Skip to Content
Delegation Oversight RN

Job Description

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California’s Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

Job Requirements

Delegation Oversight Nurse
Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and DMHC requirements including delegation standards and requirements contained in the delegation agreement.
The primary responsibilities for the position include:
•         Coordinate, conduct, and document pre-delegation and annual assessment to determine compliance with Delegated functions.
•         Develop and implement Corrective Action Plan (CAP) for medical groups that are out of compliance with delegated responsibilities, with timely follow up actions of CAP
•         Interpret statistics and plan for actions taken to improve utilization management
•         Stay current and be knowledgeable on regulatory changes and industry requirements.
•         Participate in industry collaborative teams.
•         Acts as a liaison between the Medical Groups/IPAs by responding to questions and providing needed guidance and reeducation on delegated functions as needed.
•         Work with management to design and implement tools and materials that are compliant with regulatory, legislative and Blue Shield mandated requirements
•         Design work plans and workflows to facilitate the audit, quality and cost of healthcare initiatives
•         Collaborate with internal business partners relating to Medical Groups/IPAs
•         Participate as needed in Joint Operation Committees (JOC's) for delegated groups
•         Assist in preparation of documents for CMS, DMHC, NCQA, and/or other regulatory audits as needed.
Key attributes for an individual to be successful in this position include being:
•         Highly motivated
•         Action/results oriented
•         Strong interpersonal and negotiation skills
•         Strong verbal and written communication skills
•         Intermediate level computer skills
•         Strong organizational skills and ability to work independently
•         Must be able to travel

•         Current California RN license without restrictions and three to five plus years of relevant experience or equivalent combination of education and experience.
•         Generally requires B.A. degree or equivalent.
•         Strong understanding of NCQA, CMS, and DMHC regulations and audit requirements.
•         Good clinical documentation and computer skills.
•         Strong communication and negotiation skills.

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Nurse
Education 4 Year Degree
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 180017L
CareerBuilder Tip:
For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using you are agreeing to comply with and be subject to the Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.

Delegation Oversight RN

Enter notes about this job: