JOB DESCRIPTION
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
- Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
- Prepares status reports from Delegated Entities. Develops 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.
- Develops corrective action plans when compliance issues are identified, and document follow-up to completion.
- Assists with meetings of the Delegation Oversight Committee, including the preparation of documents for committee oversight of delegated functions.
- Works with Network Management team to develop and maintain delegation agreements and assessment tools.
- Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on Molina's work team.
JOB QUALIFICATIONS
Required Education
Bachelor's Degree or equivalent combination of education and experience.
Required Experience
- 3+ years managed care experience.
- Min. 1 year experience completing delegation oversight assessment / audits.
- 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
- 5 years managed care experience.
- 2 years’ experience completing delegation oversight assessments / audits.
- Quality management / regulatory experience with increasing responsibility.
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.
PJHPO
Pay Range : $66,560 - $88,511.46 / ANNUAL
Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission.
Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package.
Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.
Job Type : Full Time Posting Date : 09 / 10 / 2024
MSL/Sr. MSL, Lung Solid Tumor (Southern CA) (Remote)
Applicable only to applicants applying to a position in any location with pay disclosure requirements under state or local law: . It is AbbVie’s policy to employ qualified persons of the greatest ability without discrimination against any employee or applicant for employment ...
Sr. Analyst - Infrastructure Planning and Execution (REMOTE)
BD is one of the largest global medical technology companies in the world. Responsible for BD’s infrastructure project shaping, estimation and delivery activities for the small and medium sized project in our portfolio, specifically focused on Cloud, Security and Operational Technology (OT) work. Re...
Sr. Therapeutic Area Specialist, Hematology (Sr. TAS) - Sacramento, CA
Engages real-time medical support through Medical on Call to reactively answer unsolicited questions and complex technical inquiries. Physical presence at the BMS worksite or physical presence in the field is an essential job function of this role which the Company deems critical to collaboration, i...
Coder III - Full Time, Days (Remote-CA Only)
The Coder III codes and abstracts clinical and demographic data from patient records to support reimbursement. Assists in maintaining accurate and complete medical records in accordance with hospital policies and procedures. Reviews, codes and abstracts, utilizing ICD-10 and CPT coding conventions, ...
Customer Service Representative (Fully Remote - CA Applicants Only)
Key Responsibilities : Respond promptly to customer inquiries via phone, email, and video conferencing Provide accurate information about our products or services Assist customers with their benefit packages Maintain a high level of professionalism and empathy in all customer interactions Escalate c...
Sr Analyst - Info Sec (Remote)
Project Responsibilities: * Create and manage System Security Plan and creation and or validation of all associated artifacts required to obtain DISA IL5 certification as well as NIST 800-53 compliance to include but not limited to a System Level Continuous Monitoring (SLCM) Strategy, HW/S...
Sr. Software Application Specialist (Strategic Projects Team) - US Remote
Because people can only be their best when they not only feel safe, but are safe. Note: This position is a remote position and candidates can be located anywhere in the US. Previous experience as a Business Analyst or Application Specialist in medium to large-sized organizations. That's mission-crit...
Md - Sr - Python developer (Remote US only)
Develop backend applications based on carefully thought-out specifications by analysts. All potential candidates should read through the following details of this job with care before making an application. This position is a great opportunity to contribute your talents in developing high-quality we...
Sr. Business Analyst -Public Sector Experience - Remote Contract
Business Analyst for a contract role open with IT Department of a large public school district in Chicago, IL. Strong communication and presentation skills, with the ability to translate technical concepts into clear business terms. Business Analyst – IT Systems. Client Industry: Public Sector/Educa...
Vendor Management Analyst (On-site in Roseville CA Only)
Strong analytical capabilities and attention to detail. Final compensation package will be determined by the work experience, education, and/or skill level of the applicant along with internal equity and alignment with geographic market data. Mechanics Bank is an equal opportunity employer and all q...