The Judge Group is currently seeking a detail-oriented and experienced Registered Nurse to join our team as a Delegation Oversight Nurse. This is a hybrid-based position. Remote Monday and Friday!

This role is responsible for ensuring delegated vendor activities (Utilization Management, Case Management, Appeals) meet all regulatory and accreditation standards. The ideal candidate will bring a strong compliance background and a proactive approach to audit and oversight functions.

Key Responsibilities

• Oversee delegated vendor activities to ensure compliance with state, federal, NCQA, and other applicable standards.
• Conduct and document pre-delegation and ongoing delegation assessments.
• Perform audits and prepare detailed audit reports.
• Present findings to the Delegation Oversight Committee.
• Develop and track corrective action plans for identified deficiencies.
• Monitor and ensure timely and complete reporting from vendors.
• Maintain documentation for delegation readiness and compliance.
  
  

Qualifications

• Active PA RN license (compact licenses not considered).
• Minimum 3 years of experience in regulatory, accreditation, or compliance within health insurance or managed care.
• Strong knowledge of federal/state regulations and NCQA standards.
• Familiarity with ACA and Medicare (QHP and Medicare Advantage).
• Excellent communication skills and attention to detail.
• Ability to manage multiple priorities effectively.
• Proficiency in Microsoft Excel for data analysis and reporting.
  
  

Join Us

If you are passionate about ensuring quality and compliance in healthcare operations and thrive in a dynamic environment, we encourage you to apply and make a meaningful impact.

Thank You,

Jacob

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