• Job Description

  Req#: 1922

  Delegate Oversight Analyst - RN

  500 Exchange Street, Providence, Rhode Island, United States of America Req #1922

  Monday, April 8, 2024

  Please email hr_business_partners@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

  Schedule: Remote -Rhode Island area
  Compensation: $73,300- 107,700

  
  Jump into the new world of health insurance:

  At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.
  

  Join others who know diversity is strength:

  We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.
  

  Why this job matters:

  Develop, implement, and monitor compliance plans based on federal and state regulatory requirements and National Committee for Quality Assurance (NCQA) and other applicable accreditation standards and renewal activities. Evaluate regulations and accreditation standards, educate affected staff, and conduct auditing of operational areas and delegated organizations to ensure effective ongoing regulatory compliance and adherence to accreditation standards.

  What you will do:

  • • Maintain a thorough and comprehensive understanding of plan business practices to assess the impact of regulatory and accreditation standards.
    • Maintain a thorough understanding of federal and state regulations and accreditation standards governing division, vendors, and other business area functions.
    • Collaborate with plan and delegate staff to ensure internal and delegate policies
    • Support regular monitoring performed by internal business areas to identify potential risk areas and improve controls. Function as subject matter expert to business areas in the development of effective monitoring tools and practices.
    • Serve as a liaison to internal departments and delegates relative to regulatory and accreditation requirements. Work collaboratively with business owners to achieve compliance objectives. Work with internal stakeholders to ensure delegate and department adherence, escalating issues to appropriate stakeholders when necessary.
    • Audit delegated organizations to monitor compliance with regulatory and accreditation standards. Assist in the development and maintenance of effective auditing tools designed to measure performance against applicable regulatory and accreditation requirements. Provide regular reporting of audit activities. Assist staff with the development of comprehensive delegation agreements that define delegated activities and performance expectations. Assist with pre-delegation assessments of potential new delegates.
    • Represent department on multi-departmental workgroups as needed.
    • Participate in department initiatives and projects.

  What you need to succeed:

  • Bachelor of Science in Nursing (BSN)
  • Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC)
  • Knowledge of National Committee for Quality Assurance accreditation requirements and guidelines
  • Knowledge of federal and RI state laws governing utilization review.
  • Broad knowledge of compliance principles, practices, and procedures
  • Strong knowledge of insurance operations and a keen understanding of the interrelationship between functional units and the agencies that regulate them
  • Ability to perform root cause analysis
  • Ability to create and monitor corrective action plans
  • Advanced analytical skills, with the ability to interpret and synthesize complex data sets
  • Knowledge of business process improvement techniques and strategies
  • Excellent verbal and written communications skills
  • Good problem solving and decision-making skills
  • Good negotiation skills and ability to interface with employees at all levels
  • Ability to effectively navigate ambiguous situations with limited direction
  • Excellent organizational skills and ability to successfully prioritize multiple tasks

  Extras:

  • Experience with health plan clinical operations in regulated lines of business
  • Healthcare Compliance Certification (CHC), Compliance & Ethics Professional Certification (CCEP), Healthcare Research Compliance Certification (CHRC), Certified Professional in Healthcare Quality Certification (CPHQ), or Certified Professional Coder (CPC).

  Location:

  • Remote: onsite 0-1 days per week. Rhode Island area.

  At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
  The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.

  Other details

  • Pay Type Salary

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• About the company

  Rhode Island's leading health insurer and an independent licensee of the Blue Cross and Blue Shield Association

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