Mgr. Delegation Oversight PCHP

Parkland Community Health Plan’s (PCHP’s) Manager, Delegation Oversight is responsible for managing and overseeing all compliance activities and requirements of Parkland Community Health Plan delegated subcontractors. Ensures compliance with all state and federal regulatory and contract requirements.

Bachelor’s degree.

Master’s degree in Healthcare Administration, Business Administration or related field is preferred.

Six (6) years of regulatory compliance and leadership experience managing projects in a large organizational setting.

Three (3) years of auditing experience at a health plan, managed care organization, or healthcare audit consulting firm.

Experience in managing vendor compliance and delegation oversight, audit, monitoring and managing regulatory issues.

Previous supervisory experience is preferred.

May have an equivalent combination of education and experience to substitute for both the education and the experience requirements.

Must have Federal Emergency Management Administration (FEMA) course certification for IS-700.B: An Introduction to the National Incident Management System (NIMS) or obtain within 30 days of placement in role.

Must have Federal Emergency Management Administration (FEMA) course certification for IS-100.C: Introduction to the Incident Command System (ICS 100) for Healthcare/Hospitals or obtain within 30 days of placement in role.

Must have Federal Emergency Management Administration (FEMA) course certification for IS-200.HCA: Applying ICS to Healthcare Organizations (ICS 200) or obtain within 30 days of placement in role.

Knowledge of Medicaid Managed Care and health plan administration.

Ability to use problem solving skills and interpret statistics to systematically analyze problems, draw relevant conclusions and devise appropriate plan of action.

Experience providing highly complex analysis, defining efficiencies in relation to compliance programs and internal controls.

Development of audit tools and methodology for pulling random samples to conduct audit work plans.

Knowledgeable and compliant with all relevant laws, rules regulations and accreditation standards and requirement (TDI, HHSC, NCQA, CMS).

Strong analytical ability with attention to detail.

Excellent verbal and written communication skills. Must be able to write professional audit reports.

Ability to manage multiple priorities simultaneously and meet deadlines.

In-depth knowledge of health plan compliance, operations, standards, policies and procedures.

General knowledge of a broad spectrum of health plan laws and regulations.

Ability to evaluate complex health plan compliance issues, seek additional guidance when necessary and make appropriate recommendations.

Ability to interact with all levels of leadership, influence change, adoption of vendor management concepts, and lead cross-functional teams and initiatives.

Ability to handle responsibilities that are complex with results that may have long-range implications.

Highly motivated with the ability to work independently in a fast-paced environment with changing priorities.

High proficiency in Microsoft Excel, Word and Access applications.

Responsible for performing regulatory/contractual delegation oversight control audits to ensure compliance with Federal and State regulatory agencies. Assures compliance to external specifications and standards. Conducts comprehensive regulatory reviews using a standard audit model.

Leads delegation oversight activities for PCHP in accordance with state and federal guidelines.

Develops, implements, and maintains the Delegation Oversight Program to ensure compliance with all internal, external, regulatory and accreditation requirements.

Develop and administer an annual work plan to monitor the performance of delegated business partners and to meet regulatory oversight and compliance requirements.

Lead the development and maintenance of departmental policies & procedures.

Lead and manage the delegation oversight team.

Conducts pre-delegation and annual audits for new and existing delegated entities ensuring that the entity continues to perform the delegated activities.

Conducts extensive investigation, critical thinking to understand root cause of problems. Problems span a wide range of difficult and unique issues across functions and/or businesses.

Chairs the Delegation Oversight Committee and participates in joint operating committee meetings with business owners and delegated vendors.

Evaluates the effectiveness of delegated vendor compliance programs and related policies and procedures designed to promote legal and ethical compliance.

Prepare professional written reports of audit findings and recommendations for corrective action.

Create and maintain audit workpapers and records in accordance with department record retention policies and regulatory requirements.

Present audit findings and recommendations to management and the Delegation Oversight Committee.

Act as a liaison and resource to the delegated entities regarding contract and regulatory requirements, as well as the communication of new or revised requirements.

Coordinates resources with internal teams and legal counsel as needed to resolve issues related to delegation oversight functions and contracts.

Acts as primary liaison and resource for PCHP with all delegated subcontractors.

Stays current on all delegation oversight issues and regulatory changes and transfers knowledge to internal and external stakeholders as needed.

Conducts staff training and in-services related to delegation oversight functions as needed.

Communicates, collaborates and cooperates with internal and external stakeholders.

1. Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.