LVN Oversight Nurse

Job Summary

The Oversight Nurse plays a crucial role in ensuring quality and compliance in delegated healthcare activities. This position is dedicated to maintaining adherence to National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid requirements, and all relevant standards associated with delegation agreements. You will contribute to the overarching strategy aimed at delivering high-quality, cost-effective care to our members.

This role is essential for supporting our Corporate Compliance division. To be considered, candidates must possess an unrestricted LVN license and demonstrate proficiency in technology. A self-directed and autonomous work ethic is essential, along with preferred experience in Care Management and Waiver Service Auditing.

Work hours : Monday - Friday 8 : 00 am - 4 : 00 pm

Essential Job Duties

• Lead the coordination, conduct, and documentation of pre-delegation and annual assessments to adhere to state, federal, and NCQA guidelines.
• Prepare and distribute audit results and follow-up correspondence as needed.
• Collaborate with delegation oversight analytics teams to review performance reports from delegated parties.
• Develop corrective action plans (CAPs) to address identified deficiencies and ensure follow-up until resolved.
• Assist leadership in creating and maintaining delegation assessment tools, policies, and reporting templates.
• Support the preparation of delegation summary reports for committees, including the Eastern US Quality Improvement Collaborative (EQIC).
• Engage in joint operation committees (JOCs) for delegated groups as needed.
• Prepare documentation for regulatory audits involving CMS, state Medicaid, and NCQA as required.

Required Qualifications

Preferred Qualifications

For current Molina employees : If you wish to apply for this position, please do so through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package and is an Equal Opportunity Employer (EOE) M / F / D / V.