Specialist, Delegation Oversight Molina Healthcare 852 reviews - Columbus, OH Job Summary Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program. Knowledge/Skills/Abilities * Under general supervision, coordinates and/or assists with all delegated activities to ensure compliance with state, federal, NCQA, and Molina requirements, such as performing analysis of annual due diligence audits and monitoring delegated activities. * Coordinates annual assessment audits for Utilization Management of Plan contracted IPA/MG's to include: mailing pre-audit letters/audit tools; scheduling audits; accurately completing delegation audit tool; reporting outcomes to management; and required follow-up (e.g., additional mailings, obtaining signature pages, and arranging annual re-audit). * Monitors post-audit delegated activities to ensure compliance with State Plan and NCQA requirements. Examples include: tracking receipt of and monitoring quarterly/yearly reports from delegated entities and assisting with development and implementation of Corrective Action Plans as non-compliant issues are identified. * Monitors Utilization Management outpatient referral denials from delegated entities. Examples include: tracking, analyzing and trending denials; determining and reporting 'outliers' to Medical Director; other management reporting. Reviews all pre-contractual UM Programs/Plans from entities applying for a contract with the Health Plan. * Produces monthly scorecards to monitor compliance of Delegation Oversight activities and delegate performance metrics. * Develops and implements tracking tools to ensure timely issue resolution and compliance with all applicable standards. Job Qualifications Required Education Bachelor's Degree or equivalent combination of education and experience. Required Experience * 2 years managed care experience. * Data analysis experience. Required License, Certification, Association Valid State Driver's License Preferred Education Bachelor's Degree in Business or Health Care related field. Preferred Experience * 3 years managed care experience. * Quality management/regulatory experience with increasing responsibility. * Experience completing delegation oversight assessments/audits. Preferred License, Certification, Association N/A To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. 16 hours ago - save job - original job Apply On Company Site Other jobs you may like Multi-Site Continuous Improvement Manager (Co... AkzoNobel Columbus, OH 30+ days ago * Specialist jobs in Columbus, OH * Jobs at Molina Healthcare in Columbus, OH * Specialist salaries in Columbus, OH Molina Healthcare Molina Healthcare 852 reviews Navigating the murky waters of federal health care plans is no easy feat, but Molina Healthcare's mission is to help Medicaid and Medicare... Let employers find you Thousands of employers search for candidates on Indeed Upload Your Resume