Cook County, IL Chicago , IL 60602
Posted 2 weeks ago
LOCATION: Health Plan Services - 4896
SHIFT: 8:30AM - 4:30PM
Job Title
Delegation and Vendor Oversight Manager, Health Plan Services
Department
CountyCare/Managed Care
This position is exempt from Career Service under the CCH Personnel Rules.
Job Summary
The Delegation and Vendor Oversight (DVO) Manager, Health Plan Services is responsible for providing assistance with oversight of delegates and vendors contracted with CountyCare. This position will be onboard and monitor delegates and vendor contracts and relationships. Manages an expanding managed care population for Medicaid and Medicare and implements enhanced capabilities for accountability and integrity of daily operations. Adheres to fraud and abuse prevention and/or detection policies and programs according to regulatory requirements.
General Administrative Responsibilities
Collective Bargaining
Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Discipline
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures, and provision of applicable collective bargaining agreements
Supervision
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Management
Contribute to the management of CCH staff and CCH' systemic development and success
Discuss and develop CCH system policy and procedure
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Typical Duties
Performs pre-delegation and annual audits per regulatory, State, and accreditation standards for all delegates.
Assists on onboarding new delegates and vendors and measuring each delegate and vendors Key Performance Indicators and contracted metrics.
Remains current with each delegate and vendor contracts and scope of work and updating scope of works as needed.
Establishes a strong relationship with each vendor and contractor to meet set key performance indicators.
Participates and may facilitate Joint Operation Meetings including Delegation and Vendor Oversight Committee.
Assists drafting Request for Proposals and collaborating with Supply Chain Management Procurement process.
Takes corrective action as necessary to address disciplinary concerns; makes recommendations to diminish the impact on productivity.
Implements enhanced capabilities for accountability and integrity of daily operations.
Plans and directs all aspects of the operations for assigned products and programs.
Oversees all aspects of assigned products and programs, establishing objectives, policies and procedures.
Ensures operational processes and policies are compliant with corporate standards and applicable local, state, and federal regulations.
Provides resolutions to managed care contractual issues pertaining to contract interpretation.
Adheres to confidentiality standards and HIPAA compliance programs.
Performs other duties as assigned.
Minimum Qualifications
Bachelor's degree from an accredited college or university is required (official transcript is due to at the time of interview)
Two (2) years of health plan experience in a Medicare health plan, Medicaid health plan, or health system including aspects of operations oversight, administration, management, delegation, and vendor oversight is required
One (1) year of experience managing delegates and vendor relationships such as a Third-Party Administrator, Vision, Dental, and Transportation vendors and Pharmacy Benefit Manager, etc. is required
Intermediate proficiency with Microsoft Office Suite (Access, Excel, PowerPoint and Word) is required (MS Office testing will be administered, 70% minimum proficiency rate is required)
Preferred Qualifications
Knowledge, Skills, Abilities and Other Characteristics
Knowledge of the principles of Medicaid and Medicare Managed Care principles and management practices
Knowledge and familiarity with Medicare and/or Medicaid insurance payment systems, inpatient, and outpatient reimbursement, such as Diagnosis-related group (DRG) reimbursement and/or Enhanced Ambulatory Patient Groupings (EAPG) reimbursement structure
Knowledge and understanding of implementation, startups and operationalizing delegates and vendors
Proficient with Microsoft Office Suite (Access, Excel, PowerPoint, and Word)
Excellent interpersonal, verbal, and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Excellent program development, management, and leadership skills
Demonstrates good computer and typing skills
Demonstrate good phone and email etiquette skills with strong response times
Demonstrate analytical and organizational, problem-solving, critical thinking and conflict management/resolution skills
Demonstrate attention to detail, accuracy, and precision to support research and presentation skills
Ability to prioritize, plan and organize projects and tasks
Ability to multi-task and meet deadlines in a fast paced and stressful environment
Ability to maintain a professional demeanor and composure when challenged
Ability to function autonomously and as a team member in a multidisciplinary team
Ability to train by presenting concepts and demonstrating tasks
Ability to perform accurate and reliable mathematical calculations to support reimbursement analysis and measure financial performance
Ability to work flexible hours
Must be able to travel to work sites throughout Cook County
Physical and Environmental Demands
This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, "Typical Duties" are essential job functions.
VETERAN PREFERENCE
PLEASE READ
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service.
To take advantage of this preference a Veteran must:
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11).
Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
OR
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
MUST MEET REQUIRED QUALIFICATIONS AT TIME OF APPLICATION
BENEFITS PACKAGE
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan
Deferred Compensation Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
COOK COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER
Cook County, IL