Delegation And Vendor Oversight Manager, Health Plan Services

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

• Master's degree from an accredited college or university is preferred (official transcript is due to at the time of interview)

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.

• Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
• CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.

COOK COUNTY GOVERNMENT IS AN EQUAL OPPORTUNITY EMPLOYER