Large

Independence Blue Cross is the leading health insurance organization in southeastern Pennsylvania. For 85 years, we have been enhancing the health and well-being of the people and communities we serve. We deliver innovative and competitively priced health care products and services; pioneer new ways to reward doctors, hospitals, and other health care professionals for coordinated, quality care; and support programs and events that promote wellness. 

Finance

Independence Blue Cross

You need an active RN license, experience in Utilization Review or Case Management, three years of auditing with NCQA guidelines, and intermediate Office365 skills.

You will assess and monitor vendor compliance, analyze regulations, develop corrective action plans, present performance reports, and support oversight processes.

Healthcare

Legal

Philadelphia

<ul><li>This&nbsp;Delegation Oversight Specialist – RN&nbsp;role involves oversight of delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements. Ideal candidate will be an excellent communicator (written and verbal) who is detail oriented, organized, able to read and interpret regulations and able to meet tight deadlines while handling multiple audits.</li></ul>Responsibilities include:<ul><li>Coordinates, conducts and documents required pre-delegation assessments and annual NCQA assessments as necessary to comply with applicable state, federal and accreditation requirements,</li><li>Conducts necessary monitoring and auditing work to ensure vendors comply with&nbsp;state, federal, NCQA and other applicable requirements.</li><li>Review reports from Delegated Entities.</li><li>Develops corrective action plans when deficiencies are identified and document follow-up to completion.</li><li>Present delegate’s performance to respective committees, including the preparation of documents for committee oversight of delegated functions.</li><li>Review implementation of new or changed regulatory requirements to help ensure adequacy of controls of oversight activities</li><li>Provide guidance of new or changed regulatory requirements and implementation of processes.</li><li>Analyzes and interprets existing and proposed legislation and regulations and determines their effects on delegation oversight process.</li><li>Conduct risk assessments to identify required audit areas and audit frequency.</li><li>Assist in developing audit tools of oversight activities.</li><li>Work collaboratively with Delegation Manager/Director to develop, establish and maintain departmental processes and procedures.&nbsp;&nbsp;</li><li>Performs other duties as required.</li></ul>Qualifications:<ul><li>Active, unrestricted RN license</li><li>Experience with either Utilization Review and/or Case Management</li><li>Three years auditing experience using NCQA guidelines preferred</li><li>Experience in delegation oversight process and working knowledge of Part C Organization Determination regulations and NCQA Health Plan standards preferred</li><li>Intermediate proficiency in the use of Office365 (e.g. Word, Excel) required</li></ul>

This Delegation Oversight Specialist – RN role involves oversight of delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements. Ideal candidate will be an excellent communicator (written and verbal) who is detail oriented, organized, able to read and interpret regulations and able to meet tight deadlines while handling multiple audits.Responsibilities include:Coordinates, conducts and documents required pre-delegation assessments and annual NCQA assessments as necessary to comply with applicable state, federal and accreditation requirements,Conducts necessary monitoring and auditing work to ensure vendors comply with state, federal, NCQA and other applicable requirements.Review reports from Delegated Entities.Develops corrective action plans when deficiencies are identified and document follow-up to completion.Present delegate’s performance to respective committees, including the preparation of documents for committee oversight of delegated functions.Review implementation of new or changed regulatory requirements to help ensure adequacy of controls of oversight activitiesProvide guidance of new or changed regulatory requirements and implementation of processes.Analyzes and interprets existing and proposed legislation and regulations and determines their effects on delegation oversight process.Conduct risk assessments to identify required audit areas and audit frequency.Assist in developing audit tools of oversight activities.Work collaboratively with Delegation Manager/Director to develop, establish and maintain departmental processes and procedures.  Performs other duties as required.Qualifications:Active, unrestricted RN licenseExperience with either Utilization Review and/or Case ManagementThree years auditing experience using NCQA guidelines preferredExperience in delegation oversight process and working knowledge of Part C Organization Determination regulations and NCQA Health Plan standards preferredIntermediate proficiency in the use of Office365 (e.g. Word, Excel) required

