FAQs
What is the primary role of a Delegation Oversight Specialist - RN?
The primary role of a Delegation Oversight Specialist - RN involves overseeing delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements.
What are the key responsibilities of this position?
Key responsibilities include coordinating and conducting pre-delegation and annual NCQA assessments, monitoring vendor compliance, reviewing Delegated Entity reports, developing corrective action plans, presenting delegate performance to committees, and analyzing regulatory changes.
What qualifications are required for this role?
Candidates must have an active, unrestricted RN license, experience in Utilization Review and/or Case Management, and three years of auditing experience using NCQA guidelines. Knowledge of delegation oversight processes and Part C regulations is preferred.
Is experience with Office365 necessary for this position?
Yes, intermediate proficiency in the use of Office365 (e.g., Word and Excel) is required for this role.
How does the Delegation Oversight Specialist contribute to compliance and risk assessment?
The specialist conducts risk assessments to identify required audit areas, analyzes existing and proposed regulations, and helps to ensure the adequacy of controls in oversight activities based on regulatory changes.
Will the specialist work alone or in collaboration with others?
The Delegation Oversight Specialist will work collaboratively with the Delegation Manager/Director to develop, establish, and maintain departmental processes and procedures.
Are there any additional duties expected from the Delegation Oversight Specialist?
Yes, the position may require the performance of other duties as necessary in addition to the outlined responsibilities.
What type of communication skills are necessary for this role?
Excellent written and verbal communication skills are essential for effectively presenting data, developing documents, and interacting with various stakeholders.
What is the significance of conducting audits for this position?
Audits are crucial for ensuring that vendors comply with state, federal, and accreditation requirements, which helps in maintaining quality and accountability within the delegated activities.