Risk & Oversight Manager III

Job Summary:

The Risk & Oversight Manager III is responsible for providing ongoing oversight and ensuring overall areas for delegation are operationalized and in compliance with state and federal provider agreements, business and accreditation requirements.

Essential Functions:

• Serve as a departmental subject matter expert in interpreting vendor and provider contract requirements, business, and compliance and regulatory requirements
• Maintain direct oversight for assigned vendors and providers
• Participate in the development and maintenance of departmental policies and procedures
• Monitor delegated/non-delegated vendor/providers and internal business owner relationships to ensure compliance, optimal delegate/non-delegate performance and achievement of business goals according to service level and other contractual requirements
• Attend and document meetings with stakeholders to provide performance metrics feedback and identify opportunities to reduce risk and cure corrective action plans
• Implement strategies to increase delegates/non-delegates engagement in driving toward quality outcomes and cost control initiatives
• Participate in the  development, approval and review of delegated/non-delegated contracts; ensure service levels meet current regulatory and quality baseline requirements
• Conduct pre-delegation assessments, ongoing delegation oversight, annual audits, deficiencies, and corrective action plans for vendors/providers.
• Participate in joint operating committee, quarterly business reviews strategic partner reviews, and operational meetings with business owners and delegated/non-delegated vendors and providers
• Implement monthly/quarterly/annual reporting and ensure timely receipt of accurate and complete all regulatory and contractually required reports for delegated vendor and provider activities
• Oversee delegate vendor and provider onboarding, including training, reporting and document retention; provide support to departments and business owners to enable effective management of delegates 
• Stay informed about the latest developments in delegation oversight field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources
• Develop and accomplish delegation program activities in support of company strategies, goals and objectives
• Coordinate activities with all levels of staff as well as with delegated and potentially delegated external entities through clear and concise verbal and written communication
• Identify problems, develop solutions and implement a chosen course of action
• Perform any other job duties as requested

Education and Experience:

• Associates degree or equivalent years of relevant work experience is required
• Minimum of three (3) years of experience in corporate compliance, vendor oversight, contract management, internal audit, quality assurance, strategic sourcing  or other highly regulated industry is required
• Experience in managing third party compliance and oversight of health-care related delegation activities, vendor audits and contracting is preferred

Competencies, Knowledge and Skills:

• Intermediate computer skills in Microsoft Office, specifically Excel and PowerPoint
• Strong knowledge in developing dashboard/ metrics reporting
• Other technologies may apply
• Knowledge of and application of regulatory compliance (Medicare, Health Exchange and/or Duals), quality measures (HEDIS/ STARS) and/or accreditation standards (NCQA/ URAC)
• Basic project management skills with ability to handle multiple projects within time constraints
• Strong interpersonal and verbal/written communication skills with demonstrated ability to influence internal/ external constituents
• Ability to interact with all levels of leadership, influence change, adoption of vendor management concepts, and lead cross-functional teams and initiatives
• Ability to handle responsibilities that are complex with results that may have long-range implications
• Highly motivated individual with the ability to work independently in a fast paced environment with changing priorities
• Knowledge of Federal, State, NCQA and  standards preferred

Licensure and Certification:

• Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel required to perform onsite audits, approximately 5%

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business