Job Description
Job Summary:
The Risk & Oversight Manager II provides oversight for assigned vendors and providers in compliance with state and federal provider agreements, business and accreditation requirements.
Essential Functions:
Maintain direct oversight for assigned vendors and providers
Participate in the development and maintenance of departmental policies and procedures
Support departmental subject matter experts in interpreting vendor and provider contract requirements, business, and compliance and regulatory requirements
Monitor delegated/non-delegated vendor/providers and internal business owner relationships to ensure compliance, optimal delegate/non-delegate performance and achievement of business goals according to service level and other contractual requirements
Document meetings with stakeholders to provide performance metrics feedback and identify opportunities to reduce risk and cure corrective action plans
Support the implementation of strategies to increase delegates/non-delegates engagement in driving toward quality outcomes and cost control initiatives
Support the development, approval and review of delegated/non-delegated contracts; ensure service levels meet current regulatory and quality baseline requirements
Conduct pre-delegation assessments, ongoing delegation oversight, annual audits, deficiencies, and corrective action plans for vendors/providers
Participate in joint operating committee and document quarterly business reviews, strategic partner reviews, and operational meetings with business owners and delegated/non-delegated vendors and providers
Maintain monthly/quarterly/annual reporting and ensure timely receipt of accurate and complete all regulatory and contractually required reports for delegated vendor and provider activities
Support delegated vendor and provider onboarding, including training, reporting and document retention; provide support to departments and business owners to enable effective management of delegates
Stay informed about the latest developments in delegation oversight field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources
Support the development and accomplishment of 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
Assist in managing operational problems by bringing the vendor and departmental ops teams together to develop solutions and implement a chosen course of action
Perform any other job duties as requested
Education and Experience:
Associates degree or equivalent years of relevant work experience is required
Minimum of two (2) years of experience in corporate compliance, vendor oversight, contract management, internal audit, quality assurance, strategic sourcing or other highly regulated industry is required
Experience in managing third party compliance and oversight of health-care related delegation activities, vendor audits and contracting is preferred
Competencies, Knowledge and Skills:
Intermediate computer skills in Microsoft Office, specifically Excel and PowerPoint
Knowledge in developing dashboard/ metrics reporting
Other technologies may apply
Knowledge of and application of regulatory compliance (Medicare, Health Exchange and/or Duals), quality measures (HEDIS/ STARS) and/or accreditation standards (NCQA/ URAC)
Basic 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 and support cross-functional teams and initiatives
Ability to multitask moderate to complex responsibilities with results that may have long-range implications
Ability to work independently in a fast paced environment with changing priorities
Knowledge of Federal, State, NCQA and standards preferred
Licensure and Certification:
Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferred
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Travel required to perform onsite audits, approximately 5%
Compensation Range:
$53,400.00 - $85,600.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
