Delegation Oversight Specialist

3 weeks ago


Philadelphia PA, United States Blue Cross and Blue Shield Association Full time
Delegation Oversight Specialist - RN

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve. This Delegation Oversight Specialist - RN role involves oversight of delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements. Ideal candidate will be an excellent communicator (written and verbal) who is detail oriented, organized, able to read and interpret regulations and able to meet tight deadlines while handling multiple audits. Responsibilities include: * Coordinates, conducts and documents required pre-delegation assessments and annual NCQA assessments as necessary to comply with applicable state, federal and accreditation requirements, * Conducts necessary monitoring and auditing work to ensure vendors comply with state, federal, NCQA and other applicable requirements. * Review reports from Delegated Entities. * Develops corrective action plans when deficiencies are identified and document follow-up to completion. * Present delegate's performance to respective committees, including the preparation of documents for committee oversight of delegated functions. * Review implementation of new or changed regulatory requirements to help ensure adequacy of controls of oversight activities * Provide guidance of new or changed regulatory requirements and implementation of processes. * Analyzes and interprets existing and proposed legislation and regulations and determines their effects on delegation oversight process. * Conduct risk assessments to identify required audit areas and audit frequency. * Assist in developing audit tools of oversight activities. * Work collaboratively with Delegation Manager/Director to develop, establish and maintain departmental processes and procedures. * Performs other duties as required. Qualifications: * Active, unrestricted RN license * Experience with either Utilization Review and/or Case Management * Three years auditing experience using NCQA guidelines preferred * Experience in delegation oversight process and working knowledge of Part C Organization Determination regulations and NCQA Health Plan standards preferred * Intermediate proficiency in the use of Office365 (e.g. Word, Excel) required. Hybrid Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.



  • Philadelphia, PA, United States Blue Cross and Blue Shield Association Full time

    Delegation Oversight Specialist - RNBring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve. This Delegation Oversight Specialist - RN role involves...


  • philadelphia, United States Blue Cross and Blue Shield Association Full time

    Delegation Oversight Specialist - RNBring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve. This Delegation Oversight Specialist - RN role involves...


  • Philadelphia, PA, United States Blue Cross and Blue Shield Association Full time

    Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve. This Delegation Oversight Specialist - RN role involves oversight of delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements....


  • Philadelphia, Pennsylvania, United States Jefferson Health Full time

    Position Overview:The Controlled Substance Oversight Specialist, reporting to the Pharmacy Informatics Manager, is tasked with the systematic monitoring of all controlled substance (CS) activities across nursing, pharmacy, and anesthesia sectors. This role encompasses the management of storage, inventory, preparation, and distribution of controlled...


  • Philadelphia, PA, United States Discovery Senior Living Full time

    Resident Care Specialist - RN About Discovery Senior Living Discovery Senior Living ranks prominently among the 5 largestsenior housing providers in the US, and is nationally renowned for designing,developing, marketing, and operating a multi-brand portfolio of upscale, luxurysenior-living communities. With over 250 communities in nearly 40states, and...


  • Philadelphia, PA, United States Discovery Senior Living Full time

    Resident Care Specialist - RN About Discovery Senior Living Discovery Senior Living ranks prominently among the 5 largestsenior housing providers in the US, and is nationally renowned for designing,developing, marketing, and operating a multi-brand portfolio of upscale, luxurysenior-living communities. With over 250 communities in nearly 40states, and...


  • Philadelphia, United States Mitchell Martin Full time

    A well-known Health Services located in Philadelphia, PA has an immediate need for a Behavior Specialist Consultant Type: HC-Full-Time/ Perm Location: Philadelphia, PA Summary: To promote the mission of facility to help individuals achieve a more independent and fulfilling life by being an effective team member. The BSC provides clinical direction of...


  • Philadelphia, Pennsylvania, United States Community Behavioral Health. Full time

    Job SummaryCommunity Behavioral Health is seeking a highly skilled Clinical Leadership Specialist to provide clinical leadership and oversight of the clinical management of members. The ideal candidate will have a strong background in clinical psychiatry, with experience in inpatient care and substance abuse treatment.Key ResponsibilitiesProvide clinical...


  • Philadelphia, Pennsylvania, United States Ansible Government Solutions Full time

    OverviewAnsible Government Solutions, LLC is actively seeking skilled Echocardiography Specialists to enhance our operations. Our team is dedicated to providing exceptional cardiac ultrasonography services.Role ResponsibilitiesAs an Echocardiography Specialist, you will be responsible for:Demonstrating comprehensive knowledge of normal and abnormal cardiac...


