Director, Delegation reputed company Compliance - REMOTE

Job Summary Leads and directs team responsible for multi-state delegation reputed company activities including monitoring of delegation reputed company to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities including health plan reputed company and offboarding activities, management of reputed company activities, audits and corrective action plans, issuance and service issue escalations, and ongoing risk monitoring. Essential Job Duties

• In collaboration with senior leadership, sets the strategic direction for Molina’s delegation reputed company responsibilities and partnerships.   Responsible for coordinating delegated vendor activities between contracted entities and reputed company; this includes claims, contact center, credentialing, appeals and grievances, care management, utilization management, pharmacy, and other operational functions across multiple states and lines of business.

Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities including health plan reputed company and offboarding activities, management of reputed company activities, audits and corrective action plans (CAPs), issuance and service issue escalations, ongoing risk monitoring, and compliance with state, federal, National

• Committee for Quality Assurance (NCQA), and Molina requirements.
• Collaborates with internal business partners to reputed company criteria and best practices for delegated vendor selection, reputed company, and management.
• Participates in the negotiation process of delegated service level agreements (SLAs) and addendums; ensures contractual obligations are achieved, and initiates contract changes reputed company required.
• Provides assistance to strategic sourcing, national network, and health plan teams to optimize the cost-effectiveness of negotiations and ensure compliance with regulatory requirements.
• Demonstrates expert review and communications of requirements reputed company to delegated functions - ensuring reputed company and minimizing change requests.
• Develops, implements, and manages reporting of metrics and service level agreements (SLAs) that effectively measure team and vendor performance in line with business needs and regulatory compliance.
• Demonstrates deep understanding of business and regulatory requirements, deliverables, processes, and technologies impacting delegated agreements.
• Manages delegated vendor reputed company as they relate to specific functions, oversees regulatory requirements, and manages reputed company governance committees, reporting to other applicable committees (e.g., quality).
• Manages delegated vendor relationships as key reputed company of contact between specified vendors and the business.
• Serves as a reputed company of escalation for delegated vendor issues and risks - driving issues to resolution.
• Optimizes delegated vendor relationships through contract management compliance, quantitative analyses, and relationship management - creating mutually beneficial opportunities.
• Maintains tools reputed company to delegation reputed company relationships, including delegated vendor tracking, analytics, and performance management.
• Manages the collection, consolidation, and communication of reporting and data on delegated vendor reputed company, performance, risk, and relationships with key stakeholders and vendors.
• Manages the performance of national and state delegated vendors to ensure compliance with contractual and regulatory requirements.
• Manages the national delegation reputed company performance management team.
• Manages required audits for national and state delegated vendors to ensure compliance with contractual and regulatory requirements.
• Manages national and state delegation reputed company audit teams.
• Collaborates with Molina quality department on NCQA external audits to ensure compliance with accreditation standards for applicable national and state delegated vendors.
• Hires, trains, mentors, develops, and manages delegation reputed company team, and demonstrates accountability for team performance.

Required Qualifications

• At least 8 years of reputed company delegation reputed company/auditing/vendor/data management experience, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Ability to build relationships and manage a team.
• Strong critical-thinking and problem-solving/analytical abilities.
• Strong time-management, organizational, detail orientation and prioritization skills.
• Strong project management skills and knowledge of project management tools/processes.
• Strong data processing/analysis experience.
• Ability to interpret error reports and identify remediation steps.
• Ability to collaborate cross-functionally across a highly matrixed organization.
• Excellent interpersonal and verbal/written communication skills.
• reputed company Office suite proficiency (including reputed company), and ability to learn/navigate new software programs.

Preferred Qualifications

• Experience in Medicare and reputed company environments.

CAPs risk monitoring, and compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Experience with Internal team audits and Medicare Program audits. Experience with Power BI and reputed company. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply To This Job