Sr. Director, Delegation & Accreditation

Job Details

Description

Position: Sr. Director, Delegation & Accreditation

The Sr. Director, Delegation & Accreditation is required to carefully monitor the performance and adherence to the Centers for Medicare and Medicaid Services (CMS), Special Need Plan, NCQA, State Medicaid, and other regulatory requirements based on client contracts.

In this role, the individual will be expected to provide a high level of program and product specific subject matter expertise and consultation and will be responsible for intensive oversight of the plan to ensure performance, quality, regulatory adherence and audit readiness.

The individual will work closely with Clinical and Market Operations teams, and other teams across the organization.

Position Requirements

• Phoenix, AZ or Nashville, TN based, preferred or remote
• Bachelor’s degree from a four-year college
• 7+ years’ experience with program management, project management, or similar experience
• 7+ years’ experience working for a health plan, and/or vendor contracting with health plans delegated for services
• 5+ years’ experience with Medicare SNP, NCQA, care management programmatic requirements
• Detail oriented, excellent prioritization, and time management skills
• Expertise partnering with internal departments to drive collaboration and results
• Highly proficient in Microsoft Excel, Word, and Powerpoint
• Experience working in high-growth environment preferred
• Valid driver’s license
  
  

Roles And Responsibilities

• Develop and oversee programmatic requirements to meet NCQA, Special Need Plan, state based and other delegated requirements
• Oversight and monitoring of ongoing auditing and compliance
• Ongoing audit readiness activities
• Scheduled and adhoc responses to health plan clients
• Oversight of monthly, quarterly, and annual audit submissions
• Monitoring of Interdisciplinary Care Team (ICT) requirements and outcomes
• Continuous evaluation of effectiveness of SNP program
• Complete mock audits to ensure audit preparedness
• Serve as subject matter expertise within the organization for NCQA and other requirements
• Strong partnership with Market and Clinical Operations to ensure compliance and effectiveness of programs
• Support Monogram as necessary with any tasks required to deliver excellent personalized kidney care and perform all other duties as assigned
• Uphold the mission and values of Monogram Health in all aspects of your role and activities
  
  

Benefits

• Opportunity to work in a dynamic, fast-paced and innovative care management company that is transforming the delivery of kidney care
• Competitive salary and opportunity to participate in company’s bonus program
• Comprehensive medical, dental, vision and life insurance
• Flexible paid leave & vacation policy
• 401(k) plan with matching contributions
  
  

About Monogram Health

We are dedicated to improving the well-being, quality of life and health outcomes for our patients by partnering with the nation's leading kidney specialists to provide transformative kidney care. Monogram Health supports patients suffering from Chronic Kidney Disease and End Stage Renal Disease by forming deep rooted relationships and preparing them both emotionally and physically for the challenges of managing kidney disease. Monogram Health uses next generation artificial intelligence algorithms to predict necessary and timely care to promote the delay of kidney disease progression, seamless transitions to dialysis and/or pre-emptive kidney transplant. We then utilize in-home visits to build meaningful relationships between patients and their care team that drive positive behavior change and optimize our patients’ health outcomes.

At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.