Delegation & Quality RN Coordinator

Moda Health•Portland, OR

2d•Hybrid

About The Position

Responsible for coordinating and performing all oversight activities to ensure compliance with NCQA, State and Federal requirements for the delegated UM functions. Audits the delegates’ structure, programs, operational design, and denial decisions. Ensures compliance and maintains readiness for accreditation organization audits. Conduct quarterly Delegation Oversight Committee meetings. Document discussions regarding compliance and delegated functions in meeting minutes.

Requirements

Current unrestricted Oregon Nursing license as a registered nurse
Experience in healthcare management and knowledge of regulatory requirements
Strong understanding of NCQA
Type a minimum of 35 wpm on a computer keyboard
Proficiency with personal computer programs such as Microsoft Word and Excel
Analytical, problem solving, memory retention, organizational and detail oriented
Excellent verbal and interpersonal communication skills including management of the angry customer
Ability to work well under pressure
Ability to come into work on time and daily
Project a professional business image telephonically and in person

Responsibilities

Perform pre-delegation review in accordance with NCQA requirements including: Review of all relevant policies and procedure, Review of ability to perform delegated function in the appropriate time frames, Review of clinical policies and comparison with current Moda Health guidelines, Review of contract terms and knowledge of scope of delegated activities, Review of workflow to implement delegated activities, Pre-delegation audit of sample files, Organizes site visit, agenda, and preparation of audit tools for pre-delegation review, Report pre-delegation review findings to the Medical Quality Improvement Committee
Perform annual review of delegation including: Annual review of program documents and structure, Review of reports associated with delegated functions, Perform audit of selected files, Review updates to clinical policies and compare with Moda Health guidelines, Submit corrective action plans for non-compliant issues and review progress, Organizes site visit, agenda, and audit tool for annual file review, Report outcomes to the Medical Quality Improvement Committee
Ability to take initiative and problem solve
Work independently and as part of an integrated team
Performs other duties as assigned