Delegation Oversight Specialist (temporary)

Job Summary

Responsible for coordinating the delegated oversight activities to ensure compliance with state, federal, NCQA, and requirements.

Duties And Responsibilities

• Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
• Develops format and documents periodic status reports from Delegated Entities.
• Develops corrective action plans when deficiencies are identified, and documents follow-up to completion.
• Ensures delegated entitys compliance with reporting requirements by tracking the receipt and completeness of reports.
• Develops corrective action plans when compliance issues are identified, and document follow-up to completion.
• Develops and maintains delegation policies and procedures.
• Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions.
• Works with Network Management team to develop and maintain delegation agreements and assessment tools.
• Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on s work team.
• Monitors financial solvency of delegated entities.
• May design and implement strategies with delegates to reduce member access grievances.
• May designs and implements or assists with program to build/improve positive relationship with delegates.
• May designs and implements or assists with strategies to increase delegates/ engagement in HEDIS and quality initiatives.
• May engages/delegates regarding cost control initiatives, Medical Care Ratio (MCR), HEDIS and CAHPS to positively influence future trends.
• May provides or coordinates technical assistance to delegates as needed to ensure they are able to comply with all requirements. Prepares delegation-related parts of QI and UM work plans and evaluations.

Knowledge, Skills And Abilities

• Extensive knowledge of Microsoft Word/Excel/Access
• Knowledge of applicable state and federal law; NCQA and HEDIS standards
• Self-motivated and directed, ability to independently manage multiple tasks or projects simultaneously to successful completion
• Ability to work effectively on a team
• Excellent interpersonal and verbal and written communication skills
• Ability to abide by s policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
• Other duties as assigned.

Required Education

• Bachelors Degree in related field or equivalent experience

Preferred Education

• Course studies in Business, Healthcare Management, etc.

Required Experience

• 2 years managed care experience.
• Data analysis experience.

Preferred Experience

• 3 years managed care experience.
• Quality management/regulatory experience with increasing responsibility.
• Experience completing delegation oversight audits.

Required Licensure/Certification

• Valid State Drivers License

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