Under the supervision of the Manager, Clinical Compliance is responsible for enforcing that delegated contracts to perform clinical functions in utilization management and population health management on behalf of the Plan is in compliance with all requirements. Reviews and audits policies procedures, desktop procedures, etc. to meet requirements. Ensures contract deliverables are met and company initiatives and goals are met. Required: Registered Nurse with at least 3-5 years in managed care setting in quality improvement, case management, or utilization management. - Project management experience. -Working knowledge of NCQA Standards and guidelines. Desired: -Auditing experience. - Clinical delegation oversight project management expereince.