Delegation Oversight Nurse - Remote - San Bernardino

Job description

JOB DESCRIPTION Job Summary Provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties: - Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements. - Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed. • Works with delegation oversight analytics representatives on monitoring of performance reports from delegated entities. - Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. - Assists with delegation oversight committee meetings. - Works with delegation oversight leadership to develop and maintain delegation...