LVN, UM Delegation Oversight Specialist

1 month ago


El Segundo, California, United States Optum Full time
Job Summary

We are seeking a highly skilled LVN, UM Delegation Oversight to join our team. As a key member of our operations team, you will be responsible for coordinating all components of Health Plan Delegation Oversight audits and performing internal quality reviews for Case Management and Utilization Management.

Key Responsibilities
  • Prepare and submit pre-audit documentation as outlined on Health Plan audit tools
  • Communicate with Health Plan auditors related to audit documents and processes
  • Collaborate across the organization to gather necessary documentation to meet audit requirements
  • Facilitate onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence
  • Participate in performance improvement activities
  • Conduct comprehensive internal audits of the end-to-end utilization management process
  • Conduct focused internal audits of a specific element or process change based on identified trends or new process implementation
Requirements
  • Graduation from an accredited Licensed Vocational/Practical Nurse program
  • Current LVN/LPN license
  • 2+ years of clinical experience working as an LVN/LPN
  • 1+ years of utilization management experience, especially Prior Authorization
Preferred Qualifications
  • 3+ years of experience working as an LVN/LPN
  • 2+ years of care management, utilization review or discharge planning experience
  • Experience in an HMO or experience in a Managed Care setting
  • Base knowledge of requirements for Medicare, Medi-Cal and Commercial lines of business

UnitedHealth Group offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.



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