• The Delegation Oversight Program Manager is responsible for the oversight and monitoring of Samaritan Health Plans’ delegated vendors across various healthcare services, including utilization management, population health, dental care organizations (DCOs), and non-emergent transportation (NEMT). This role ensures compliance with contractual agreements, regulatory requirements, and quality standards to optimize member health outcomes and ensure the delivery of high-quality, cost-effective care.

• Current unencumbered Oregon RN License required within 90 days of hire. BSN preferred. Master's degree in a related field preferred.
• One (1) year clinical nursing experience plus four (4) years health plan, case management and/or utilization management experience required.
• Experience or training in the following required:
  • Health care delivery systems and/or managed care patients.
  • Computer applications including electronic documentation (e.g., MS Office, EPIC, Clinical Care Advanced).
• Experience in the following preferred:
  • Team leadership.
  • Case management.
  • Medicare and Medicaid rules and regulations and health plan benefit structure and policy.

Oversight and Monitoring:

• Develop and implement comprehensive oversight plans for delegated vendors, including utilization management, population health, DCOs, and NEMT.

• Conduct regular audits and reviews of vendor performance, including data analysis, and compliance assessments.

• Analyze performance data to identify trends, areas of improvement, and potential risks.

• Develop and implement corrective action plans to address performance deficiencies and ensure compliance.

• Maintain accurate and up-to-date records of vendor performance and oversight activities.

• Audit clinical reviews for both clinical and regulatory appropriateness compliance respectively.

Contract Management:

• Review and interpret delegation agreements and contracts.

• Monitor delegate compliance with contractual obligations.

• Participate in contract negotiations and renewals.

Relationship Management:

• Establish and maintain strong working relationships with delegated vendors.

• Serve as the primary point of contact for delegate inquiries and concerns.

• Collaborate with delegates to improve performance and address issues.

Regulatory Compliance:

• Maintain current knowledge of relevant state and federal regulations, including NCQA, CMS, and state-specific requirements.

• Ensure delegate compliance with all applicable regulations.

• Prepare and submit required reports to regulatory agencies.

Quality Improvement:

• Identify opportunities to improve the quality of care delivered through delegated vendors.

• Develop and implement quality improvement initiatives.

• Monitor the effectiveness of quality improvement efforts.

Reporting and Communication:

• Prepare regular reports on vendor performance and oversight activities for senior management.

• Communicate effectively with internal and external stakeholders.

• Participate in cross-functional teams to address delegation-related issues.

• Rarely (1 - 10% of the time)	Occasionally (11 - 33% of the time)	Frequently (34 - 66% of the time)	Continually (67 – 100% of the time)
  CLIMB - STAIRS LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs LIFT (Knee to chest: 24"-54") 0 – 20 Lbs LIFT (Waist to Eye: up to 54") 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds BEND FORWARD at waist KNEEL (on knees)	STAND WALK – LEVEL SURFACE ROTATE TRUNK Standing REACH - Upward PUSH (0 - 20 pounds force) PULL (0 - 20 pounds force)	SIT CARRY 2-handed, 0 - 20 pounds ROTATE TRUNK Sitting REACH - Forward	MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist