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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Position Overview: The Delegation Oversight Program Manager will be primarily responsible for the design, implementation, and management of the Delegation Oversight program. Primary responsibilities will include developing effective strategies for oversight of First Tier, Downstream, and Related Entities (FDRs) and Subcontractors to ensure these third parties perform in accordance with all state and federal regulatory and contract requirements.
In collaboration with other business unit leaders, design and implement a program to effectively oversee the performance of FDRs and Subcontractors that perform a delegated function on behalf of PacificSource.
Chair the Delegation Oversight Committee Develop and manage the strategy and process for performing an annual risk assessment of FDRs and Subcontractors that will inform the development of an annual work plan to oversee these entities.
Develop and manage the strategy and process for conducting pre-delegation assessments of all FDRs and Subcontractors in accordance with CMS and OHA requirements.
In collaboration with the Delegation Oversight Committee, develop the annual work plan which will outline the annual audit plan for FDRs and Subcontractors.
Manage and oversee the process for initiating corrective action plans for non-compliance identified within FDRs and Subcontractors Prepare and present the status of the delegation oversight program and FDR/Subcontractor performance data to Compliance Committee.
Manage and oversee the preparation and submission of FDR and Subcontractor regulatory reporting requirements to CMS and OHA.
Responsible for oversight, management, development, implementation, and communication of delegation oversight programs.
Coordinate delegation oversight by maintaining collaborative partnerships with key departments.
Responsible for process improvement and working with other departments to improve interdepartmental delegation oversight processes.
Utilize lean methodologies for continuous improvement.
Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities.
Participate in compliance initiatives as needed. Perform day to day tasks of the compliance department as needed.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: Minimum 4 experience in the healthcare or health insurance industry with specific experience in Medicare and Medicaid compliance required.
Education, Certificates, Licenses: Bachelor's degree in Business, Health Care Administration, Finance, Accounting or a related field required. Master's Degree preferred.
Knowledge: Ability to gain a thorough understanding of PacificSource compliance initiatives. Respond timely to regulatory inquiries. Maintain sufficient reference materials to adequately research compliance issues. Ability to organize large projects that involve working with multi-functional teams under strict deadlines. Ability to communicate effectively with all levels of the organization both verbally and in writing. Working knowledge of medical terminology. Ability to read and understand health contract and benefits language. Ability to work under time pressures, and to deal with emotional situations.
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
We are committed to doing the right thing.
We are one team working toward a common goal.
We are each responsible for customer service.
We practice open communication at all levels of the company to foster individual, team and company growth.
We actively participate in efforts to improve our many communities-internally and externally.
We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
This employer is a corporate member of
myGwork - LGBTQ+ professionals, the business community for LGBTQ+ professionals,
students, inclusive employers & anyone who believes in workplace equality.
- Problem Solving
- Project Management
- Team Building