Risk & Oversight Manager II

🌍 Remote, USA 🎯 Full-time 🕐 Posted Recently

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

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.