Senior Specialist, Delegation Oversight (Remote)

Molina Healthcare; Macon (GA); Remote; USD 45,000 - 86,000; Full time

Job summary

A healthcare organization is seeking a professional in Macon, Georgia, responsible for overseeing compliance in delegated activities within the quality improvement scope. A Bachelor's degree and at least 3 years of managed care experience are required. This role involves developing reports and corrective action plans while working closely with oversight committees and network management teams. The position offers a competitive salary range and benefits package.

Benefits

Competitive benefits package

Qualifications

• Bachelor's Degree or equivalent combination of education and experience.
• 3+ years managed care experience.
• Min. 1 year experience with delegation oversight assessment/audits.

Responsibilities

• Oversee delegated activities for compliance requirements.
• Prepare status reports and develop corrective action plans.
• Assist with Delegation Oversight Committee meetings.

Skills

Delegation oversight assessment

Data analysis

Compliance tracking

Education

Bachelor's Degree

Job description

JOB DESCRIPTION

Job Summary

Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program.

KNOWLEDGE/SKILLS/ABILITIES

• Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
• Prepares status reports from Delegated Entities. Develops corrective action plans when deficiencies are identified, and documents follow-up to completion. Ensures 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.
• Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions.
• Works with Network Management team to develop and maintain delegation agreements and assessment tools.
• Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team.

JOB QUALIFICATIONS

Required Education

Bachelor's Degree or equivalent combination of education and experience.

Required Experience

• 3+ years managed care experience.
• Min. 1 year experience completing delegation oversight assessment/ audits.
• Data analysis experience.

Required License, Certification, Association

Valid State Driver's License

Preferred Education

Bachelor's Degree in Business or Health Care related field.

Preferred Experience

• 5 years managed care experience.
• 2 years’ experience completing delegation oversight assessments/audits.
• Quality management/regulatory experience with increasing responsibility.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $45,390 - $85,511 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.