Manager Delegation Oversight Programs
This position is responsible for managing delegation oversight functions to ensure compliance with accreditation standards, federal, state and local regulatory and contractual obligations. This role is responsible for managing implementation and auditing oversight of delegation oversight processes, requirements, and tools. Responsible for monitoring and identifying potential areas of noncompliance by conducting annual and investigational audits and / or performing compliance reviews and performing risk assessments; and reporting identified performance or compliance issues to leadership. Provides advice and guidance to operational areas regarding proper policies and procedures. Ensures the integrity, auditability, and accuracy of reported data. Represents the company in external audits and compliance matters as well as regulatory meetings and activities. Additionally, this position will collaborate with internal and external business partners to provide guidance and recommendations around the development, maintenance and enhancements of programs, products and services.
• Bachelor's Degree with 5 years' experience in business or healthcare OR 7 years health insurance operations experience,
• 4 years' experience in project management and implementations
• 2 years' supervisory or team leadership experience
• Experience in performing delegation oversight and monitoring multiple delegated functions,
• Knowledge of NCQA. CMS regulations and Managed Care
• Executive presence with the ability to influence internal and external partners.
• Experience managing multiple small to large projects in a cross-functional environment
• Ability to interact effectively with all levels of internal and external customers
• Operations experience including coordination of problem resolution through various departments
• Proven problem-solving ability and experience in managing multiple assignments with critical deadlines
• Excellent data analysis, reporting, and presentation skills
• Strong team development, coaching, negotiation, and ethical decision-making skills
• Ability and willingness to travel to providers locations and other HCSC sites.
• PC proficiency to include Excel, Adobe Visio, Word and Power Point.
•This position will be located in Naperville
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Network Management / Provider Relations Job Type Full-Time Regular Location IL - Naperville
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