigation strategies; 13. Proficiency in tools like Confluence, SharePoint, or One Drive for document management and collaboration. - The total cash range for this position in Austin is $137,500 to $192,500/year. - Starting pay for this role will vary based on multiple factors, including location, available budget, and an individual’s knowledge, skills, and experience. Pay ranges may be modified in the future. - Expedia Group is proud to offer a wide range of benefits to support employees and their families, including medical/dental/vision, paid time off, and an Employee Assistance Program. To fuel each employee’s passion for travel, we offer a wellness & travel reimbursement, travel discounts, and an International Airlines Travel Agent (IATAN) membership. View our full list of benefits. #LI-DNI The total cash range for this position in Austin is $110,500.00 to $155,000.00. Employees in this role have the potential to increase their pay up to $177,000.00, which is the top of the range, based on ongoing, demonstrated, and sustained performance in the role. Starting pay for this role will vary based on multiple factors, including location, available budget, and an individual’s knowledge, skills, and experience. Pay ranges may be modified in the future. Expedia Group is proud to offer a wide range of benefits to support employees and their families, including medical/dental/vision, paid time off, and an Employee Assistance Program. To fuel each employee’s passion for travel, we offer a wellness & travel reimbursement, travel discounts, and an International Airlines Travel Agent (IATAN) membership. View our full list of benefits. Accommodation requests If you need assistance with any part of the application or recruiting process due to a disability, or other physical or mental health conditions, please reach out to our Recruiting Accommodations Team through the Accommodation Request. We are proud to be named as a Best Place to Work on Glassdoor in 2024 and be recognized for award-winning culture by organizations like Forbes, TIME, Disability:IN, and others. Expedia Group's family of brands includes: Brand Expedia®, Hotels.com®, Expedia® Partner Solutions, Vrbo®, trivago®, Orbitz®, Travelocity®, Hotwire®, Wotif®, ebookers®, CheapTickets®, Expedia Group™ Media Solutions, Expedia Local Expert®, CarRentals.com™, and Expedia Cruises™. © 2024 Expedia, Inc. All rights reserved. Trademarks and logos are the property of their respective owners. CST: 2029030-50 Employment opportunities and job offers at Expedia Group will always come from Expedia Group’s Talent Acquisition and hiring teams. Never provide sensitive, personal information to someone unless you’re confident who the recipient is. Expedia Group does not extend job offers via email or any other messaging tools to individuals with whom we have not made prior contact. Our email domain is @expediagroup.com. The official website to find and apply for job openings at Expedia Group is careers.expediagroup.com/jobs. Expedia is committed to creating an inclusive work environment with a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. This employer participates in E-Verify. The employer will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS) with information from each new employee's I-9 to confirm work authorization.