  • Philadelphia, Pennsylvania, United States Deborah Heart and Lung Center Full time

    Position OverviewRole SummaryPosition Overview: The Rehabilitation Specialist is responsible for delivering therapeutic interventions to individuals experiencing physical impairments. This role involves educating patients, their families, and healthcare team members about the significance of rehabilitation therapy. The specialist will also collaborate with...


  • Philadelphia, Pennsylvania, United States Community Behavioral Health. Full time

    Job SummaryCommunity Behavioral Health is seeking a highly skilled and experienced Clinical Leadership Specialist to join our team. As a key member of our clinical leadership team, you will be responsible for providing clinical oversight and guidance to our care coordination team, ensuring that our members receive high-quality, evidence-based care.Key...


  • Philadelphia, Pennsylvania, United States Community Behavioral Health. Full time

    Job SummaryCommunity Behavioral Health is seeking a highly skilled and experienced Clinical Leadership Specialist to join our team. As a key member of our clinical leadership team, you will be responsible for providing clinical oversight and guidance to our care coordination team, ensuring that our members receive high-quality, evidence-based care.Key...


  • Philadelphia, Pennsylvania, United States The Philadelphia Academies Inc Full time

    Administrative Operations Specialist (full-time)The Administrative Operations Specialist will deliver essential operational assistance to the organization and the 9th Grade Success Network team. This includes managing financial documentation, overseeing supply logistics, coordinating events, and providing communication support. This position reports directly...


  • Philadelphia, Pennsylvania, United States Team Clean Inc. Full time

    Job OverviewPosition Title: Custodial Account Management SpecialistThe Custodial Account Management Specialist at Team Clean Inc. plays a crucial role in maintaining the precision and reliability of client accounts associated with custodial services. This position entails addressing account inconsistencies, offering assistance to clients, and working...


  • Philadelphia, Pennsylvania, United States Tetra Tech Full time

    About the RoleWe are seeking a highly motivated and detail-oriented Industrial Hygienist/Environmental Specialist to join our team at Tetra Tech. As an IH Specialist, you will play a critical role in overseeing the real-time collection of asbestos field data at various sites throughout the City of Philadelphia.Key ResponsibilitiesAssist a multidisciplinary...

  • Wound Care Specialist

    20 hours ago


    Philadelphia, Pennsylvania, United States Chapel Manor - Philadelphia, PA Full time

    Join Our Team as a Wound Care SpecialistChapel Manor Center in Philadelphia, PA is seeking a highly skilled and motivated Wound Care Specialist to join our team. As a key member of our nursing center, you will play a vital role in leading our skin health and wound management program.Key Responsibilities:Lead and integrate a fully developed Skin Health and...


  • Philadelphia, Pennsylvania, United States Iovance Biotherapeutics, Inc. Full time

    Position Overview: The Quality Control Analyst I – Sample Management is responsible for the efficient and timely distribution of quality control samples to support various quality control initiatives. This role involves managing sample inventory and overseeing both internal and external sample distribution, ensuring proper storage and shipping conditions...

  • MSAT Specialist

    1 week ago


    philadelphia, United States Planet Pharma Full time

    614140 MSAT SpecialistDirect HirePhiladelphia, PAMon-Friday standard business hoursMSAT SpecialistOverviewThe MSAT Specialist is a Manufacturing Operations cell therapy subject matter expert. The MSAT Specialist reports to the Senior Manager, MSAT and EM and is responsible for manufacturing data analysis, contributing to deviation root cause analysis, and...

  • MSAT Specialist

    1 week ago


    philadelphia, United States Planet Pharma Full time

    614140 MSAT SpecialistDirect HirePhiladelphia, PAMon-Friday standard business hoursMSAT SpecialistOverviewThe MSAT Specialist is a Manufacturing Operations cell therapy subject matter expert. The MSAT Specialist reports to the Senior Manager, MSAT and EM and is responsible for manufacturing data analysis, contributing to deviation root cause analysis, and...

  • MSAT Specialist

    3 weeks ago


    Philadelphia, United States Planet Pharma Full time

    614140 MSAT SpecialistDirect HirePhiladelphia, PAMon-Friday standard business hoursMSAT SpecialistOverviewThe MSAT Specialist is a Manufacturing Operations cell therapy subject matter expert. The MSAT Specialist reports to the Senior Manager, MSAT and EM and is responsible for manufacturing data analysis, contributing to deviation root cause analysis, and...