Delegation Oversight Specialist - Chicago Illinois

Company: Provider Partners Health Plan
Location: Chicago, Illinois
Posted On: 01/19/2025

Oversees delegated activities to ensure compliance primarily with NCQA and CMS requirements including delegation standards and requirements contained in the PPHP 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 documents follow-up to completion.
• Assists with meetings of the Credentialing Committee, including the preparation of documents for committee oversight of delegated functions.
• Prepares delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys and participates on PPHP's work team.JOB QUALIFICATIONSRequired Education:Bachelor's Degree or equivalent combination of education and experience.Required Experience:
  • 5+ years in experience in credentialing in a managed care field
  • Min. 1 year experience completing delegation oversight assessment/auditing
  • Data analysis experience
  • Proficiency in Excel including reporting toolsPreferred Credentials:
    • Credentialing certificationPreferred Education:Bachelor's Degree in Business or Health Care related field.Preferred Experience:
      • 8 years managed care experience.
      • 2 years' experience completing delegation oversight assessments/audits.
      • Quality management/regulatory experience with increasing responsibility.*To all current PPHP employees: If you are interested in applying for this position, please apply through the intranet job listing.Provider Partners Health Plan offers a competitive benefits and compensation package. PPHP is an Equal Opportunity Employer (EOE) M/F/D/V.
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