Delegation Oversight Specialist - RN
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
This Delegation Oversight Specialist – RN role involves oversight of delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements. Ideal candidate will be an excellent communicator (written and verbal) who is detail oriented, organized, able to read and interpret regulations and able to meet tight deadlines while handling multiple audits.
Responsibilities include:
- Coordinates, conducts and documents required pre-delegation assessments and annual NCQA assessments as necessary to comply with applicable state, federal and accreditation requirements,
- Conducts necessary monitoring and auditing work to ensure vendors comply with state, federal, NCQA and other applicable requirements.
- Review reports from Delegated Entities.
- Develops corrective action plans when deficiencies are identified and document follow-up to completion.
- Present delegate’s performance to respective committees, including the preparation of documents for committee oversight of delegated functions.
- Review implementation of new or changed regulatory requirements to help ensure adequacy of controls of oversight activities
- Provide guidance of new or changed regulatory requirements and implementation of processes.
- Analyzes and interprets existing and proposed legislation and regulations and determines their effects on delegation oversight process.
- Conduct risk assessments to identify required audit areas and audit frequency.
- Assist in developing audit tools of oversight activities.
- Work collaboratively with Delegation Manager/Director to develop, establish and maintain departmental processes and procedures.
- Performs other duties as required.
Qualifications:
· Active, unrestricted RN license
- Experience with either Utilization Review and/or Case Management
- Three years auditing experience using NCQA guidelines preferred
- Experience in delegation oversight process and working knowledge of Part C Organization Determination regulations and NCQA Health Plan standards preferred
- Intermediate proficiency in the use of Office365 (e.g. Word, Excel) required.
Hybrid
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.