Delegation Oversight Clinical Auditor Rn Ii

The Delegation Oversight Clinical Auditor RN II is responsible for ensuring that delegates contracted to perform Utilization Management (UM) functions on behalf of L.A. Care (LAC) are in compliance with all UM regulatory requirements and new legislation through the maintenance of required policies, procedures, workflows, processes, and audit tools necessary to meet the requirements.
This position utilizes a rapid team approach for needed improvements identified through external audits of delegated entities. The role assists in maintaining continuous quality improvement in the Delegation Oversight Clinical Audit unit, ensuring that departmental, divisional, and organizational goals are accomplished by overseeing and facilitating compliance of the Plan Partners, Participating Provider Groups (PPG), Specialty Health Plans (SHP), and contracted provider network as managed by the Delegation Oversight Department.
This position is responsible, as part of the oversight team, for ensuring compliance of the Plan Partners and/or Participating Physician Groups (PPG) to regulatory, contractual, and L.A. Care requirements.

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