Delegation And Vendor Oversight Manager - Health Plan Services

Cook County Government•Chicago, IL

2d•Onsite

About The Position

The Delegation and Vendor Oversight (DVO) Manager, Health Plan Services, assists with oversight of delegates and vendors contracted with CountyCare. The role onboards and monitors delegates, vendor contracts, and relationships, and supports an expanding Medicaid and Medicare managed care population by enhancing accountability and integrity in daily operations. The manager follows fraud and abuse prevention and detection policies and programs in accordance with regulatory requirements. The position plans and directs operations for assigned products and programs, oversees their objectives, policies, and procedures, and ensures operational processes comply with corporate standards and applicable local, state, and federal regulations. It also addresses managed care contractual issues, including contract interpretation, and maintains confidentiality and HIPAA compliance. This role is based at 605 S. Wolcott Ave., Chicago, IL 60612, with a stated shift of 8:30 AM–4:30 PM. Travel to work sites throughout Cook County is required. The position functions in a healthcare environment and must adhere to hospital and department safety requirements, including PPE, hand hygiene, and applicable engineering and work-practice controls. The position is exempt from Career Service under CCH Personnel Rules.

Requirements

Bachelor's degree from an accredited college or university; official transcripts must be provided at the time of interview.
At least two years of health plan experience in a Medicare health plan, Medicaid health plan, or health system, including aspects of operations oversight, administration, management, delegation, and vendor oversight.
At least one year of experience managing delegates and vendor relationships, such as relationships with third-party administrators, vision, dental, and transportation vendors, and pharmacy benefit managers.
Intermediate proficiency with Microsoft Office Suite, including Access, Excel, PowerPoint, and Word.
Knowledge of Medicaid and Medicare managed care principles and management practices.
Knowledge of Medicare and/or Medicaid insurance payment systems and inpatient and outpatient reimbursement, such as DRG and/or EAPG reimbursement structures.
Knowledge and familiarity with implementation, startups, and operationalizing delegates and vendors.
Strong interpersonal, verbal, and written communication skills for communicating with staff at all levels and a patient population representing diverse cultures and age groups.
Program development, management, and leadership skills.
Good computer and typing skills.
Good phone and email etiquette and strong response times.
Analytical, organizational, problem-solving, critical-thinking, and conflict-management and resolution skills.
Attention to detail, accuracy, and precision to support research and presentation skills.
Ability to prioritize, plan, and organize projects and tasks.
Ability to multitask and meet deadlines in a fast-paced and stressful environment.
Ability to maintain a professional demeanor and composure when challenged.
Ability to function autonomously and as a member of a multidisciplinary team.
Ability to train others by presenting concepts and demonstrating tasks.
Ability to perform accurate and reliable mathematical calculations to support reimbursement analysis and measure financial performance.
Ability to work flexible hours.
Ability to travel to work sites throughout Cook County.
Must meet all required qualifications at the time of application filing.
Employment offers are contingent on satisfactory professional and employment references, healthcare and criminal background checks, appropriate licensure or certifications, and successful completion of a physical and pre-employment drug screen.

Nice To Haves

Master's degree from an accredited college or university is preferred.

Responsibilities

Perform pre-delegation and annual audits for delegates in accordance with regulatory, state, and accreditation standards.
Assist with onboarding new delegates and vendors and measuring their key performance indicators and contracted metrics.
Maintain current knowledge of delegate and vendor contracts and scopes of work, updating scopes of work as needed.
Build strong relationships with vendors and contractors to meet established key performance indicators.
Participate in and potentially facilitate Joint Operation Meetings, including the Delegation and Vendor Oversight Committee.
Assist with drafting Requests for Proposals and collaborate with Supply Chain Management on procurement.
Take corrective action as necessary to address disciplinary concerns and recommend ways to reduce impacts on productivity.
Implement enhanced capabilities that support accountability and integrity in daily operations.
Plan and direct operations for assigned products and programs.
Oversee assigned products and programs, including establishing objectives, policies, and procedures.
Ensure operational processes and policies comply with corporate standards and applicable local, state, and federal regulations.
Resolve managed care contractual issues related to contract interpretation.
Adhere to confidentiality standards and HIPAA compliance programs.
Perform other duties as assigned.
Follow applicable hospital and department safety requirements, including PPE, handwashing and sanitizing, and engineering and work-practice controls.