The Sr. Specialist, Delegation Oversight is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with DMHC and DHCS requirements including delegation standards and requirements contained in the Molina Medical Compliance and Fraud, Waste and Abuse Program.

　　Remote position. (M-F 8:00 AM to 5:30 PM PST).

　　For this position we are seeking a candidate with previous data analysis and/or project management experience. A background in Utilization Management, Claims, Credentialing and Delegation Oversight is beneficial. Able to work independently in a high-volume environment. Further details to be discussed during our interview process.

　　KNOWLEDGE/SKILLS/ABILITIES

　　Coordinates, conducts, and documents delegation assessments as necessary to comply with state, federal, and any other applicable Access and Availability and Network Adequacy requirements.

　　Prepares status reports from Delegated Entities. Develops corrective action plans when deficiencies are identified, and documents follow-up to completion. Ensures compliance with Access and Availability and Network Adequacy reporting requirements

　　Develops corrective action plans when Access and Availability compliance issues are identified, and document follow-up to completion.

　　Works with Network Management team to develop and maintain delegation agreements and assessment tools related to the evaluation of Access and Availability and Network Adequacy.

　　Prepares delegation oversight document evidence for state and federal monitoring and NCQA accreditation surveys and participates on Molina’s work team as needed.

　　With limited supervision, the Sr. Specialist, Delegation Oversight is responsible for data compilation, data management, data analysis, and reporting.

　　Extracts and consolidates data from multiple sources, using industry-based tools or manually; able to process data effectively using Microsoft Excel.

　　Supports department leadership with developing project plans, monitoring and reporting status of project tasks, and reporting on overall status of projects.

　　Develops ongoing oversight, data validation audits, Corrective Action Plans, and monitoring/tracking functions based on external regulatory audit results.

　　Develops and analyzes trend reports to ensure contractual and regulatory compliance and performance improvement standards and for identification of any training needs.

　　Demonstrates strong analytical and problem-solving skills; self-starter.

　　Demonstrates ability to work independently or in a team, support multiple projects at once, and perform other duties or special projects as required.

　　JOB QUALIFICATIONS

　　Required Education

　　Bachelor's Degree or equivalent combination of education and experience.

　　Required Experience

　　3+ years experience in Access and Availability and Network Adequacy

　　Data analysis experience

　　Required License, Certification, Association

　　Valid State Driver's License

　　Preferred Education

　　Bachelor's Degree in Business or Health Care related field.

　　Preferred Experience

　　3 Years Access and Availability and Network Adequacy

　　Strong technical proficiency in data analysis; database software

　　5 years managed care experience.

　　2 years delegation oversight experience

　　Regulatory audit experience

　　Project management experience

　　Proficient in MS Excel

　　Pay Range: $52,199 - $101,788 / ANNUAL

　　*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.