Delegation Management Specialist I

Dignity Health

Bakersfield, CA

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JOB DETAILS

SALARY

$36–$49.07 Per Hour

LOCATION

Bakersfield, CA

POSTED

30+ days ago

Responsibilities

*This position will be work from homewithin California.

Position Summary:

The Delegation Management Specialist I supports the Delegation Management Specialist II along with the Delegation Management Department (DOD) in the management and monitoring of delegated health plan compliance which complies with all applicable regulations and statutes in adherence with the Dignity Health MSO (DHMSO) Compliance Framework. The Delegation Management Specialist will possess extensive experience in healthcare compliance, contract management, and delegation management. Will act as a liaison between the contracted provider groups in the delegation management process; to include problem-solving issues for internal and external stakeholders.

Responsibilities may include:

- Manage and evaluate the delegation agreements between DHMSO and contracted entities, ensuring compliance and adherence to contractual obligations.

- Assists with document delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.

- Ensure all compliance requirements are met for the delegated function, including credentialing, training, and auditing.

- Establish and maintain effective communication channels with contracted entities such as healthcare providers, health plans, and service vendors.

- Conduct regular risk assessments and risk management activities to ensure safe and effective delegated functions.

- Participate in the development and implementation of corrective action plans (CAP) to address identified issues. May include the following: CAP responses and timely submission to the health plan as a result of the HP/agency audit findings. This will include close collaboration with various departments within the DHMSO to provide the CAP response in a timely manner to the health plan.

- Will support the DOD and team, preparing and sending the requested information to the health plans prior to the audit.

- Collaborate with delegated entities to improve the quality of services provided.

- Ensure that quality improvement initiatives are effectively implemented and tracked.

- Leverage project management skills to prioritize and complete all assigned tasks, acting as a subject matter expert (SME) supporting assigned areas, and interacts with all levels of internal and external customers to correspond, answer questions and resolve issues as they arise.

- Prepare comprehensive reports for senior management and regulatory agencies.

- Communicate findings and recommendations to stakeholders.

- Ensure that delegated entities are up-to-date with regulatory changes and requirements.

- Collaborate with internal departments to ensure timely and accurate communication regarding provider performance and concerns.

- Assist in the revision of delegation management audit tools in accordance with standards set by NCQA, the Plan’s policies and procedures and other State and Federal guidance tools as required.

Qualifications

Minimum Qualifications:

- 2+ years administrative experience in supporting a compliance, auditing arena, coordination of audits.

- High School Diploma or GED

Preferred Qualifications:

- Several years of experience in delegation Management, compliance management, or a related field preferred.

- Associates Degree or Bachelor’s Degree in a relevant field (e.g., healthcare management, business administration, compliance) preferred.

- Knowledge of DMHC, NCQA, CMS and other regulatory bodies preferred.

- Knowledge of HIPPA, managed care environment preferred.

- Strong technical proficiency in data analysis; database software preferred.

- Certified Compliance Professional (CCP) preferred.

- Certified Professional in Healthcare Quality (CPQH) preferred.

- Certified Healthcare Auditor (CHA) preferred.

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV)

Pay Range**

$36.00 - $49.07 /hour
We are an equal opportunity/affirmative action employer.

About the Company

Dignity Health

Hello. We welcome the chance to help you feel your best. Excellent, affordable health care, delivered with compassion, is what we stand for. Since our founding in 1986, we've made it our goal to create environments that meet each patient's physical, mental, and spiritual needs. We also believe this healing philosophy promotes the wellbeing of our staff and the places they serve.Dignity Health is made up of more than 60,000 caregivers and staff who deliver excellent care to diverse communities in 21 states. Headquartered in San Francisco, Dignity Health is the fifth largest health system in the nation and the largest hospital provider in California.Through teamwork and innovation, faith and compassion, advocacy and action, we endeavor every day to keep you happy, healthy, and whole.Dignity Health began as a single hospital founded on the belief that all people deserve medical care, regardless of their background, ethnicity, or circumstances.The Sisters of Mercy, originally founded by Catherine McAuley in Dublin, Ireland in 1831, vowed to serve people who suffer from poverty, sickness, and lack of education. In 1854, eight Sisters arrived in San Francisco, California and immediately began caring for residents of a city struck by cholera, then typhoid and influenza. They founded St. Mary's Hospital, now the oldest continuously operating hospital in the city.Eventually, one facility became many, expanding to serve a rapidly growing population while strengthening its commitment to keeping the human person at the forefront of modern medicine.In 1986, two congregations of the Sisters of Mercy joined their ten hospitals together, forming Catholic Healthcare West. In 2012, we changed our name to Dignity Health to better describe what we stand for. Dignity is something everyone is born with. To us, "Dignity" means showing respect for all people by providing excellent care and helping them lead healthy, meaningful lives.Today, Dignity Health is one of the largest health systems in the nation with 400 care sites across a 22-state network, including 39 hospitals -- 24 of which are Catholic and 15 are other-than-Catholic. The mission and values we were founded upon remain the same. Through teamwork and innovation, faith and compassion, advocacy and action, we endeavor every day to keep our patients happy, healthy, and whole. Hello humankindness.

COMPANY SIZE

2,000 to 2,499 employees

INDUSTRY

Healthcare Services

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