LVN, UM Delegation Oversight

Role Snapshot:

• Start Date: Immediate openings available
• Company: Pathremotenetwfh
• Location: Remote
• Compensation: a competitive salary
• Position: LVN, UM Delegation Oversight

 

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About the position The LVN, UM Delegation Oversight position at UnitedHealth Group is a remote role that plays a crucial part in the coordination of Health Plan Delegation Oversight audits and internal quality reviews for Case Management and Utilization Management. Under the general direction of the Delegation Oversight Manager, the individual in this role will be responsible for preparing and submitting pre-audit documentation as outlined on Health Plan audit tools, ensuring compliance with regulatory requirements, and facilitating onsite, virtual, or desktop compliance audit reviews. This position requires effective communication and collaboration across the organization to gather necessary documentation to meet audit requirements, as well as participation in performance improvement activities. The role involves conducting comprehensive internal audits of the end-to-end utilization management process and focused internal audits of specific elements or process changes based on identified trends or new process implementations. The successful candidate will enjoy the flexibility of working remotely from anywhere within the U.S., with work hours set from 8 am to 5 pm PST. This position offers a challenging environment that rewards performance and provides clear direction for success, along with opportunities for professional development and growth within the organization. Responsibilities • Prepares and submits pre-audit documentation as outlined on Health Plan audit tools , • Communicates with Health Plan auditors related to audit documents and processes , • Collaborates across the organization to gather necessary documentation to meet audit requirements , • Facilitates onsite/virtual/desktop compliance audit reviews to ascertain regulatory requirements adherence , • Participates in performance improvement activities , • Conducts comprehensive internal audits of the end-to-end utilization management process , • Conducts focused internal audits of specific elements or process changes 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 in Prior Authorization Nice-to-haves • 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 Managed Care setting , • Base knowledge of requirements for Medicare, Medi-Cal, and Commercial lines of business Benefits • Comprehensive benefits package , • Incentive and recognition programs , • Equity stock purchase , • 401k contribution Apply Job!

 

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