Oversee compliance for UM and CM to deliver an unmatched patient experience and ensure delegation compliance.
Audit individual charts according to QA Audit Protocols to ensure compliance with program responsibilities and best practices.
Possess knowledge of contractual, accreditation, federal and business requirements for assigned program and ensure compliance with program requirements and develop corrective action plans as needed.
Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives.
Establish workflows that meet compliance requirements and align with organization-wide clinical protocols.
Lead the review of policies and procedures, program descriptions, and evaluations.
Conduct training for new team members and other internal parties as required.
Provide statistical and performance feedback, and coaching on a regular basis to each team member in their assigned region.
Create and maintain a high-quality work environment so team members are motivated to perform at their highest level.
Provide continual evaluation of processes and procedures.
Responsible for suggesting methods to improve area operations, efficiency, and service to both internal and external staff.
Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model.

Bachelor’s in Nursing
Active RN license within one or more OSH states
Willingness to obtain cross-state licensure, as needed
5+ years of healthcare experience, preferably in a primary care and/or managed care setting
2+ years direct supervisory experience
Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
Knowledge of Medicare/Medicaid and NCQA requirements
Practical and operational experience in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements
Demonstrated experience leading teams, competence with change management, and leading process improvement
Knowledge relating to healthcare delivery workflows, project management, and quality improvement is required
Prior experience in a similar role at an IPA, Health Plan or MSO will be advantageous
Strong teamwork and interpersonal skills
Proficient with Microsoft Office, Google Suite, and healthcare EMRs

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support physical, emotional, and financial well-being

RN Manager – Delegation Compliance

Key skills