The Judge Group
The Judge Group is actively recruiting for a remote Clinical Compliance Nurse Work Location: Remote/Telecommute; candidates can live anywhere in the USA but must work PST hours. Work Hours: Monday-Friday, 8am-5pm PST.
Required Qualifications: Graduation from an accredited Licensed Vocational/Practical Nurse program. Current CA LVN/LPN license 2+ years of care management, utilization review (prior authorization), or discharge planning experience. Preferred Qualifications: Experience in an HMO or Managed Care setting. Basic knowledge of requirements for Medicare, Medi-Cal, and Commercial lines of business. Interview Process: Conducted via video conferencing.
Need help crafting an effective cover letter and resume for this role?
Get access to our expert resources: our proven framework offers successful strategies, helps you find the best-fit positions, craft standout cover letters, optimize your resume, and much more.
Get Started
Collaborate with the Manager of Delegation Oversight to manage delegation oversight and regulatory audits. Utilize knowledge of clinical services regulatory and delegation requirements to represent Optum Clinical Services during delegation oversight audits. Act as a liaison between Health Plan delegated entities and Clinical Services Operational teams (Utilization Management and Case Management). Serve as a liaison between Delegation Oversight and cross-functional areas/departments across the organization. Use, protect, and disclose Optum patients’ protected health information (PHI) in accordance with HIPAA standards.
Best Value
%20(2).svg){kind=small}
Advanced
%20(1).svg){kind=small}
Basic
.svg)
.svg)
.svg)
.svg)
.svg)
