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Supervisor, Compliance Delegation - 25-174

Supervisor, Compliance Delegation - 25-174

Hill Physicians Medical GroupSan Ramon, CA, US
23 days ago
Job type
  • Full-time
Job description

Compliance Delegation Supervisor

We're delighted you're considering joining us! At Hill Physicians Medical Group, we're shaping the healthcare of the future : actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team! Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement : At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description

Under direct supervision of the Manager, Compliance Delegation and support the Compliance Officer, this position will provide guidance, supervise, assist with the schedule of the daily workflow of Compliance Delegation Specialist I, and performing tasks for the Compliance Delegation Function. The supervisor assists the Manager in ensuring the appropriate implementation of the compliance delegation programs, monitoring of outcomes, and appropriate interventions. The supervisor tracks, distributes and ensures new regulatory requirements are researched and implemented as appropriate. The supervisor also conducts, analyzes, and reports internal monitoring, identifying / supporting compliance risks and interventions as it relates to Hill Physicians Medical Group compliance with delegated activities including NCQA, state and federal regulatory requirements, and health plan delegation oversight programs for all regions. Performs compliance monitoring of systems, processes, and resources used by Hill Physicians to support the delegation program for compliance.

Job Responsibilities

  • Health Plan Delegation Audit Requests and Monitoring
  • Researches, Tracks and Monitors the regulatory changes received and ensures distribution to appropriate operational areas timely and follow-up of implementations.
  • Supports external audit requests with file preparation and monitoring reviews, prepares or coordinates response for audit tools, corrective actions, or other requests from the health plans or regulators.
  • Assists and collaborates with the compliance delegation team and operational departments to prepare and review requested Health Plan audit files, corrective action plans (CAPs), CAP responses to Health Plans, and implementation plans to accomplish goals.
  • Assists Manager with ongoing monitoring of implementation corrective plans or new workflows.
  • Conducts preparing requests and reviews during compliance investigations to ensure compliance with policies and procedures, health plan, regulatory or other requirements.
  • Assists Manager in ensuring compliance with regulatory and contractual requirements through Utilization Management and Quality Improvement policies and procedures.
  • Assists Manager with ongoing monitoring of implementation corrective plans or new workflows.
  • Identifies areas of risk utilizing regulatory guidance and benchmark tools, provides recommendations to the Manager for improvement. and assists in developing action plans for improvement.
  • Participates in the preparation of responses for Corrective Action Plans and ensures compliance and adherence to all corrective action activities outlined in CAP.
  • Ensures that plan receives timely responses, and any issues are immediately addressed and escalated when appropriate.
  • Collaborate with other areas of the business to develop internal training materials and training of other departments on guidelines and processes.
  • Assists the Manager with recommending solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences.
  • Develop and implement root cause resolutions to internal and external operational and personnel issues.
  • Monitors, tracks, and communicates with relevant departments regarding quality improvement trends, and assists in preparations of metric reports and development of meaningful improvement plans.
  • Provides immediate feedback to appropriate parties regarding corrective action.
  • Reviews processes and / or policies and provides recommendations to the Manager for improvement.
  • Any other duties or projects as assigned to support the Compliance Team.

Required Experience

  • Excellent verbal and written communication skills required with attention to detail.
  • Excellent analytical skills required.
  • Excellent presentation and interpersonal skills required.
  • Previous experience presenting to management and / or external constituents required.
  • Knowledge of clinical and industry terminology and procedures preferred.
  • Knowledge of NCQA, CMS, DMHC, HEDIS, California Health and Safety Codes, and Milliman, Care Guidelines.
  • Teaching and training experience in a health care setting.
  • Policy and procedure writing with an emphasis on regulatory guidelines.
  • Critical thinking skills and analytical experience in utilization and quality management.
  • Comfortable navigating various system applications.
  • Proficient (advanced skill) in MS Office applications, (Word, Excel, and Outlook required).
  • Management experience in a health care setting.
  • Knowledge of regulatory and accrediting requirements specific to Utilization Management, Quality Improvement, and Managed Healthcare.
  • Knowledge of Compliance Program requirements, implementation, and monitoring.
  • Ability to work effectively with a variety of customers including physicians, managers, providers, office staff, health plans, and internal staff members.
  • Other duties as assigned.
  • Hybrid Remote, On-site and Work from Home.

    • Required Education

  • Bachelor's degree in related field or equivalent experience, 3+ plus years of experience in healthcare / law, or equivalent experience. 6+ years in Compliance Delegation Health Plan Audits.
  • Previous experience as a lead in a functional area, managing cross-functional teams on large-scale projects or supervisory experience including hiring, training, assigning work, and managing the performance of staff.
  • Preferred Compliance Certification CHC, must obtain certification to advance.

    • Additional Information

    Salary : $100,000 - $125,000 Yearly

    Hill Physicians is an Equal Opportunity Employer

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    Compliance Supervisor • San Ramon, CA, US