Manager, Provider Delegation Oversght

SCAN Health Insurance • Long Beach, CA

2d • Hybrid

About The Position

Ensures SCAN’s contracted Provider Organizations and other First Tier, Downstream and Related (FDR) entities deliver timely, appropriate, and quality care and services to SCAN members consistent with the Center for Medicare and Medicaid Services (CMS) and relevant state, federal and accrediting body requirements. Provides operational expertise to all delegation oversight processes and activities for non-clinical functions such as finance, claims, delegate data (ODAG/DOR), credentialing, and FDR Compliance programs.

Requirements

• Bachelor's Degree or equivalent experience
• 5 + years of Compliance experience required.
• Experience with delegation oversight.
• Experience working for a managed care organization such as: an HMO, IPA or Medical Group is required.
• Experience with coordinating diverse groups of individuals to achieve success of the overall program.
• Working knowledge of guidelines and regulations relevant to FDR Compliance including Medicare, Medicaid, DHCS, DMHC, and NCQA.
• Excellent leadership, communication (written and verbal), and interpersonal skills.
• Strong organizational, critical thinking, analytical, and decision-making skills.
• Ability to manage competing priorities and tasks to ensure all deliverables are met timely, and work independently and collaboratively as needed.
• Ability to work well in a fast-paced and dynamic environment with limited supervision.
• A background check is required.

Nice To Haves

• 2-3 Management experience preferred.

Responsibilities

• Manages and oversees day-to-day operations of the Delegation Oversight Unit non-clinical functions; finance, claims, delegate data (ODAG/ODR), credentialing and FDR Compliance programs.
• Facilitates continuous quality improvements within the SCAN provider network by developing systems to assess, monitor and improve performance of delegated entities and other First Tier, Downstream and related entities (FDR).
• Maintains audit readiness by ongoing training, competency assessment, auditing, monitoring of metrics and developing and implementing corrective action.
• Manages internal and external audits and assessments, and implement corrective action plans as to address audit findings.
• Develops and/or enhances meaningful management reports to monitor staff productivity and department activities to identify potential issues and areas for improvements.
• Conducts ongoing analysis; making recommendations for process improvements in work flow, organization, communication, and overall staff and program efficiency.
• Promotes compliance with all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies’ standards such as the National Committee for Quality Assurance (NCQA) as it relates to delegation oversight activities.
• Facilitates assigned Committees and workgroup activities by analyzing and reporting data and metrics, escalating issues where appropriate, and resolve outstanding action items.
• Develops, implements, and maintains department documentation including policies and procedures, desktop policies, job aids, work plans, staff education materials, tracking matrixes, and other documents as requested to ensure improved efficiency, productivity and outcomes.
• Assists Director in preparation of department annual budget, annual evaluation, and other activities as requested by management.
• Collaborates with internal departments to develop policies and procedures, and implement and monitor daily activities.
• Serves as a resources and point of contact to internal and external customers including FDRs.
• Ensures compliance with federal and state regulations and SCAN Policies and Procedures.
• Supports and coordinates daily department activities by providing strong leadership.
• Achieves organizational and departmental goals by communicating expectations; planning, monitoring, and appraising performance; coaching and counseling employees as necessary.
• Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO) along with 11 paid holidays per year, 1 floating holiday, birthday off, 2 volunteer days, and Recharge days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• A competitive compensation and benefits program
• A work-life balance

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree