Delegation Project Leader
Delegation Project Leader
Delegation exists when an entity is contracted to perform functions and assume responsibilities on behalf of the organization. The organization retains final authority and, therefore, conducts periodic oversight of the delegate. The Delegation Project Leader will interact with all levels of management, internal and external customers such as vendors, providers, government officials, accrediting agencies and external consultants. Responsibilities will be to oversee the delegation of processes across multiple product lines by performing pre-delegation assessments, ongoing delegation oversight and auditing of delegated entities so as to ensure their policies and procedures, documentation, systems, staffing and ability to provide reports are operational and are in compliance with regulatory/statutory and as applicable accreditation guidelines. Assesses clinical care and activities related to quality, utilization management, and case management, interfaces with a diverse range of clinical and administrative professionals, resolves complex issues, and performs data analytic and reporting activities.
Responsibilities & Requirements
At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, and Accountability. These values are not just words on paper - we live them every day.
- Delegation Project Leader would have a/an Bachelor's Degree in Nursing and 6 years of professional experience in six years progressive experience in health care administration, project leader or project support or equivalent combination or related experience and education is required. At least three years experience must be in coordination and oversight of health-care related delegation activities and contracting. Master’s degree strongly preferred. or equivalent combination of education and experience.
- Experience in Utilization Management preferred.
- In depth knowledge of managed care principles.
- Ability to develop and accomplish delegation program activities in support of Regence wide strategies, goals and objectives. Demonstrated experience in project related work such as report preparation, project documentation, policy and procedure writing including ability to organize, analyze and interpret statistical data, and prepare corporate communications is required.
- Demonstrated knowledge of and application of regulatory and quality standards and measures including but not limited to Medicare, URAC, NCQA, etc.
- Ability to identify the need for clinical services delegated contract and evolution.
- Strong project management skills with ability to handle multiple projects within time constraints.
- Ability to coordinate activities with delegated and potentially delegated external entities through clear and concise verbal and written communication.
- Ability to negotiate and resolve complex and sensitive project and team issues with diplomacy and persuasiveness.
- Ability to coordinate activities with all levels of staff through strong clear and concise verbal and written communication skills.
- Demonstrated analytical ability to identify problems, develop solutions and implement a chosen course of action.
Required Licenses, Certifications, Registration, Etc.
- Licensed registered nurse with unrestricted license strongly preferred.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
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Cambia Health Solutions, headquartered in Portland, Oregon, is dedicated to transforming health care. We put people at the heart of everything we do as we work to make the health care system better and more economically sustainable for people and their families. Our company reaches more than 70 [...]