Current jobs related to Delegation Oversight Specialist - philadelphia - Blue Cross and Blue Shield Association

  • Utilization Management RN Specialist

    1 month ago

    Philadelphia, Pennsylvania, United States Open Systems Technologies Full time

    Job Title: Utilization Management RNWe are seeking a skilled Utilization Management RN to join our team at Open Systems Technologies. As a Utilization Management RN, you will play a critical role in ensuring compliance with federal and state laws, accreditation standards, and company policies.Key Responsibilities:Conduct audits and ongoing monitoring of...

  • Behavioral Specialist Consultant

    1 week ago

    Philadelphia, Pennsylvania, United States Mitchell Martin Full time

    Job Summary: Mitchell Martin is seeking a highly skilled Behavioral Specialist Consultant to join our team. As a key member of our clinical staff, you will be responsible for providing clinical direction and oversight to our youth services team. This includes developing and implementing individualized treatment plans, collecting and analyzing data, and...

  • Behavioral Specialist Consultant

    1 month ago

    Philadelphia, Pennsylvania, United States Mitchell Martin Full time

    Job Title: Behavioral Specialist ConsultantWe are seeking a highly skilled Behavioral Specialist Consultant to join our team at Mitchell Martin. As a key member of our team, you will be responsible for providing clinical direction and oversight of services to individuals, including the implementation of individualized treatment plans.Key...

  • MSAT Specialist

    2 weeks ago

    philadelphia, United States Planet Pharma Full time

    MSAT 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 owning steps of the manufacturing process tech transfer. The MSAT Specialist is also...

  • MSAT Specialist

    3 weeks ago

    Philadelphia, United States Planet Pharma Full time

    MSAT 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 owning steps of the manufacturing process tech transfer. The MSAT Specialist is also...

  • Quality Assurance Specialist

    1 month ago

    Philadelphia, Pennsylvania, United States Meet Full time

    Quality Assurance Engineering SpecialistMeet our growing Biotech client, seeking a Quality Assurance Engineering Specialist/Senior level to join their team in Philadelphia, PA.Job Summary:As a Quality Assurance Engineering Specialist in the pharmaceutical industry, you will play a critical role in ensuring the quality and compliance of our products...

  • Quality Assurance Specialist

    1 week ago

    Philadelphia, Pennsylvania, United States Meet Full time

    Job Title: Quality Assurance SpecialistJob Summary:Meet is seeking a Quality Assurance Specialist to ensure the quality and compliance of our products throughout the development and manufacturing processes. As a Quality Assurance Specialist, you will collaborate with cross-functional teams to implement quality assurance strategies, conduct risk assessments,...

  • Water Management Specialist

    1 month ago

    Philadelphia, Pennsylvania, United States Veolia Water Technologies (VWT) Full time

    Job Title: Water Management SpecialistVeolia Water Technologies, Inc. is seeking a highly skilled Water Management Specialist to join our team in the greater Philadelphia area.Job Summary:The Water Management Specialist will be responsible for managing total account responsibility within the assigned territory, ensuring profitability of accounts, and...

  • OB Hospitalist Specialist

    2 weeks ago

    Philadelphia, Pennsylvania, United States Integrity Healthcare Full time

    Join Our Team as an OB Hospitalist!We are seeking a highly skilled and dedicated OB Hospitalist to join our team at Integrity Healthcare. As a key member of our maternity care team, you will provide medical oversight for the Labor and Delivery and Post Partum Units, ensuring the care and safety of maternity patients.Key Responsibilities:Provide medical...

  • EHS Specialist

    3 weeks ago

    Philadelphia, Pennsylvania, United States The British Standards Institution (BSI) Full time

    About the RoleWe are seeking a highly skilled and experienced EHS Specialist to join our team at BSI. As an EHS Specialist, you will play a critical role in ensuring the health, safety, and environmental well-being of our clients and their employees.Key ResponsibilitiesAssist with laboratory inspections and investigations to identify and mitigate potential...

