Delegated Oversight Support Director

Summary

MedPOINT Management, Inc. (MPM) provides all aspects of managed care management services to Independent Physician Associations (IPAs) and hospital clients.  The Director of Delegation Oversight Support (DOS) position plays an important, strategic client relationship role for IPA/hospital clients; their Health Plans; and regulators.  As Director of DOS you will report directly to the Compliance Officer; primary responsibilities include:

• Managing effective, timely, and compliant support for audits and request for information from upstream business partners
• Compliance oversight of potential and existing MPM vendors to ensure ongoing regulatory/ contractual compliance
• Building positive, collaborative relationships with MPM functional areas to develop key performance indicators (KPIs) and effective/efficient methods for responding to client audits/requests for information
• Manage client reporting for internal and external delegation oversight audit activity

Duties and Responsibilities

• Manage all external audits/requests for information from business partners, ensuring accurate, timely and compliant submissions
• Develop and maintain methods/tools that support accurate and timely submissions
• Develop and maintain monitoring methods/tool to self-identify and correct potential noncompliant information prior to submissions
• Support MPM functional areas to develop root cause analysis and potential solutions and to corrective action plans (CAPs) requested from clients’ HPs (CAPs)
• Create and maintain P&Ps that document methods and protocols
• Create an annual plan to perform oversight activities of existing MPM delegated vendors (audit, monitoring, attestations)
• Create and maintain a Delegated Vendor inventory list/database, which includes MPM’s representative responsible for relationship management, compliance/oversight requirements, etc.
• Coordinate pre-delegation and ongoing delegation monitoring and auditing as applicable with internal SMEs.
• Maintains documentation in regards to all delegation oversight activities.
• Establishes defined sanction/disciplinary policy terms for delegate vendors to encourage positive performance/discourage poor performance and non-compliance
• Creates and maintains P&Ps defining timelines; extension request and review process; delay documentation including rationale; CAP request process; and audit closeout process.
• Collaborates with internal SMEs from functional areas who are liaisons to the Compliance/Delegated Oversight function
• Working with functional SMEs, develop KPI reporting to monitoring ongoing, compliant performance for all operational areas
• Create dashboard reporting for functional and Senior leadership, including proactive trend analysis to prevent/detect timely potentially noncompliant scenarios
• Chair Delegation Oversight meetings and presents results to MPM and client Senior Leadership
• Management of small team within the Compliance department (e.g., Project Manager, Project Analyst)

Minimum Job Requirements

• BS/BA required, Master’s Degree preferred
• Strong familiarity with California State and CMS healthcare regulations & vendor management experience
• Minimum of 5 years’ experience working in health care operations with a focus on vendor management
• Minimum 3 years’ leadership experience in Legal, Compliance, and/or Vendor Management roles
• Prior experience with government programs (Medicaid and Medicare), regulatory and compliance standards
• Knowledge of Legal, Contractual, and Regulatory language
• Knowledge and experience in vendor Delegation Oversight
• Proficiency in Microsoft Office Suite, Smartsheet, and other software

Knowledge, Skills and Abilities Required

• Capability of effective planning and priority setting; excellent multitasking/organization skills
• Ability to communicate effectively and maintain client relationships
• Excellent writing skills for P&P development and stakeholder messaging
• Ability to demonstrate leadership strength through action
• Ability to communicate with all levels of management and influence employees through strong communication and presentation skills