Delegation Oversight Clinical Nurse Auditor - LVN, Senior

Your Role

The Delegation Oversight Compliance team is responsible for working with appropriate departments in the areas of compliance, process improvement, and member/provider satisfaction for all product lines. Reviews, research and responds to customer complaints relating to quality of medical care and service. Recommend and/or implement process improvements related to the potential quality of medical care and service. The Delegation Oversight Clinical Nurse Auditor – LVN, Senior, will report to the Delegations Oversight Compliance Manager.

The Clinical Nurse Auditor - LVN, Senior is responsible for independently conducting comprehensive delegation oversight audits to evaluate delegated entities’ compliance with the California Department of Managed Health Care (DMHC) All Plan Letter (APL) 24-019, Rule 1300.67.2.2. The position conducts regulatory compliance assessments of delegated medical groups, Independent Practice Associations (IPAs), Management Services Organizations (MSOs), and other contracted entities to ensure the accuracy, completeness, and reliability of information provided to the health plan for regulatory oversight.

As a senior-level auditor, this position independently manages complex audit assignments, evaluates regulatory risks, develops audit findings, monitors corrective actions, and provides technical guidance to delegated entities. The position supports the organization’s regulatory readiness and accountability for delegated functions.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

- High School Diploma/GED and completion of a state-approved Vocational Nursing (LVN) program
- Current unrestricted CA LVN License
- 5 years of prior relevant experience
- Strong critical thinking, analytical, and problem-solving skills

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.