Providence Health & Services Consultant-Medicare Advantage Delegation Program in Beaverton, Oregon
Providence St. Joseph Health is calling a Consultant - Medicare Advantage Delegation Program to our location in Beaverton, OR.
In this position you will have the following responsibilities:
Manages the PHA Delegation Oversight Program in its entirety.
Analyzes, interprets and communicates regulatory interpretations to delegates, leadership and staff at PHA.
Audits and monitors delegated entities for full compliance with CMS regulations.
Performs annual attestation and assessment process for delegated entities.
Consults with internal and external resources including legal counsel as needed to fulfill these duties.
Provides orientation, training, and support to leadership and staff at PHA regarding regulatory compliance and contract requirements for Medicare products as it relates to delegated entities.
Provides support and serves as the primary resource for delegated entities.
Required qualifications for this position include:
Bachelor’s degree OR Associates degree and 4 years experience in a related field.
5 years of relevant health plan, compliance and/or legal experience or experience in another regulated industry.
5 years prior experience with two of the following: Process improvement, policy and procedure development, technical or legal writing, written customer communications.
Extensive knowledge of federal regulations, specifically regarding Medicare Advantage health plans.
Extensive knowledge of Medicare Advantage health plan business processes.
Demonstrated ability to summarize complex, technical materials and make clear presentations of that information to varied audiences.
Demonstrated ability to effectively communicate regulatory requirements to leadership and staff personnel.
Demonstrated effectiveness in applying problem solving and critical thinking skills.
Demonstrated ability to effectively evaluate fiscal, operational, marketing and regulatory information and to develop sound recommendations to meet related opportunities and challenges.
Demonstrated ability to successfully manage multiple tasks, shifting priorities and adjust to externally imposed deadlines.
Proficiency with standard word processing, spreadsheet, and data-base software.
Demonstrated project management skills, including planning and implementation.
Demonstrated expertise in taking initiative in addressing and solving procedural, functional, and communications related issues
Ability to work and lead multiple outside entities and relationships.
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Health Plan/Insurance Nursing
Req ID: 210770