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Delegation Oversight Spec I- Healthcare Vendor Oversight

Location : REMOTE
Job Type : Contract
Reference Code : 14513
Hours : Full Time
Required Years of Experience : 2+
Required Education : Bachelor degree or equivalent experience
Travel : No
Relocation : No
Job Category : Program Manager

Job Description :

Major health care organization is looking for an contracted Delegation Oversight Specialists to support their team in Irving, TX. 


 


* THIS IS A CONTRACT, FULLY REMOTE POSITION THAT IS CURRENTLY BUDGETED TO LAST APPROX. 6 MONTHS (WITH POSSIBILITY OF EXTENSION) AND OFFERS A PAY RATE OF $36/HOUR. 


 


Overview




The Delegation Oversight Specialist is responsible for coordinating the delegated oversight activities to ensure compliance with state, federal, NCQA, and the company's requirements. 




Responsibilities include but are not limited to: 



  • 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 entity's 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 Molina's work team. 

  • Monitors financial solvency of delegated entities. 

  • May design and implement strategies with delegates to reduce member access grievances. 

  • May engage/delegate regarding cost control initiatives, Medical Care Ratio (MCR), HEDIS and CAHPS to positively influence future trends. 


Required Qualifications :

Qualifications


 


Education



  • Bachelor Degree in related field or equivalent experience


  


Experience/Knowledge/Skills/Abilities



  • 2 years of managed care experience- Vendor Oversight Experience

  • Data analysis experience (Health Care field)

  • Extensive knowledge of Microsoft Word/Excel/Access 

  • Knowledge of applicable state and federal law; NCQA and HEDIS standards

  • 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 




 


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