Quality Delegation Specialist

P3 Health Partners is committed to ensuring the health and safety of our team members, patients and communities we serve. As a part of this commitment, all candidates must receive their COVID-19 vaccine prior to joining the team. If you have any questions about our interview and hiring procedures, please contact PeopleServices@p3hp.org.

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

We are looking for a Quality Delegation Specialist. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Las Vegas, Nevada, then you should consider joining our team.

QUALITY DELEGATION SPECIALIST

Job Purpose: The Quality Delegation Specialist supports the Manager, Quality Delegation in preparing for health plan client delegation oversight audits and maintaining federal, national, state and health plan regulations. In addition, he/she prepares program work plans, program descriptions, and program evaluations, as well as assists with other projects as assigned. The Quality Delegation Specialist develops and executes Quality Committees. The Quality Delegation Specialist is responsible for performing internal audits, conducting continuous analysis of findings, and identifying opportunities for improvement, reporting findings to the Manager, Director, and VP. The Quality Delegation Specialist must be forward-thinking and innovative to collaborate with different departments and streamline processes.

Department Purpose: The Medical Management Department encompasses Utilization Management, Quality Management, and Care Management. The Quality Management ensures compliance with policies and procedures as dictated by but not limited to the following: Centers for Medicare and Medicaid Services (CMS), the National Committee on Quality Assurance (NCQA), and respective health plans.

Key responsibilities:

• Monitor Quality Committee Compliance
• Documentation (Agenda, Meeting Minutes, Action Items), PowerPoint, timelines, annual documents (Confidentiality & Affirmative Statements)
• Assist with policy and standard operating procedure development
• Assist with Annual Program Documents-creating, tracking, and updating
• Develop and execute National Quality Committees (QUC, MEC, Peer Review)
• Assist with CAP responses
• Assist with External Audit preparation
• Conduct monthly quality assurance phone monitoring
• Provide feedback with barriers to Supervisor/Manager/Director
• Assist with monthly phone metrics
• Assist with monthly internal denial file audits
• Distribute and compile responses for the quarterly Provider Satisfaction with Utilization Management Survey
• Compile response for the quarterly Member Satisfaction with Care Management
• Assist with monitoring quality of care related complaints
• Assist with Sub-delegate audits and monthly monitoring of all sub delegates
• Delivery of monthly/quarterly reports to each health plan and SNP plan
• Objectively review an organization's business processes
• Evaluate the efficacy of risk management procedures that are currently in place
• Ensure that the organization is complying with relevant laws and statutes

Qualifications:

• Bachelor’s Degree in Health Care Administration, Public Policy, Compliance, Business Administration, Accounting or another related field
• 3 years’ experience with policies and procedures
• 2 years’ experience in a Managed Care environment
• Knowledge of federal, national, state, and health plan regulatory requirements
• Analytical and critical thinking
• Business acumen
• IT skills
• Effective communication
• Project management
• Master’s Degree preferred