Senior Specialist, Delegation Oversight (Remote)

Molina Healthcare; Milwaukee (WI); Remote; USD 45,000 - 86,000; Full time

Job summary

A leading healthcare organization in Milwaukee is seeking a dedicated professional for quality improvements within their Delegation Oversight Department. This role focuses on ensuring compliance with standards and conducting assessments. Ideal candidates will possess a Bachelor's degree and a minimum of 3 years in managed care, alongside strong data analysis skills. The position offers a competitive salary range of $45,390 - $85,511 annually.

Benefits

Competitive benefits package

Equal Opportunity Employer

Qualifications

• 3+ years managed care experience required.
• Min. 1 year experience in delegation oversight assessments/audits.
• Valid State Driver's License required.

Responsibilities

• Coordinate and document delegation assessments.
• Develop corrective action plans for compliance issues.
• Prepare documents for committee oversight.

Skills

Delegation oversight assessment

Data analysis

Compliance tracking

Corrective action planning

Education

Bachelor's Degree

Bachelor's Degree in Business or Health Care

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.