Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

This position is responsible for performing compliance monitoring of sub-contracted organizations, working collaboratively with departments across CareOregon. Primary responsibilities include delegation oversight, process improvement, and reporting.

Essential Responsibilities

Delegation Oversight

• Work at the guidance of and with input from the Regulatory Manager to interpret and apply complex regulations, laws, and guidelines and to evaluate delegated entities for compliance with contractual and regulatory requirements.
• Work in coordination with the Delegation Oversight Committee, Quality Assurance Unit, Medical Directors, and other stakeholders throughout CareOregon.
• Conduct pre-delegation and annual audits for new and existing delegated entities for compliance in areas outlined in delegated agreements; oversee any Corrective Action Plans (CAP) resulting from such reviews.
• Ensure delegation expectations and standards are clearly understood by contractors.
• Ensure the contractor performs the delegated activities in accordance with the agreement and regulatory requirements.
• Develop, revise, and maintain all delegation audit tools and written agreements as necessary to comply with regulatory requirements.

Process Improvement

• Participate in the process of identifying ongoing opportunities for process improvement.
• Act as a resource to health plan partners and identify training opportunities that result in improvement.
• Participate in workgroup meetings related to regulatory expectations.

Reporting

• Prepare all audit reports including correspondence and corrective action plans to ensure that provider satisfies all requirements within allotted timeframes.
• Maintain all documentation to support evidence of compliance with all delegation requirements.
• Maintain responsibility for tracking, completion, and timely submission of required reports to CareOregon by subcontracted organizations.
• Present audit findings to the Delegation Oversight Committee.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 2 years' experience in regulatory compliance and/or delegation oversight (Master's degree in law, health care, or related field may be considered in lieu of experience)

Preferred

• Experience in a managed care setting with a background in Oregon Health plan (Medicaid) and the Centers for Medicare and Medicaid Services (CMS)
• Bachelor's Degree in a health-related field helpful

Knowledge, Skills and Abilities Required

Knowledge

• Understanding of, or ability to quickly learn, health plan functions and how they relate to delegation

Skills and Abilities

• Competency with computer software programs, e.g., MS Outlook, Word, Excel, and PowerPoint

• Effective communication skills, including written, verbal, and listening
• Growing engagement and partnership skills with a broad array of stakeholders
• Ability to research, understand, interpret, and communicate federal and state requirements, including the Code of Federal Regulations, Oregon Revised Statutes and Administrative Rules, with some input from Regulatory Manager as needed
• Ability to learn and perform all aspects of audit activities, including developing audit plans (objectives, methodology, sampling, testing), preparing work papers, and documenting evidence in accordance with professional auditing standards
• Growing ability to prepare clear, concise, and objective audit reports with recommendations for improvement and communicate findings including performing appropriate follow-up, with input from Regulatory Manager as needed
• Ability to use critical thinking skills in problem solving
• Growing ability to set work goals independently and prioritize work to balance competing deadlines in a professional manner, while managing multiple tasks
• Ability to maintain strict confidentiality of information
• High degree of initiative and motivation
• Ability to work in an environment with diverse individuals and groups
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.