Senior Specialist, Delegation Oversight (Remote)

Job description

JOB DESCRIPTION Job Summary Provides senior level support for delegation oversight activities. Oversees delegated activities to ensure compliance with state, federal, contractual, National Committee for Quality Assurance (NCQA), and Molina requirements. Essential Job Duties: - Under general leadership supervision, performs pre and post-delegation assessments and annual credentialing audits and monitoring of delegated activities to ensure compliance with NCQA, state and federal requirements. - Monitors post-audit delegated activities to ensure compliance with state health plan and NCQA requirements. - Prepares status reports from delegated entities. - Ensures compliance with reporting requirements by tracking the receipt and completeness of reports. - Evaluates monthly scorecards to monitor compliance of delegation oversight activities and delegate performance metrics. - Develops corrective action plans (CAPs) when compliance issues are identified, and documents follow-up to completion. - Assists in the preparation of the delegation oversight committee, including the preparation of documents for committee oversight of delegated functions. - Assists in preparation of delegate profile...