Manager, Provider Delegation Oversight
 SCAN Group | |
paid holidays, tuition reimbursement, 401(k)
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 United States, California, Long Beach | |
 Feb 06, 2025 | |
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Description
About SCAN SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter. The Job Ensures SCAN's contracted Provider Organizations and other First Tier, Downstream and Related (FDR) entities deliver timely, appropriate, and quality care and services to SCAN members consistent with the Center for Medicare and Medicaid Services (CMS) and relevant state, federal and accrediting body requirements. Provides operational expertise to all delegation oversight processes and activities for non-clinical functions such as finance, claims, delegate data (ODAG/DOR), credentialing, and FDR Compliance programs. You Will Manages and oversees day-to-day operations of the Delegation Oversight Unit non-clinical functions; finance, claims, delegate data (ODAG/ODR), credentialing and FDR Compliance programs. Facilities continuous quality improvements within the SCAN provider network by developing systems to assess, monitor and improve performance of delegated entities and other First Tier, Downstream and related entities (FDR). Maintains audit readiness by ongoing training, competency assessment, auditing, monitoring of metrics and developing and implementing corrective action. Manages internal and external audits and assessments, and implement corrective action plans as to address audit findings. Develops and/or enhances meaningful management reports to monitor staff productivity and department activities to identify potential issues and areas for improvements. Conducts ongoing analysis; making recommendations for process improvements in work flow, organization, communication, and overall staff and program efficiency. Promotes compliance with all regulatory and quality standards including but not limited to: Centers for Medicare and Medicaid Services (CMS), Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and accreditation bodies' standards such as the National Committee for Quality Assurance (NCQA) as it relates to delegation oversight activities. Facilitates assigned Committees and workgroup activities by analyzing and reporting data and metrics, escalating issues where appropriate, and resolve outstanding action items. Develops, implements, and maintains department documentation including policies and procedures, desktop policies, job aids, work plans, staff education materials, tracking matrixes, and other documents as requested to ensure improved efficiency, productivity and outcomes. Assists Director in preparation of department annual budget, annual evaluation, and other activities as requested by management. Collaborates with internal departments to develop policies and procedures, and implement and monitor daily activities. Serves as a resources and point of contact to internal and external customers including FDRs. Ensures compliance with federal and state regulations and SCAN Policies and Procedures. Supports and coordinates daily department activities by providing strong leadership. Achieves organizational and departmental goals by communicating expectations; planning, monitoring, and appraising performance; coaching and counseling employees as necessary. Maintains staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. All other duties as assigned. Your Qualifications Bachelor's Degree or equivalent experience 5 + years of Compliance experience required. 2-3 Management experience preferred. Experience with delegation oversight. Experience working for a managed care organization such as: an HMO, IPA or Medical Group is required. Experience with coordinating diverse groups of individuals to achieve success of the overall program. Leadership- Lead and inspire teams to achieve Problem Solving- Good problem-solving skills Communication- Good communication and interpersonal skills Working knowledge of guidelines and regulations relevant to FDR Compliance including Medicare, Medicaid, DHCS, DMHC, and NCQA. Excellent leadership, communication (written and verbal), and interpersonal skills. Strong organizational, critical thinking, analytical, and decision-making skills. Ability to manage competing priorities and tasks to ensure all deliverables are met timely, and work independently and collaboratively as needed. Ability to work well in a fast-paced and dynamic environment with limited supervision. What's in it for you? We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now! At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more. SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required. #LI-CS2 #LI-Hybrid Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
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