Job Information
Washington State Job Bank Delegation and Quality Oversight Specialist in Portland, Oregon
Career Opportunities: Delegation and Quality Oversight Specialist (24865) Requisition ID 24865 - Posted 03/13/2025 - Health Share of Oregon - Full Time - Permanent - Portland - Multi Location (18) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Delegation and Quality Oversight Specialist Exemption Status Exempt Department Delegation and Quality Oversight Manager Title Delegation and Quality Oversight Manager Direct Reports n/a Requisition # 24865 Pay and Benefits Estimated hiring range $73,035 - $89,265, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This is a fully remote role, but you must reside in one of the listed 9 states. Job Summary The Delegation and Quality Oversight (DQO) Specialist is responsible for monitoring performance of delegated entities, providing oversight of delegated functions including care and utilization management, quality assurance and performance improvement programs, and helping to ensure program integrity. Essential Responsibilities Performs audits and conducts ongoing monitoring of delegated entities to ensure compliance with federal and state laws, Medicaid regulations, Health Share contracts and related policies and procedures. Reviews materials submitted, including policies, sample files, program documentation and other materials relevant to the audit protocol. Conducts analysis of data relevant to the functional areas of the audit; identifies opportunities for improvement. Writes reports summarizing findings; monitors plans of correction submitted in response to findings. Presents or reports findings and recommendations to the Delegation Oversight Committee. Participates in the development of evaluation tools that produce quantitative and qualitative data on performance of delegated entities. Reviews grievance system analyses submitted by delegated entities and ensures grievance systems are managed in accordance with Oregon Administrative Rules. Provides updates to manager on quality and delegation oversight responsibilities and recommends program improvements. Participates in an annual risk assessment that identifies and evaluates delegation risk as part of the Enterprise Risk Management program. Provides back-up support in representing Health Share at contested case hearings and administrative reviews, ensuring that hearings and reviews are managed in accordance with Oregon Administrative Rules. Convenes partners and stakeholders in compliance to share best practices and facilitate the alignment of systems, processes and resources. Participates in oversight and data review/collection related to long-term services and supports as well as coordination with local agency staff. Conducts Fraud, Waste and Abuse investigations, working with subcontractors as needed Compiles quarterly and annual Fraud, Waste and Abuse reporting Understand, analyze and communicate about key performance metrics related to social determinants of health, health disparities, housing, and cross-sector data partnerships. Organizational Responsibilities Perform work in alignment with the organization's mission, vision and values. Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. Strive to meet annual business goals in support the organization's strategic goals. Adhere to the organization's policies, procedures and