Delegation Oversight Specialist - RN - Independence Blue Cross

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission&lt;em&gt; to enhance the health and well-being of the people and communities we serve.&lt;br&gt;&lt;br&gt;&lt;/em&gt;This &lt;strong&gt;Delegation Oversight Specialist – RN&lt;/strong&gt; role involves oversight of delegated activities to ensure compliance with NCQA accreditation standards, CMS, and state regulatory requirements. Ideal candidate will be an excellent communicator (written and verbal) who is detail oriented, organized, able to read and interpret regulations and able to meet tight deadlines while handling multiple audits.&lt;br&gt;&lt;br&gt;&lt;strong&gt;Responsibilities Include&lt;br&gt;&lt;br&gt;&lt;/strong&gt;&lt;ul&gt;&lt;li&gt;Coordinates, conducts and documents required pre-delegation assessments and annual NCQA assessments as necessary to comply with applicable state, federal and accreditation requirements,&lt;/li&gt;&lt;li&gt;Conducts necessary monitoring and auditing work to ensure vendors comply with state, federal, NCQA and other applicable requirements.&lt;/li&gt;&lt;li&gt;Review reports from Delegated Entities.&lt;/li&gt;&lt;li&gt;Develops corrective action plans when deficiencies are identified and document follow-up to completion.&lt;/li&gt;&lt;li&gt;Present delegate’s performance to respective committees, including the preparation of documents for committee oversight of delegated functions.&lt;/li&gt;&lt;li&gt;Review implementation of new or changed regulatory requirements to help ensure adequacy of controls of oversight activities&lt;/li&gt;&lt;li&gt;Provide guidance of new or changed regulatory requirements and implementation of processes.&lt;/li&gt;&lt;li&gt;Analyzes and interprets existing and proposed legislation and regulations and determines their effects on delegation oversight process.&lt;/li&gt;&lt;li&gt;Conduct risk assessments to identify required audit areas and audit frequency.&lt;/li&gt;&lt;li&gt;Assist in developing audit tools of oversight activities.&lt;/li&gt;&lt;li&gt;Work collaboratively with Delegation Manager/Director to develop, establish and maintain departmental processes and procedures. &lt;/li&gt;&lt;li&gt;Performs other duties as required.&lt;br&gt;&lt;br&gt;&lt;/li&gt;&lt;/ul&gt;&lt;strong&gt;Qualifications&lt;br&gt;&lt;br&gt;&lt;/strong&gt;&lt;ul&gt;&lt;li&gt; Active, unrestricted RN license&lt;/li&gt;&lt;li&gt;Experience with either Utilization Review and/or Case Management&lt;/li&gt;&lt;li&gt;Three years auditing experience using NCQA guidelines preferred&lt;/li&gt;&lt;li&gt;Experience in delegation oversight process and working knowledge of Part C Organization Determination regulations and NCQA Health Plan standards preferred&lt;/li&gt;&lt;li&gt;Intermediate proficiency in the use of Office365 (e.g. Word, Excel) required.&lt;br&gt;&lt;br&gt;&lt;/li&gt;&lt;/ul&gt;&lt;strong&gt;Hybrid&lt;br&gt;&lt;br&gt;&lt;/strong&gt;Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday &amp;amp; Thursday) and remotely 2 days a week (Monday &amp;amp; Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.

Delegation Oversight Specialist - RN

You must have a relevant bachelor’s degree, 8+ years in healthcare roles, knowledge of health plans, strong project management skills, and the ability to influence stakeholders.

You will lead customer implementation projects, develop strategies, manage cross-functional teams, address issues, communicate with stakeholders, and ensure smooth execution of client benefits changes.