  • MSAT Specialist

    2 weeks ago

    Philadelphia, United States Planet Pharma Full time

    OverviewThe 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 owning steps of the manufacturing process tech transfer. The MSAT Specialist is also responsible for...

  • Cybersecurity Specialist III

    1 week ago

    Philadelphia, Pennsylvania, United States H2 Performance Consulting Full time

    H2 Performance Consulting is committed to building a diverse workforce and is an Equal Opportunity/Affirmative Action Employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status or disability status.The...

  • Financial Management Specialist

    2 weeks ago

    Philadelphia, Pennsylvania, United States Michael Page Full time

    Our client, a reputable commercial General Contractor, is seeking a skilled Financial Management Specialist to lead their accounting department. The ideal candidate will oversee all accounting functions, including payroll, accounts payable, accounts receivable, and general ledger management. Additionally, they will be responsible for coordinating with...

  • Data And Reporting Specialist

    1 month ago

    Philadelphia, United States Partner's Consulting, Inc. Full time

    Title: Business Analyst I - Data & Reporting SpecialistLocation: Philadelphia, PAType: ContractOur client is seeking a Business Analyst I who will lead efforts to utilize data, trend analysis, and reporting to improve processes and drive efficient solutions. The Business Analyst I will gather, develop, validate, and analyze data across multiple teams and...

  • Data And Reporting Specialist

    1 month ago

    Philadelphia, United States Partner's Consulting, Inc. Full time

    Title: Business Analyst I - Data & Reporting SpecialistLocation: Philadelphia, PAType: ContractOur client is seeking a Business Analyst I who will lead efforts to utilize data, trend analysis, and reporting to improve processes and drive efficient solutions. The Business Analyst I will gather, develop, validate, and analyze data across multiple teams and...

  • Financial Operations Specialist

    1 week ago

    Philadelphia, Pennsylvania, United States Jefferson Health Full time

    Job SummaryThe Financial Operations Specialist will be responsible for providing financial and operational oversight to the Division of Pulmonary, Allergy, and Critical Care and the Division of Hospital Medicine. This role will involve preparing budgets, financial forecasts, and analyzing variances. The successful candidate will also be responsible for...

  • Senior Quality Assurance Specialist

    1 week ago

    Philadelphia, Pennsylvania, United States Meet Full time

    Job Title: Senior Quality Assurance SpecialistJob Summary:We are seeking a highly skilled Senior Quality Assurance Specialist to join our team. As a key member of our quality assurance team, you will play a critical role in ensuring the quality and compliance of our products throughout the development and manufacturing processes.Key Responsibilities:Quality...

  • Industrial Hygiene Specialist

    2 weeks ago

    Philadelphia, Pennsylvania, United States Tetra Tech Full time

    About the RoleTetra Tech is seeking a highly motivated and detail-oriented Industrial Hygiene Specialist to join our team in Philadelphia, PA. As an Industrial Hygiene Specialist, you will assist a multidisciplinary team of scientists and engineers to oversee the real-time collection of asbestos field data at sites throughout the City of Philadelphia.The...

  • Quality Assurance Engineering Specialist

    2 weeks ago

    Philadelphia, Pennsylvania, United States Meet Full time

    Meet Our Team:We are seeking a highly skilled Quality Assurance Engineering Specialist to join our team in Philadelphia, PA.About the Role:As a Quality Assurance Engineering Specialist, you will play a critical role in ensuring the quality and compliance of our products throughout the development and manufacturing processes. You will collaborate with...

  • Utilization Management RN

    3 weeks ago

    Philadelphia, United States Open Systems Technologies Full time

    Job DescriptionJob DescriptionContract to Hire position!Job Category Insurance Professional & ClinicalJob Title Utilization Management RNJob DescriptionThe candidate MUST have Managed Care, audit and oversight experience on utilization management, and case management and must have unrestricted RN license to practice either in NJ or PA.. The candidate MUST...

Delegation Oversight Specialist

3 months ago

philadelphia, 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.