Senior RN Manager of Delegation Compliance

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Company:
Oak Street Health

Title:

Senior RN Manager of Delegation Compliance

Location:

Remote / Treehouse

This position is responsible for a range of activities supporting delegated Care Management and Utilization Management functions. These may include, but are not limited to, responsibility for implementation of new delegated functions, including project planning, system readiness, accountability for reporting requirements, hiring, training, and internal/external communication required for launch.

The Manager ensures departmental adherence to program standards, ensures the care programs meet compliance requirements and metrics as set by the health plan and CMS, provides initial and ongoing education to staff, and serves as the liaison between OSH and insurance providers, other business partners, vendors and internal stakeholders as required.

• Oversee compliance for UM and CM to deliver an unmatched patient experience and ensure delegation compliance.
• Audit individual charts according to QA Audit Protocols to ensure compliance with program responsibilities and best practices.
• Possess knowledge of contractual, accreditation, federal and business requirements for assigned program and ensure compliance with program requirements and develop corrective action plans as needed.
• Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives.
• Establish workflows that meet compliance requirements and align with organization-wide clinical protocols.
• Lead the review of policies and procedures, program descriptions, and evaluations.
• Conduct training for new team members and other internal parties as required.
• Provide statistical and performance feedback, and coaching on a regular basis to each team member in their assigned region.
• Create and maintain a high-quality work environment so team members are motivated to perform at their highest level.
• Provide continual evaluation of processes and procedures.
• Responsible for suggesting methods to improve area operations, efficiency, and service to both internal and external staff.
• Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model (e.g. care team, social work, behavioral health, utilization management, patient engagement, central telehealth, etc.) to promote patient outreach and engagement and identify and address patient needs.
• Serve as point of contact for / management of health plan relationships related to delegated care management.
• Oversight of delegated entities and internal operating partners servicing Care Coordination, including management of operational performance and program execution.
• In partnership with Business Intelligence, set, implement and monitor system configuration requirements in accordance with operational and regulatory specifications required for new programs.
• Complete report submissions, including validation where needed.
• Other duties as assigned.

• Bachelor’s in Nursing.
• Active RN license within one or more OSH states.
• Willingness to obtain cross‑state licensure, as needed.
• 5+ years of healthcare experience, preferably in a primary care and/or managed care setting.
• 2+ years direct supervisory experience.
• Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire.
• Knowledge of Medicare/Medicaid and NCQA requirements.
• Practical and operational experience in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements.
• Demonstrated experience leading teams, competence with change management, and…