What are the responsibilities and job description for the UM Delegation Oversight Specialist position at MedPOINT Management?
Summary
Under the supervision of UM Delegation Oversight Sr. Supervisor, the UM Delegation Oversight Specialist’s primary role is to be the gatekeeper of all UM Compliance communication and deliverables that are requested by the health plan. This role is essential to the Delegation Oversight team to maintain Health Plan’s requests organized, timely submissions, or escalate to UM leadership when necessary to meet UM deadlines.
Duties and Responsibilities:
- Responsible for continuous oversight of UM and Compliance communication/requests received from the health plan:
- Conduct corrective action plan (CAP) response audit review and validation before submission to ensure response includes issue, root cause analysis, and remediation plan
- Point person to read and acknowledge all UM Compliance emails
- Disseminate request to UM point of contact (POC) by area of compliance request/audit
- Follow up with POC for compliance deliverables to meet deadlines
- Collect and compile from various sub-departments before submission to Compliance/Health Plan
- Manage and ensures appropriate and timely follow-up on internal and external deliverables
- Assist in preparation for UM Entrance and Exit Health Plan interviews including scheduling
- Update and maintain a smart sheet tracker to assign a point of contact and follow through with deliverables
- Interface with various departments for compliance-related activities, as needed
- Initiate UM and cross-departmental collaboration when a CAP is identified with multiple departments to strategize on short-and long-term goals to remediate risk
- Assist in the preparation of reports and ad hoc documents for presentation by leadership to appropriate meetings/committees.
- Attend UM/Compliance meetings as requested
Minimum Job Requirements:
- High School Diploma (Bachelor’s degree preferred)
- Knowledge of NCQA Standards, DMHC, DHCS, and CMS Regulatory Requirements
- 2 years’ experience in utilization management compliance preferred
- Advanced proficiency in Microsoft Suite (Excel, Word, PowerPoint)
- EZCAP knowledge a plus
Skills and Abilities:
- Strong organizational, task prioritization, and delegation skills
- Ability to multi-task while remaining adaptable and flexible in a fast-paced environment
- Ability to keep up with constant changes as needed from the health plan
Salary Range:
- $30 - $32 hourly
Salary : $30 - $32
