DELEGATION AND VENDOR OVERSIGHT MANAGER - HEALTH PLAN SERVICES Job Number: 00124438 Job Posting : May 21, 2020, 7:10:33 PM Closing Date : Jun 5, 2020, 4:59:00 AM Full-time A.M. P.M. Posting Salary : COMPETITIVE SALARY Organization: Health and Hospital Systems
Location: 600 W. Jackson Blvd., Chicago, IL 60661 Shift: Days
Job Summary
The Delegation and Vendor Oversight (DVO) Manager, Health Plan Services is responsible for providing assistance with oversight of delegates and vendors contracted with CountyCare. This position will be onboard and monitor delegates and vendor contracts and relationships. Manages an expanding managed care population for Medicaid and Medicare and implements enhanced capabilities for accountability and integrity of daily operations. Adheres to fraud and abuse prevention and/or detection policies and programs according to regulatory requirements. This position is exempt from Career Service under the CCH Personnel Rules.
Typical Duties
- Performs pre-delegation and annual audits per regulatory, State, and accreditation standards for all delegates.
- Assists on onboarding new delegates and vendors and measuring each delegate and vendors Key Performance Indicators and contracted metrics.
- Remains current with each delegate and vendor contracts and scope of work and updating scope of works as needed.
- Establishes a strong relationship with each vendor and contractor to meet set key performance indicators.
- Participates and may facilitate Joint Operation Meetings including Delegation and Vendor Oversight Committee.
- Assists drafting Request for Proposals and collaborating with Supply Chain Management Procurement process.
- Takes corrective action as necessary to address disciplinary concerns; makes recommendations to diminish the impact on productivity.
- Implements enhanced capabilities for accountability and integrity of daily operations.
- Plans and directs all aspects of the operations for assigned products and programs.
- Oversees all aspects of assigned products and programs, establishing objectives, policies and procedures.
- Implements enhanced capabilities for accountability and integrity of daily operations
- Ensures operational processes and policies are compliant with corporate standards and applicable local, state and federal regulations. Oversees all aspects of assigned products and programs, establishing objectives, policies and procedures
- Provides resolutions to managed care contractual issues pertaining to contract interpretation.
- Adheres to confidentiality standards and HIPAA compliance programs.
- Performs other duties as assigned.
Minimum Qualifications - Bachelor's Degree from an accredited college or university is required
- Two (2) years of health plan experience in a Medicare health plan, Medicaid health plan, or health system including aspects of operations oversight, administration, management, delegation and vendor oversight is required
- One (1) year of experience managing delegates and vendor relationships such as a Third Party Administrator, Vision, Dental, and Transportation vendors and Pharmacy Benefit Manager, etc is required
- Intermediate proficiency with Microsoft Office Suite (Access, Excel, PowerPoint and Word) (May be required to test for proficiency) is required
Preferred Qualifications -
Masters degree from an accredited college or university is preferred
Knowledge, Skills, Abilities and Other Characteristics
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Knowledge of the principles of Medicaid and Medicare Managed Care principles and management practices . -
Knowledge and familiarity with Medicare and/or Medicaid insurance payment systems, inpatient and outpatient reimbursement, such as Diagnosis-related group (DRG) reimbursement and/or Enhanced Ambulatory Patient Groupings (EAPG) reimbursement structures -
Knowledge and understanding of implementation, startups and operationalizing delegates and vendors -
Proficient with Microsoft Office Suite (Access, Excel, PowerPoint and Word) -
Excellent interpersonal, verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups -
Excellent program development, management and leadership skills -
Demonstrates good computer and typing skills -
Demonstrate good phone and email etiquette skills with strong response times -
Demonstrate analytical and organizational, problem-solving, critical thinking and conflict management/resolution skills -
Demonstrate attention to detail, accuracy and precision to support research and presentation skills -
Ability to prioritize, plan and organize projects and tasks -
Ability to multi-task and meet deadlines in a fast paced and stressful environment -
A bility to maintain a professional demeanor and composure when challenged -
Ability to function autonomously and as a team member in a multidisciplinary team -
Ability to train by presenting concepts and demonstrating tasks -
Ability to perform accurate and reliable mathematical calculations to support reimbursement analysis and measure financial performance -
Ability to work flexible hours VETERAN PREFERENCE PLEASE READ When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service. To take advantage of this preference a Veteran must :
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Meet the minimum qualifications for the position. -
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?" -
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable OR A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing. If items are not attached, you will not be eligible for Veteran Preference VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
BENEFITS PACKAGE - Medical, Dental, and Vision Coverage
- Basic Term Life Insurance
- Pension Plan
- Deferred Compensation Program
- Paid Holidays, Vacation, and Sick Time
- You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview. *Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen. *CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor. COOK COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER |
