Job DescriptionInsight Global is looking for a Delegation Oversight Manager for one of their largest healthcare clients in California. The Delegation Oversight Manager is responsible for oversight and management of the processes and staff supporting Clinical Services Oversight with regulatory and delegation contractual requirements. The collaborative effort includes but is not limited to partnering with the Utilization Management and Care Management leadership on process improvement initiatives to support compliance. This position is M-F, 8am-5pm and fully remoteDuties include but are not limited to:
Works with the Director of Delegation Oversight Clinical Services to implement and maintain the Clinical Services compliance framework that includes management of delegation oversight and regulatory audits, internal monitoring, corrective action plan development and resolution.
Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each internal and external customer.
Serves as a subject matter expert to cross-functional staff regarding clinical services regulatory and delegation requirements, and impact to operational processes.
Serves as a role model for Delegation Oversight staff for relationship management with internal and external stakeholders
Participates in the documentation effort of department workflow processes to ensure clarity and appropriate training with respect to specific tasks and job requirements
Participates in educational programs to enhance care management (utilization management and case management) compliance knowledge and ensures staff participation as well.
Manages internal monitoring/auditing process as applicable
Manages Appeal processing as applicable
Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
They may reside anywhere in the USA but must work PST hours. 8am-5pm.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] . To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .Skills and Requirements
Active RN or LVN license
3- 5 years Managed Care Experience in Utilization Management and/or Case Management and Compliance
Experience training or educating clinical and non-clinical staff in a variety of venues and settings preferred
A base knowledge of requirements for Medicare, Medi-Cal and Commercial lines of businessExperience in an HMO or experience in a Managed Care setting required nullWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].