Project Manager, Delegation Support
ASH Companies - San Diego, CA

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American Specialty Health, Inc. is seeking an experienced Project Manager. With the high level of internal and external interaction involved with this position, the Regulatory and Program Compliance is looking for candidates with articulate oral and written communication. Successful candidates will need to have a strong background in regulatory compliance audits, accreditation activities, client delegation activities including client audits and delegation agreements.

Responsibilities

· Provides project management support, with direction from Director, for audit coordination of onsite and desktop regulatory and client delegation audits, in a constantly changing environment.

· Acts as point of contact for clients regarding delegation functions.

· Externally communicates with clients, to educate, coordinate activities, and resolve unique problems recommending a course of action. (Accepts or returns client calls within the same business day of receipt, Monday through Friday, 8 A.M. to 5 P.M.)

· Provides high level of service to meet client expectations on a daily basis. This includes timely response and follow up.

· Keeps Director abreast of issues related to delegation activities on a routine basis.

· Seeks support from and provides client delegation updates at Key Process Team (KPT) meetings as appropriate.

· Communicates with Director, VP RPC, COO and other department heads on high level issues to ensure appropriate response and resolution.

· Maintains timely and accurate documentation of client interactions, activities, and issue resolution including audits. Client issues must be tracked and documented.

· Accountable for creating a comprehensive audit summary after each client audit and distribute internally as appropriate.

· Responsible to maintain and present the client audit report card to Director and VP on a quarterly basis.

· Coordinates with internal staff to collect necessary files, policies, procedures and other documents to support client audits.

· Establishes and maintains positives professional relationships with internal and external customers.

· Proactively engages internal customers and subject matter experts to effectively manage internal and external customer expectations.

· Acquires and maintains knowledge of NCQA and URAC standards, and ASH policies and procedures, as pertains to the audit function and supports Director, time permitting, with accreditation related tasks and projects.

· Collaborates with OPS and Clinical staff to develop responses for Corrective Action Plans (CAP).

· Presents and reviews responses to client CAPs, delegation agreements, and other client requests, at internal meetings, based on knowledge of unique issues.

· Develops and maintains metrics to ensure timely, consistent, and accurate quality of all audit summary reports and health plan responses.

· Communicates unique aspects of client delegation activities at various meetings with internal and external customers to support delegation functions.

Qualifications

· Bachelor’s degree in health care, health information, business management or related field; or equivalent.

· Advanced training or certification in health care preferred.

· Minimum three years experience health care administration or equivalent; with specific experience in managed care operations, regulatory compliance, contract review, coordination of policy and process development, delegation support, and management of VIP events, structured meetings and audits. Proven experience and developed Customer Service skills required.

· Proficient in MS Office with intermediate experience in Word, Excel and database management.

· Must have acceptable credit to qualify for a company American Express Card.

Core Competencies

· Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.

· Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.

· Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

· Ability to effectively organize, prioritize, multi-task and manage time.

· Demonstrated accuracy and productivity in a changing environment with constant interruptions.

· Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.

· Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time.

Physical Requirements

Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

ASH is an Equal Opportunity Employer. We encourage minorities, females, veterans and individuals with disabilities to apply.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment Opportunity Posters provided by OFCCP here .

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.