Delegation Oversight Specialist I
|Location:||Long Beach, CA|
The Judge Group is looking for a Compliance Oversight Specialist!Apply for this Job
Responsible for coordinating the delegated oversight activities to ensure compliance with state, federal, NCQA, and Molina requirements.
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 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.
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 Molina'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
Bachelor's Degree in related field or equivalent experience
0-2 years managed care experience.
Data analysis experience.
Valid State Driver's License
If interested, please send updated resume to Mason Voge at firstname.lastname@example.org!!