- Centene Corporation (Raleigh, NC)
- …initiatives. + Serve as a companywide resource and liaison on delegation contract issues and provisions, communications, workflow, and corrective action /performance ... improvements initiatives. + Makes recommendations to contracting on suitability of provider groups to support growth that supports compliance and performance. + Communicate decisions on audit compliance to provider groups, communicate sanctions to provider… more
- LA Care Health Plan (Los Angeles, CA)
- Delegation Oversight Clinical Auditor RN II Job Category: Clinical Department: Audit Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... net required to achieve that purpose. Job Summary The Delegation Oversight Clinical Auditor RN II is...is responsible for ensuring that delegates contracted to perform Utilization Management (UM) functions on behalf of LA Care… more
- Molina Healthcare (Richmond, KY)
- **Job Description** **Job Summary** The Sr Auditor , Delegation Oversight will independently perform audits of multi-delegated functions with minimal oversight ... NCQA, CMS and State Medicaid entities. **Job Duties** + Oversees Utilization Management, Claims, Organizational Credentialing, and Crisis Call Center delegated… more