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Career Opportunities: Delegation and Quality Oversight Manager (24509) Requisition ID 24509 - Posted 12/17/2024 - Health Share of Oregon - Full Time - Permanent - Portland - Multi Location (2) Job Description Print Preview Job Title Delegation and Quality Oversight Manager Exemption Status Exempt Department Health Share of Oregon Manager Title Director, Compliance and Quality Oversight Direct Reports Delegation and Quality Oversight Specialists and Coordinators Requisition # 24509 Pay and Benefits Estimated hiring range $109,251 - $133,529 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a hybrid position that will require you to go into the downtown Portland office once a month for meetings. Job Summary The Delegation and Quality Oversight Manager plays a lead role overseeing the work of the Delegation and Quality Oversight (DQO) team. The work of that team includes delegation oversight of subcontracted entities, fraud waste and abuse prevention planning and investigations, grievances, hearings and appeals, corporate risk assessment and compliance education and technical assistance. This position develops, designs, implements, and oversees policies and processes to assess compliance with delegated functions and assurance of provision of quality services to Health Share members. This position is responsible for the collaboration between Health Share and subcontracted entity staff to ensure that all delegated functions and quality oversight activities are meeting federal, state and Health Share contracted and regulatory requirements. Essential Responsibilities Compliance and Quality Oversight Operations Oversee compliance, External Quality Review, and audits of subcontracted organizations from pre-audit notifications through to completion and oversight of required plans of correction. Develop and implement policies and procedures that meet the Oregon Health Authority contractual requirements, including all audits by external parties. Oversee the daily operations of Health Share's Grievance System program, including tracking, documentation, collection, file maintenance, reporting and resolution of the hearings, appeals and grievances processes. Develop and lead Health Share's delegation auditing and compliance monitoring activities to address specific healthcare compliance risks utilizing the Seven Elements of an Effective Compliance program. Maintain and revise processes to prevent, detect, and correct any evidence of internal control deficiencies, duplication of efforts, or fraud, waste, and abuse including monitoring of the Compliance Hotline. Organize, prioritize, and assign work; monitor status of work in progress and confer with staff to assist with complex/problem situations and provide technical expertise. Develop and implement compliance and quality oversight trainings for internal and external staff. Act as an expert resource for Health Share staff and delegated entities, providing consultation as needed. Develop proactive communication strategies for all levels of the organization and external stakeholders. Organize and conduct Compliance Workgroup meetings related to compliance and regulatory expectations. Support the Director of Compliance and Quality Oversight with the Compliance, fraud, waste, and abuse and Enterprise Risk Management process. Manage contracts, deliverables, timelines and expectations with partners and project vendor(s). Oversee the process of tracking, completion, and timely submission of required reports to Health Share by subcontracted organizations. Iden