Coord Credentialing Delegation Oversight

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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 Newtown Square, 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.

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Responsibilities:

As a member of the Corporate Credentialing team, the Delegation Oversight Coordinator will interface with delegated provider groups, complete required auditing and reporting related to provider delegation, and ensure adherence with NCQA, and /or state, federal, and business requirements. Serve as a key contact for communications and ensure compliance with performance metrics.

Conduct pre-delegation, annual and corrective action oversight audits.

Continuous monitoring of master spreadsheet of all delegates to ensure timely completion of audits.

Complete annual or more frequent if required on-site or desktop audits.

Submit delegation reports and spreadsheets to appropriate committees.

Coordinate monthly delegate reporting according to the reporting schedule.

Review data specifications with delegates annually to ensure compliance.

Review and revise (as needed) delegation agreement annually to include any NCQA, Federal or State changes.

Assist in managing the delegation policies and procedures.

Interface with the health plan's functional departments to address any service related issues.

Work with CACTUS Enhanced Importer.

Support delegates data entry efforts.

Gatekeeper of all delegate agreements.

Report audit outcomes and delegation monitoring results to management.

Develop, implement and monitor Corrective Action plans, when needed.

Use critical thinking and problem solving skills to help ensure successful delegation partnerships and quality provider data.

Education/Experience:

Bachelor’s Degree or equivalent work experience.

Excellent verbal and written communication skills, including the ability to present to small groups.

Strong ability to work independently.

Strong ability to create, monitor, and analysis provider data.

Ability to represent the organization in a professional manner.

Ability to prioritize and manage multiple tasks/priorities simultaneously.

The ability to work in a fast paced environment.

Demonstrate attention to detail.

Strong assessment and problem-solving skills.

Displays good judgment in apprising management of situations that are incompatible with established policies for which there is little precedence.

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

This position could require up to 50% travel; candidates must have a valid driver’s license and car insurance.

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.