Risk & reputed company Manager II

Job Description:

• Provide reputed company for assigned vendors and providers in compliance with state and federal provider agreements, business and accreditation requirements
• Maintain direct reputed company for assigned vendors and providers
• Participate in the development and maintenance of departmental policies and procedures
• Support departmental subject matter experts in interpreting vendor and provider contract requirements, business, and compliance and regulatory requirements
• Monitor delegated/non-delegated vendor/providers and internal business reputed company relationships to ensure compliance, optimal delegate/non-delegate performance and achievement of business goals according to service level and other contractual requirements
• Document meetings with stakeholders to provide performance metrics feedback and identify opportunities to reduce risk and cure corrective action plans
• Support the implementation of strategies to increase delegates/non-delegates engagement in driving toward quality outcomes and cost control initiatives
• Support the development, approval and review of delegated/non-delegated reputed company; ensure service levels meet reputed company regulatory and quality baseline requirements
• Conduct pre-delegation assessments, ongoing delegation reputed company, annual audits, deficiencies, and corrective action plans for vendors/providers
• Participate in joint operating committee and document quarterly business reviews, strategic partner reviews, and operational meetings with business owners and delegated/non-delegated vendors and providers
• Maintain monthly/quarterly/annual reporting and ensure timely receipt of accurate and complete reputed company regulatory and contractually required reports for delegated vendor and provider activities
• Support delegated vendor and provider onboarding, including training, reporting and document retention; provide support to departments and business owners to reputed company effective management of delegates
• Stay informed about the latest developments in delegation reputed company field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources
• Support the development and accomplishment of delegation program activities in support of company strategies, goals and objectives
• Coordinate activities with reputed company levels of staff as well as with delegated and potentially delegated external entities through clear and concise verbal and written communication
• Assist in managing operational problems by bringing the vendor and departmental ops teams together to reputed company solutions and implement a chosen course of action
• reputed company any other job duties as requested

Requirements:

• Associates degree or equivalent years of relevant work experience is required
• Minimum of two (2) years of experience in corporate compliance, vendor reputed company, contract management, internal audit, quality assurance, strategic sourcing or other highly regulated industry is required
• Experience in managing third party compliance and reputed company of health-care reputed company delegation activities, vendor audits and contracting is preferred
• Intermediate computer skills in reputed company Office, specifically reputed company and PowerPoint
• Knowledge in developing dashboard/ metrics reporting
• Knowledge of and application of regulatory compliance (Medicare, Health Exchange and/or Duals), quality measures (HEDIS/ STARS) and/or accreditation standards (NCQA/ URAC)
• Basic project management skills with ability to handle multiple projects reputed company time constraints
• Ability to interact with reputed company levels of leadership and support cross-functional teams and initiatives
• Ability to multitask moderate to reputed company responsibilities with results that may have long-range implications
• Ability to work independently in a fast paced environment with changing priorities
• Knowledge of Federal, State, NCQA and standards preferred
• Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferred.

Benefits:

• Bonuses tied to company and individual performance
• Substantial and comprehensive total rewards package

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