Supervisor, Delegation Oversight, LVN (Hybrid Work Schedule)

Date: Nov 17, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 6370 

 

Position Summary/Position

 

Under the direction of the Manager of Utilization Management, Operations, the Delegation Oversight Supervisor, LVN is responsible for the development, implementation, monitoring and clinical oversight to ensure all delegates remain in compliance with regulatory requirements. The Delegation Oversight Supervisor, LVN will utilize quality auditing tools and assist UM Management in identifying potential risks from delegates.

Major Functions (Duties and Responsibilities)

 

1. Conduct final quality audit of tools completed by Delegation Oversight nurses and review corrective action plans submitted by the delegates. 
2. Assist in reviewing required document submissions from delegates during monthly/focused audits.
3. Interpret compliance and regulatory requirements to ensure IEHP processes are operationalized and in compliance with all regulatory agencies.
4. Collaborate and provide support to delegates to ensure implementation of policies/procedures and regulations.
5. Assist in the development, implementation, and maintenance of effective delegation oversight audit tools.
6. Participate in IPA’s monthly/annual/focused audits and provide guidance on regulatory requirements and best practices.
7. Collaborate with Provider Delegation Team to coordinate and lead monthly/focused audits.
8. Collaborate with UM leadership to update UM policies related to delegation activities.
9. Work closely with other departments to ensure timely and accurate response to information requests concerning delegates.
10. Attend prior auth staff meetings and education trainings necessary to maintain current UM knowledge.
11. Mentor and provide training and direction to the Delegation Oversight nurses within the unit.
12. Actively participate in internal quality improvement process enhancements, LEAN projects and managing for daily improvement (MDI).

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Three (3) or more years of utilization management experience in a health care delivery setting. One (1) year minimum of supervisory/lead capacity experience.

Preferred Experience

 

Experience in an HMO or experience in a Managed Care setting preferred.

Education Qualifications

 

High school diploma or GED required.

Professional Certification

 

Certified Professional in Healthcare Quality (CPHQ) preferred. 

Professional Licenses

 

Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required.

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

 

Knowledge of Title 22, Title 10, DMHC, DHCS, NCQA, and CMS regulatory requirements specifically as they relate to UM/Health Plan correspondence. Knowledge of quality assurance processes preferred. 

Skills Requirement

 

Ability to research and analyze data, strong verbal and written communication skills, advanced knowledge of Microsoft applications (Microsoft Word, Excel, Power Point).

Abilities Requirement

 

Exhibits a high attention to detail. Must be able to work independently and maintain positive relationships with internal and external contacts at all levels. 

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Word processing involving computer keyboard and screens, and automobile travel within the Inland Empire.

 

Starting Salary: $75,296.00  - $95,992.00  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles