Healthcare Delegation & Compliance Lead

Healthcare Support Staffing; Long Beach (CA); On-site; USD 41,000 - 51,000; Full time

Job summary

HealthCare Support Staffing, Inc. (HSS) is a leading healthcare recruiting and staffing firm placing professionals with major healthcare facilities across the United States.

We are seeking an RN or LVN with strong NCQA/HEDIS knowledge and extensive managed care experience to coordinate delegation assessments and ensure compliance. You will develop reports, action plans, and follow-up to address deficiencies, ensuring timely submission of required documents and reports.

Qualifications

• Must be RN or LVN.
• Bachelor’s degree in related field or equivalent experience.
• Familiarity with physician referrals, medical decision-making, working in a clinical environment, compliance practices.
• 1+ years clinical experience as RN
• 8-10 years managed care experience
• Extensive knowledge of MS Word/Excel/Access
• Knowledge of NCQA and HEDIS standards and applicable state and federal laws

Responsibilities

• Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
• Develops format and documents periodic status reports from Delegated Entities.
• Develops corrective action plans when deficiencies are identified, and documents follow-up to completion.
• Ensures delegated entity’s compliance with reporting requirements by tracking the receipt and completeness of reports.
• Develops corrective action plans when compliance issues are identified, and document follow-up to completion

Skills

Clinical experience

Compliance knowledge

NCQA/HEDIS knowledge

Physician referrals familiarity

Medical decision-making

Education

Bachelor’s degree in related field or equivalent experience

Tools

MS Word

MS Excel

MS Access

Job description

HealthCare Support Staffing, Inc. (HSS) is a leading healthcare recruiting and staffing firm placing professionals with major healthcare facilities across the United States.

We are seeking an RN or LVN with strong NCQA/HEDIS knowledge and extensive managed care experience to coordinate delegation assessments and ensure compliance. You will develop reports, action plans, and follow-up to address deficiencies, ensuring timely submission of required documents and reports.