UM, Delegation Specialist
3 weeks ago
Under the general direction of the UM Delegation Specialist, the UM Delegation Coordinator is responsible for preparing, coordinating, and collaborating with UM and MPM departmental teams to facilitate delegated activities i.e. audit documents, regulatory reporting, and regulatory committee meetings. The UM DO Coordinator must have the ability to deliver quality results with tight deadlines and maintain accurate records and documentation.
Duties and Responsibilities
· Prepare and submit all standard and nonstandard compliance documents and research-related issues of a highly complex nature and recommend solutions
· Requests, collects, and distributes a variety of documentation from departmental teams necessary to facilitate the auditing and monitoring functions
· Ensures auditing and monitoring documentation is complete, and received promptly
· Interacts with departmental and MPM stakeholders for deliverable reviews and approvals
· Maintain MPM and Health Plan training materials
· Attend scheduled UM Committee meetings and assist with developing meeting packets, minutes, and follow up on action items for all client groups
· Assist with the development and reporting of quarterly & annual UM ICE Coalition reports
· Assist with maintaining and updating PPG Policies and Procedures per health plan and regulatory requirements
· Collaborate with UM delegation specialist and work closely with the VP of Medical Affairs and key contact for all UM compliance and non-compliance-related inquiries and issues
· Assist with UM pre-delegation/Annual Audit UM Document submission
· Assist with the development of NCQA/Audit Standards road mapping
· Assist with guidance and support on complying with delegated plan functions
· Perform any other job-related assignments, as needed
Minimum Job Requirements
· Knowledge of and application of regulatory and quality standards and measures including but not limited to State Medicaid Programs, Medicare, and Quality Accreditation (e.g., State Medicaid regulations, CMS, NCQA, etc.)
· 2+ years of Managed Care experience required.
· Knowledge of audit processes and applicable federal regulatory and accredited standards
Skill and Abilities
· Effective verbal and written communication skills, a must
· Exceptional attention to details
· Excellent planning and organizational skills
· Ability to prioritize and manage multiple tasks simultaneously
· Strong interpersonal skills; ability to collaborate effectively with both internal and external contacts
· Ability to work independently and take direction
MedPOINT, a large MSO in the San Fernando Valley, offers competitive salaries and benefits in a collaborative working environment. For immediate consideration of this position, please e-mail your resume and salary requirements to personnel@medpointmanagement.com
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