Senior Specialist, Delegation Oversight

Molina Healthcare•Long Beach, CA

21d

About The Position

Provides senior level support for delegation oversight activities. Oversees delegated activities to ensure compliance with state, federal, contractual, National Committee for Quality Assurance (NCQA), and Molina requirements. Essential Job Duties Under general leadership supervision, performs pre and post-delegation assessments and annual credentialing audits and monitoring of delegated activities to ensure compliance with NCQA, state and federal requirements. Monitors post-audit delegated activities to ensure compliance with state health plan and NCQA requirements. Prepares status reports from delegated entities. Ensures compliance with reporting requirements by tracking the receipt and completeness of reports. Evaluates monthly scorecards to monitor compliance of delegation oversight activities and delegate performance metrics. Develops corrective action plans (CAPs) when compliance issues are identified, and documents follow-up to completion. Assists in the preparation of the delegation oversight committee, including the preparation of documents for committee oversight of delegated functions. Assists in preparation of delegate profiles and works with the network management team to develop and maintain delegation agreements and assessment tools. Assists in preparation of delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys. Provides training and support to new and existing delegation oversight team members.

Requirements

At least 3 years of managed care experience, year experience completing delegation oversight assessment/ audits, or equivalent combination of relevant education and experience.
Data analysis experience.
Ability to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required.
Ability to collaborate cross-functionally across a highly matrixed organization.
Attention to detail and organizational skills.
Critical-thinking, and problem-solving/analytical abilities.
Project management skills/knowledge of project management tools/processes.
Effective interpersonal and verbal/written communication skills.
Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs.

Nice To Haves

Quality management/regulatory/delegation oversight/auditing experience with increasing responsibility.

Responsibilities

Performs pre and post-delegation assessments and annual credentialing audits and monitoring of delegated activities to ensure compliance with NCQA, state and federal requirements.
Monitors post-audit delegated activities to ensure compliance with state health plan and NCQA requirements.
Prepares status reports from delegated entities.
Ensures compliance with reporting requirements by tracking the receipt and completeness of reports.
Evaluates monthly scorecards to monitor compliance of delegation oversight activities and delegate performance metrics.
Develops corrective action plans (CAPs) when compliance issues are identified, and documents follow-up to completion.
Assists in the preparation of the delegation oversight committee, including the preparation of documents for committee oversight of delegated functions.
Assists in preparation of delegate profiles and works with the network management team to develop and maintain delegation agreements and assessment tools.
Assists in preparation of delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys.
Provides training and support to new and existing delegation oversight team members.