Risk & Oversight Manager II

Job Description:

• Provide oversight for assigned vendors and providers in compliance with state and federal provider agreements, business and accreditation requirements
• Maintain direct oversight for assigned vendors and providers
• Participate in the development and maintenance of departmental policies and procedures
• Support departmental subject matter experts in interpreting vendor and provider contract requirements, business, and compliance and regulatory requirements
• Monitor delegated/non-delegated vendor/providers and internal business owner relationships to ensure compliance, optimal delegate/non-delegate performance and achievement of business goals according to service level and other contractual requirements
• Document meetings with stakeholders to provide performance metrics feedback and identify opportunities to reduce risk and cure corrective action plans
• Support the implementation of strategies to increase delegates/non-delegates engagement in driving toward quality outcomes and cost control initiatives
• Support the development, approval and review of delegated/non-delegated contracts; ensure service levels meet current regulatory and quality baseline requirements
• Conduct pre-delegation assessments, ongoing delegation oversight, annual audits, deficiencies, and corrective action plans for vendors/providers
• Participate in joint operating committee and document quarterly business reviews, strategic partner reviews, and operational meetings with business owners and delegated/non-delegated vendors and providers
• Maintain monthly/quarterly/annual reporting and ensure timely receipt of accurate and complete all regulatory and contractually required reports for delegated vendor and provider activities
• Support delegated vendor and provider onboarding, including training, reporting and document retention; provide support to departments and business owners to enable effective management of delegates
• Stay informed about the latest developments in delegation oversight field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources
• Support the development and accomplishment of delegation program activities in support of company strategies, goals and objectives
• Coordinate activities with all levels of staff as well as with delegated and potentially delegated external entities through clear and concise verbal and written communication
• Assist in managing operational problems by bringing the vendor and departmental ops teams together to develop solutions and implement a chosen course of action
• Perform any other job duties as requested

Requirements:

• Associates degree or equivalent years of relevant work experience is required
• Minimum of two (2) years of experience in corporate compliance, vendor oversight, contract management, internal audit, quality assurance, strategic sourcing or other highly regulated industry is required
• Experience in managing third party compliance and oversight of health-care related delegation activities, vendor audits and contracting is preferred
• Intermediate computer skills in Microsoft Office, specifically Excel and PowerPoint
• Knowledge in developing dashboard/ metrics reporting
• Knowledge of and application of regulatory compliance (Medicare, Health Exchange and/or Duals), quality measures (HEDIS/ STARS) and/or accreditation standards (NCQA/ URAC)
• Basic project management skills with ability to handle multiple projects within time constraints
• Ability to interact with all levels of leadership and support cross-functional teams and initiatives
• Ability to multitask moderate to complex responsibilities with results that may have long-range implications
• Ability to work independently in a fast paced environment with changing priorities
• Knowledge of Federal, State, NCQA and standards preferred
• Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferred.

Benefits:

• Bonuses tied to company and individual performance
• Substantial and comprehensive total rewards package

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