BRING YOUR PASSION FOR IMPROVING THE DELIVERY OF PATIENT CARE
Our client, a progressive, successful managed care organization is looking for innovative and energetic Delegation Oversight professionals to join their team.
The Delegation Oversight Specialist will ensure that affiliated medical groups maintain compliance with Health Plan requirements.
- Managing Health Plan reporting both routine and ad-hoc.
- Assisting with annual oversight audit preparation and audit completion
- Coordinating CAP responses, assuring CAP implementation and compliance
- Ensuring regulatory compliance processes for health plan, state, and federal entities
- Developing positive and productive working relationships with Health Plan representatives
- Promoting compliant UM and CM processes in collaboration with Medical Groups, Data Analysts, and Delegation Oversight Team
- Bachelor’s Degree in Healthcare related field or graduate from an accredited school for nursing
- 3-5 years of managed care experience required
- Minimum one year of UM delegation oversight audit experience with a Health Plan or MSO required
- Knowledge base including DMHC, DHCS, CMS, and NCQA regulatory requirements
- Proficient in Microsoft Office programs
- Enjoy working in a fast-paced environment that values creative problem solving and strong interpersonal skills
Qualified candidates are invited to contact Emily Outhwaite at Med-Exec Solutions for additional details.
Job Type: Full-time
- Dental insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Professional development assistance
- Tuition reimbursement
- Vision insurance
- Monday to Friday
- One location
This Company Describes Its Culture as:
- Aggressive — competitive and growth-oriented
- Outcome-oriented — results-focused with strong performance culture
- Waiting period may apply
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