RN Manager – Delegation Compliance

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Supervise compliance for Utilization Management (UM) and Case Management (CM) to provide an exceptional patient experience and ensure adherence to delegation standards.

• Review individual patient records in accordance with Quality Assurance (QA) Audit Protocols to verify compliance with program obligations and best practices.

• Have a comprehensive understanding of contractual, accreditation, federal, and business requirements for the designated program, ensuring compliance and formulating corrective action plans as necessary.

• Develop work procedures and processes that align with company and departmental standards, procedures, and strategic objectives.

• Create workflows that fulfill compliance obligations and are in harmony with organization-wide clinical protocols.

• Lead the evaluation of policies and procedures, program descriptions, and assessments.

• Facilitate training for new team members and other internal stakeholders as required.

• Provide regular statistical and performance feedback, along with coaching to each team member in their respective regions.

• Cultivate and uphold a high-quality work environment to ensure team members are inspired to perform at their best.

• Continuously assess processes and procedures for improvement.

• Responsible for recommending methods to enhance operational efficiency, service quality, and effectiveness for both internal and external staff.

• Collaborate with other leaders in the OSH program to implement initiatives that support the integration of delegated services with the core OSH care model.

⛳️ Requirements

• Bachelor’s degree in Nursing.

• Active RN license in one or more OSH states.

• Willingness to obtain cross-state licensure as necessary.

• 5+ years of experience in healthcare, preferably within a primary care and/or managed care environment.

• 2+ years of direct supervisory experience.

• Certified Case Manager (CCM) or equivalent case management certification is required, or willingness to obtain within 12 months of hire.

• Familiarity with Medicare/Medicaid and NCQA requirements.

• Practical and operational experience in a managed care setting, ideally with knowledge of related legal, regulatory, and health plan requirements.

• Proven experience in leading teams, managing change, and driving process improvements.

• Required knowledge regarding healthcare delivery workflows, project management, and quality improvement.

• Prior experience in a similar position at an Independent Practice Association (IPA), Health Plan, or Managed Services Organization (MSO) is a plus.

• Strong teamwork and interpersonal skills.

• Proficient in Microsoft Office, Google Suite, and healthcare Electronic Medical Records (EMRs).

🏝️ Benefits

• 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.