LVN/RN Delegation Oversight Auditor

Job Summary

To support a growing healthcare organization, the full-time Remote LVN/RN Delegation Oversight Auditor will conduct Utilization Management (UM) and Case Management (CM) audits, ensuring compliance with regulatory and operational standards while collaborating with delegated provider organizations to enhance performance.

Key responsibilities

• Conduct UM/CM audits to evaluate compliance with CMS and contractual requirements
• Engage with delegated entities to communicate audit findings and facilitate corrective actions
• Perform risk assessments to prioritize audits based on compliance and performance trends

Required qualifications

• 3-5 years of experience in Utilization and Case Management within HMO, Medicare Advantage, or IPA settings
• Active, unrestricted State License for Licensed Vocational Nurse (LVN) or Registered Nurse (RN)
• Demonstrated knowledge of Medicare audit processes and regulatory requirements governing UM/CM
• Bachelor's Degree in nursing or equivalent; Master's degree preferred
• 1-2 years of experience conducting oversight audits of delegated entities