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AmeriHealth Caritas Delegation Contract Coordinator in Philadelphia, Pennsylvania

Delegation Contract Coordinator

Location: Philadelphia, PA

Primary Job Function: Medical Management

ID**: 21237

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

Responsibilities:

The primary purpose of the Delegation Contract Coordinator is to interface with delegated provider groups, complete reporting related to provider/subcontractor delegation, and ensure adherence with NCQA , state and business requirements. Serves as a key contact for delegated provider groups and health plans, ensures compliance with established contract, and monitors provider/subcontractor performance. Specific responsibilities and tasks are outlined below:

  • Supports Delegation Oversight across the multiple lines of business, including Medicaid, Medicare and Long Term Services and Supports.

  • Act as the primary liaison for the MCO with all delegated subcontractors.

  • Ensure timely submission of vendor statutory reporting and implementation and submission of statutory process improvement plans associated with vendors not meeting metrics.

  • Provides expert knowledge and guidance internally and externally around delegation oversight requirements and standards.

  • Responsible for resolution of vendor Corrective Action Plans and follow through to completition.

  • Maintains a thorough understanding of corporate key functional areas including: Sourcing, Operations, IS (encounters) and Population Health.

  • Conducts state’s contract analysis (RFPS, AHCA Contract, CMS Manage Care Manual) across all lines of business to ensure plan delegation oversight compliance elements are met.

  • Documents, evaluates and validates regulatory compliance with all requirements of all regulatory agencies including, but not limited to, AHCA, CMS, URAC (when applicable) and NCQA.

  • Ensures subcontractor performance standards are met in accordance with agreement/SOW and regulatory requirements.

  • Collects and summarizes performance data, identifies opportunities for improvement, and presents to Quality Improvement committees.

  • Participates in site visit preparation and execution (readiness reviews prep and interviews) by regulatory agency and accreditation agencies.

  • Managing compliance oversight for monthly delegation reports, including timely receipt of accurate and complete reporting for all regulatory and contractual –required reports required from subcontractors.

  • Maintains all documentation to support evidence of compliance with all delegation requirements.

  • Report audit outcomes and delegation monitoring results to management, Health Plan and Quality Committees.

  • Facilitate monthly Vendor Partnership meetings with key stakeholders and subcontractor representatives.

  • Responsible for the development, implementation and monitoring of Corrective Action Plans and/or Performance Improvement Plans, when needed.

  • Travel requirement: approximately 25% - 50%.

Education/ Experience:

  • Bachelor’s Degree in business or a healthcare related field or equivalent work experience.

  • 3-5 years of credentialing, delegation, or relevant provider data experience.

Other Skills:

  • Proficient in Access, Word, Excel, Power Point, etc. and company applications i.e., CACTUS, Facets.

  • Ability to travel. This position requires 25 – 50%travel.

  • Current state driver’s license and car insurance.

EOE Minorities/Females/Protected Veterans/Disabled

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