Delegation Oversight Specialist II
Company: The Judge Group
Location: Irving
Posted on: January 12, 2021
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Job Description:
Location: Irving, TXDescription: Our client is currently seeking
a Remote Delegation Oversight Specialist II! This candidate needs
to be able to work Monday - Friday - 8am - 5pm CST.Essential
Functions: 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. Knowledge/Skills/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 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 Required
Education: Bachelor's Degree in related field or equivalent
experience Required Experience: 2-4 years managed care experience.
Data analysis experienceIf you are interested, or know anyone that
might be, you can reach me at--949-527-4550 or eflores@judge.com
Contact: eflores@judge.comThis job and many more are available
through The Judge Group. Find us on the web at www.judge.com
Keywords: The Judge Group, Irving , Delegation Oversight Specialist II, Other , Irving, Texas
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