Analyst, Delegation Oversight

Role Description

Provides analyst support for delegation oversight activities including monitoring delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Responsible for gathering, coordinating, analyzing, and processing compliance data from the provider network delegates, and providing support for quality assurance compliance measure requirements and delegation oversight committee meetings.

• Monitors delegated activities to ensure compliance with state health plan and National Committee for Quality Assurance (NCQA) requirements to include:
  • Tracking receipts of monthly reports from delegated entities
  • Monitoring monthly reports for continued compliance with delegated responsibilities
  • Meeting with delegation oversight auditors monthly to review reports and identify need for corrective action measures
  • Producing summary reports presented at delegation oversight committee meetings
• Reports on delegated entity performance using web-based compliance tool, including performance metrics and remediation efforts when performance falls below acceptable standards.
• Participates in planning meetings and communicates to delegation oversight team and provider network team, delegate needs during development of new software platforms.
• Develops new and maintains existing department reporting tools to ensure reporting of performance and compliance with all NCQA, Centers for Medicare and Medicaid Services (CMS), and applicable state standards.
• Supports the delegation oversight committee meeting, including agenda and document preparation, distribution of meeting materials, minute taking and scheduling of follow-up meetings as necessary.
• Maintains list of delegated entities including functions delegated, auditors responsible, and delegation exceptions.
• Provides administrative delegation oversight-related support including training, department SharePoint site maintenance, and updates to the monthly sanction list tracking tool.
• Maintains member/provider confidentiality and professionalism in all communications.

Qualifications

• At least 2 years of experience data management experience in a professional setting, preferably in health care, or equivalent combination of relevant education and experience.
• Data processing/analysis experience.
• Ability to interpret error reports and identify remediation steps.
• Ability to function independently and autonomously.
• Attention to detail, critical-thinking and problem-solving/analytical abilities.
• Experience with SharePoint and PowerBI.
• Ability to maintain attendance to support required quality and quantity of work.
• Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.
• Effective interpersonal and verbal/written communication skills.
• Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs.

Preferred Qualifications

• Delegation oversight experience.

Benefits

Molina Healthcare offers a competitive benefits and compensation package.

Company Description

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.