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Delegation Oversight Program Manager, Camarillo, CA


Organization: Gold Coast Health Plan
Category: Professional
Location: Camarillo, CA
Date Job Posted: August 29, 2022
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Delegation Oversight Program Manager

Full Time Regular
Professional
Camarillo, CA, US

Requisition ID: 1319

POSITION SUMMARY

Responsible for coordinating and performing all pre-delegation and annual due diligence audits and monitoring of delegated activities to ensure compliance with NCQA, State and Federal requirements. Direct and audit the delegate’s structure, programs, operational design to ensure GCHP members receive appropriate, high-quality, cost-effective services according to State and Federal guidelines. Coordinate with GCHP internal stakeholders to facilitate the Joint Operational Meetings (JOM) with all delegated entities.

The Delegation Oversight Compliance Program Manager will lead and provide expert technical assistance to highly visible, sensitive, and multifaceted projects. He/she will investigate compliance concerns identified, summarize findings, develop recommendations for action plans, and provide oversight for the implementation of corrective action measures to promote and strengthen organizational compliance.

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s)

  • Facilitate Joint Operation Meetings (JOM's) for all delegated groups Prep for audits on the Health Plan and have the ability to speak on each facet of delegation oversight during audit interviews by the Plans regulators Support the development, maintenance and refinement of audit tools and templates Analyze, update, and modify procedures and processes to continually improve operations; provide recommendations to Compliance Committee
  • Stay informed about the latest developments in delegated oversight field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources.
  • Develop and accomplish delegation program activities in support of company strategies, goals and objectives.
  • Coordinate activities with all levels of staff as well as with delegated and potentially delegated external entities through clear and concise verbal and written communication.
  • Negotiate and resolve complex and sensitive project and team issues with diplomacy and persuasiveness Identify problems, develop solutions and implement a chosen course of action.

POSITION QUALIFICATIONS

  • Competency Statement(s)

Accountability - Ability to accept responsibility and account for his/her actions.

Decision Making - Ability to make critical decisions while following company procedures Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

Judgment - The ability to formulate a sound decision using the available information.

Management Skills - Ability to organize and direct oneself and effectively supervise others Presentation Skills - Ability to effectively present information publicly.

Systems Analysis - Ability to determine how a system should work and how changes in conditions, operations, and the environment will affect outcomes.

Analytical Skills - Ability to use thinking and reasoning to solve a problem.

Research Skills - Ability to design and conduct a systematic, objective, and critical investigation.

Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

Interpersonal - Ability to get along well with a variety of personalities and individuals.

Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

Communication, Oral - Ability to communicate effectively with others using the spoken word.

Communication, Written - Ability to communicate in writing clearly and concisely.

SKILLS & ABILITIES

Education: High School Graduate or General Education Degree (GED): Required

Bachelor's Degree (four-year college or technical school): Required

Field of Study: Business Administration, Healthcare Administration, or related field or the equivalent combination of education and/or experience required.

Experience: 5 plus years of experience in in delegation oversight in managed care, Program management or project management experience. Auditing experience in a managed care setting

Computer Skills: Advanced computer skills included in the MS Office products.

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