Delegation Oversight Specialist-RN

Immediate need for a talented Delegation Oversight Specialist-RN. This is a 06+ Months Contract opportunity with long-term potential and is located in Philadelphia, PA (Hybrid). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-89458

Pay Range: $45 - $49/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• Coordinates, conducts and documents delegation assessment as necessary to comply with state, federal, NCQA and any other applicable requirements.
• Perform pre-delegation assessment
• Conduct audits and prepare audit reports of assigned vendors.
• Prepare and present audit reports to the Delegation Oversight Committee.
• Develop corrective action plans when deficiencies are identified, documents follow-up to completion
• Ensure compliance with reporting requirements by tracking receipt and completeness of reports.
• Prepare and maintain documentation required for delegation readiness and ongoing compliance.

Key Requirements and Technology Experience:

• Skills-Compliance, NCQA & Medicare, Utilization Review.
• 3-5 years of experience in regulatory, accreditation or compliance role within the health insurance, health or managed care industry.
• Must have an active, unrestricted license in PA.
• Knowledge of applicable federal, state regulations and accreditation (NCQA).
• A strong understanding of ACA and Medicare benefits and regulations including QHP and Medicare Advantage requirements.
• Excellent verbal and written communication skills
• High attention to details
• Ability to manage multiple priorities
• Must have strong proficiency in Microsoft Excel, including the ability to organize and analyze data, create and manage spreadsheets, utilize formulas, and generate reports.   

Our client is a leading Health Insurance Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
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