Delegation Oversight Nurse

Job DescriptionCandidate must be located and licensed in CA. This is a telework role, that may require some travel, as needed. Working schedule: Monday-Friday, standard business hours.The Delegation Oversight Specialist - Nurse will be accountable for managing the development, implementation and ongoing maintenance of project(s) with relatively complex scope and deliverables. Delegation Oversight Nurse will be part of a team that oversees the following: Local committee structure and facilitation, to include Delegation Oversight Committee UM audits that fall outside pre-delegation review, annual audits and Corrective Action Plan (CAP) follow-up related to annual audits Scorecards/Dashboard reports, Notice of Action (NOA) denials reviews, performance tracking/trending, timeliness and accuracy and any additional delegation oversight deliverables needed to meet regulatory and/ or contractual requirements New delegate implementation State approvals for change in scope, termination, CAPS, etc. Plan level processes for monitoring/reporting state requirements for delegation oversightPay RangeThe typical pay range for this role is:Minimum: 43,700Maximum: 97,400Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- 3+ years of delegation oversight experience as it relates to utilization management - 3+ years of managed care experience, or experience working for an MCO or IPA (independent physician association)- Active and unrestricted RN licensure in the state of CACOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Experience with review of notice of action documentation- Experience with quick turnaround times in UM prior authorization requirements- Experience or understanding of DMHC, DHCS, or other regulatory requirements- Experience with quality management activities related to initial health assessmentsEducation- Associate's degree or nursing diploma required- Bachelor's degree preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2026-04-04