Senior RN Manager of Delegation Compliance
Core
Manage delegated Care Management and Utilization Management functions, ensuring compliance with program standards, CMS requirements, and health plan metrics while overseeing operational performance.
Role type
Senior Manager of Delegation Compliance (Nursing)
Builds
Delegated Care Management and Utilization Management programs for Oak Street Health
Domain
Healthcare / Managed Care / Utilization Management
Deliverable
client delivery
Required skills
Nursing licensure, Care Management certification, Medicare/Medicaid knowledge, QA audit protocols, corrective action planning, process improvement, team leadership, change management, project management, clinical assessment
Preferred skills
Managed care environment experience, IPA/Health Plan/MSO background, cross-state licensure willingness, BI system configuration
Technologies
Microsoft Office, Google Suite, healthcare EMRs
Responsibilities
Oversee compliance for UM and CM, audit individual charts per QA protocols, establish work procedures and workflows, lead policy review and staff training, provide performance feedback and coaching, manage health plan relationships, oversee delegated entities and operational partners, monitor system configuration requirements, complete report submissions
Seniority
Senior, hands-on IC with supervisory responsibilities