Primary coordinator of all vendor relationships whether clinical or nonclinical. This role includes interaction with vendors relative to vendor management, monitoring, auditing, reporting, credentials, data analysis, project management, and regulatory compliance with CMS, NM OSI, TDI, NCQA, and URAC.
- Coordinates conduct, and documents delegation assessments as necessary to comply with state, federal, NCQA and any other applicable requirements.
- Develop and prepare status reports from Delegated Entities. Assist with developing corrective action plans when deficiencies are identified, and documents follow-up to completion. Ensures compliance with reporting requirements by tracking the receipt and completeness of reports.
- Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions.
- Works with the various departments as applicable to develop and maintain delegation agreements and assessment tools.
- Prepares delegation oversight document evidence for state and federal monitoring visits and NCQA accreditation surveys.
- Assist in preparation of audits, which includes departmental education, training/meetings, and quality communication.
- Vendor Relationships- Management, PBM's, Non-Clinical
- Working knowledge of Microsoft Excel
- Working knowledge of Database Management
- 3 years Health Plan and/or Managed Care Experience
- Minimum 1-year experience completing delegation oversight assessment/audits
- Data analysis experience
- Quality management/regulatory experience with increasing responsibility preferred
C. Licenses, Registrations, or Certifications