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Manager, Delegation Oversight

Company Name:
Healthcare Partners
Manager, Delegation Oversight
Req: 16675
Department: Corporate
Schedule: Full Time
Shift: Days
Hours: TBD
Job Details: Bachelor's Degree
HEALTHCARE PARTNERS MEDICAL GROUP, a division of DaVita HealthCare Partners, Inc. (DVA: NYSE), is a top-rated Southern-California medical group and is widely recognized for its achievements in clinical excellence and patient satisfaction. Since 1992, HealthCare Partners has been committed to developing innovative models of healthcare delivery that improve patients' quality of life while containing healthcare costs. HealthCare Partners manages and operates medical groups and affiliated physician networks in Arizona, California, Nevada, Florida and New Mexico. As of Sept. 30, 2013, HealthCare Partners provides integrated care management for approximately 760,000 managed care patients. - Read More -
We are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all.
If you're looking to make a difference with a large, financially stable, well-recognized medical group, DaVita HealthCare Partners may be the employer for you.
HealthCare Partners may be the employer for you. We are currently seeking aManager, Delegation Oversight:
OVERVIEW OF POSITION:
Responsible for the auditing and ongoing management of the delegation oversight program for health plan contracts. Coordinates all health plan audits of HealthCare Partners and audits all HealthCare partners delegated providers for downstream compliance. Coordinates audits and program management to ensure that HealthCare Partners meets the operational, clinical and regulatory requirements of our health plan partners and all applicable regulatory agencies.
ESSENTIAL FUNCTIONS:
Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners' (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Serves as the subject matter expert in interpreting health plan and regulatory requirements and ensuring overall areas for delegation are functional and in compliance.
Develops and administers an annual work plan to monitor the performance of delegated business partners and to meet regulatory oversight and compliance requirements.
Leads the development and maintenance of departmental policies and procedures.
Monitors delegated providers or vendors to ensure compliance, optimal delegate performance and achievement of business goals according to service level and other contractual requirements.
Designs and implements strategies to increase delegates' engagement in driving toward quality outcomes and cost control initiatives.
Provides oversight of the development, approval and review of all delegated contracts and ensures service levels meet current regulatory and quality baseline requirements.
Develops delegation oversight document evidence and pre-delegation and annual audit tools for state, federal and quality audits / accreditation initiatives.
Conducts pre-delegation assessments and ongoing delegation oversight.
Prepares audit materials and attend audit readiness sessions.
Participates in joint operating committee meetings with business owners and delegated vendors.
Implements monthly and quarterly reporting and ensures timely receipt of accurate and complete all regulatory and contractually required reports for delegated vendor activities.
Analyzes, updates, and modifies procedures and processes to continually improve operations.
Stays 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.
Develops and accomplishes delegation program activities in support of company strategies, goals and objectives.
Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
EDUCATION:
Bachelor's degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.
Master's degree in HealthCare Administration, Public Health, Business Administration or related area preferred.
EXPERIENCE:
Minimum:
Over 5 years and up to and including 7 years of experience in the health care industry, which could include healthcare administration or other highly regulated industry.
Experience in managing vendor compliance and oversight of health-care related delegation activities, contracting and vendor management.
Strong cross functional and project management experience.
Preferred:
Health plan or provider contract compliance experience.
Experience speaking before individuals and groups, vendors and executive leadership.
Clinical or nursing background.
Background in procurement, contract development and negotiations, vendor assessment and management.
KNOWLEDGE, SKILLS, ABILITIES:
Computer literate.
Advanced computer skills including Microsoft Office suite and other business related software systems.
Knowledge of and application of regulatory and quality standards and measures including but not limited to State Medicaid Programs, Medicare and Quality Accreditation (e.g., ODM, KDMS, CMS, NCQA, URAC, etc.).
Strong project management skills with ability to handle multiple projects within time constraints.
Strong interpersonal and verbal / written communication skills with demonstrated ability to influence internal / external constituents.
Ability to interact with all levels of leadership, influence change, adoption of vendor management concepts and lead cross-functional teams and initiatives.
Ability to handle responsibilities that are complex with results that may have long-range implications.
HR Use Only: CB

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