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Sr Specialist, Delegation Oversight (Claims)- REMOTE - CA ONLY

Company: Molina Healthcare
Location: Long Beach
Posted on: November 26, 2022

Job Description:

JOB DESCRIPTIONJob SummaryResponsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program.This position is in California and is in Claims.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 QUALIFICATIONSRequired EducationBachelor'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, AssociationValid State Driver's LicensePreferred EducationBachelor'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.
        To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.#PJHPO -#Li-BeMorePay Range: -$45,390.49 - $88,511.46 a year**Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Keywords: Molina Healthcare, Long Beach , Sr Specialist, Delegation Oversight (Claims)- REMOTE - CA ONLY, Other , Long Beach, California

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