Bachelors

Masters

Business, Operations & Strategy

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals.&nbsp;&nbsp;If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.Independence is looking for a&nbsp;Customer Implementation Executive. Candidates for this role will have the experience, skills, and competencies required to Lead our&nbsp;Implementation Process.&nbsp;Responsibilities include the following:<ul><li>Develops strategy and execution plan for all accounts managed by Customer Implementation Team</li><li>Responsible for implementation project delivery for new large customers and significant changes to current customer benefits.</li><li>Leads customer implementations across the enterprise.</li><li>Develops and improves customer&nbsp;implementation processes</li><li>Oversees customer implementation processes for designated accounts</li><li>Manages cross-functional teams in the&nbsp;end-to-end&nbsp;complex implementation&nbsp;process (matrix model)</li><li>Serves as lead resource for Sales, Marketing, Operations and IS Management</li><li>Serves as primary customer interface and sole point of contact for all business areas that touch customer implementation for the implementation process</li><li>Directs dedicated functional experts (billing, customer service, claims, EDI etc…) on corrective action steps/ issue resolution to ensure end-to-end resolution of issues.</li><li>Leads, directs, and communicates the results of the customer implementation.</li></ul>2. Root Cause Analysis:<ul><li>Responsible for the identification of issues in the Implementation process and determination of root cause.</li><li>Responsible for the identification of alternative solutions to issues that are complex and require an understanding of how the outcome will affect the customer, other stakeholders, and multiple internal areas/ departments.&nbsp;</li></ul>3.&nbsp;Communication<ul><li>Responsible for the implementation communication plan for customers and all stakeholders (internal and external)</li><li>Communicates effectively with customers, technical systems associates, sales and marketing, and all business areas involved in the customer implementation process.</li></ul>4. Risk Mitigation Planning<ul><li>Responsible for risk mitigation planning for the customer implementation process.</li><li>Understands the issues that may be potential roadblocks to a smooth successful customer implementation and develops mitigation plans to ensure successful execution</li></ul>5.&nbsp;Customer Implementation Point Person<ul><li>Acts as an implementation consultant to the customer and across the organization</li><li>Maintains&nbsp;on-going knowledge of the organization and the customer implementation process and capabilities</li><li>Acts as resource for understanding the implementation process</li><li>Acts as a resource to the customer and Sales for understanding the options and capabilities available to the customer</li></ul>Bachelor’s degree in business administration, Health Care Administration or related field or an equivalent combination of education and experience.&nbsp;Preferred:&nbsp;Master's&nbsp;Degree or MBAProject Management Certification8 or more&nbsp;years' experience&nbsp;in one or more of the following areas within the healthcare industry:&nbsp;account services, sales, service installation/ implementation, health plan operations such as claims, enrollment, benefits administration or group set-upKnowledge<ul><li>Demonstrated experience managing complex project implementations</li><li>Experience with Optum RX Claim and RX Operational activities&nbsp;</li><li>Working knowledge of Self-Funding and Fully Insured Health Plans</li><li>Understanding of healthcare insurance products and processing</li><li>Expertise in billing and claims administration functional areas</li><li>Ability to educate and influence complex, cross-functional business partners on Self-Funded products and services</li><li>Ability to define, develop, document, and implement formal Policies and Procedures related to Self-Funded products and services</li><li>Strong interpersonal skills to include persuasion and negotiation</li><li>Demonstrated ability to influence operational management</li></ul>HybridIndependence has implemented a “Hybrid” model which consists of Associates working in the&nbsp;office&nbsp;3 days a week (Tuesday, Wednesday &amp; Thursday) and remotely 2 days a week (Monday &amp; Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated&nbsp;remote&nbsp;days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals.  If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.Independence is looking for a Customer Implementation Executive. Candidates for this role will have the experience, skills, and competencies required to Lead our Implementation Process. Responsibilities include the following:Develops strategy and execution plan for all accounts managed by Customer Implementation TeamResponsible for implementation project delivery for new large customers and significant changes to current customer benefits.Leads customer implementations across the enterprise.Develops and improves customer implementation processesOversees customer implementation processes for designated accountsManages cross-functional teams in the end-to-end complex implementation process (matrix model)Serves as lead resource for Sales, Marketing, Operations and IS ManagementServes as primary customer interface and sole point of contact for all business areas that touch customer implementation for the implementation processDirects dedicated functional experts (billing, customer service, claims, EDI etc…) on corrective action steps/ issue resolution to ensure end-to-end resolution of issues.Leads, directs, and communicates the results of the customer implementation.2. Root Cause Analysis:Responsible for the identification of issues in the Implementation process and determination of root cause.Responsible for the identification of alternative solutions to issues that are complex and require an understanding of how the outcome will affect the customer, other stakeholders, and multiple internal areas/ departments. 3. CommunicationResponsible for the implementation communication plan for customers and all stakeholders (internal and external)Communicates effectively with customers, technical systems associates, sales and marketing, and all business areas involved in the customer implementation process.4. Risk Mitigation PlanningResponsible for risk mitigation planning for the customer implementation process.Understands the issues that may be potential roadblocks to a smooth successful customer implementation and develops mitigation plans to ensure successful execution5. Customer Implementation Point PersonActs as an implementation consultant to the customer and across the organizationMaintains on-going knowledge of the organization and the customer implementation process and capabilitiesActs as resource for understanding the implementation processActs as a resource to the customer and Sales for understanding the options and capabilities available to the customerBachelor’s degree in business administration, Health Care Administration or related field or an equivalent combination of education and experience. Preferred: Master's Degree or MBAProject Management Certification8 or more years' experience in one or more of the following areas within the healthcare industry: account services, sales, service installation/ implementation, health plan operations such as claims, enrollment, benefits administration or group set-upKnowledgeDemonstrated experience managing complex project implementationsExperience with Optum RX Claim and RX Operational activities Working knowledge of Self-Funding and Fully Insured Health PlansUnderstanding of healthcare insurance products and processingExpertise in billing and claims administration functional areasAbility to educate and influence complex, cross-functional business partners on Self-Funded products and servicesAbility to define, develop, document, and implement formal Policies and Procedures related to Self-Funded products and servicesStrong interpersonal skills to include persuasion and negotiationDemonstrated ability to influence operational managementHybridIndependence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

Customer Implementation Executive - Independence Blue Cross

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.&lt;br&gt;&lt;br&gt;&lt;strong&gt;Responsibilities&lt;br&gt;&lt;br&gt;&lt;/strong&gt;Independence is looking for a &lt;strong&gt;Customer Implementation Executive&lt;/strong&gt;. Candidates for this role will have the experience, skills, and competencies required to Lead our &lt;strong&gt;Implementation Process. &lt;/strong&gt;Responsibilities include the following:&lt;br&gt;&lt;br&gt;&lt;ul&gt;&lt;li&gt;Develops strategy and execution plan for all accounts managed by Customer Implementation Team&lt;/li&gt;&lt;li&gt;Responsible for implementation project delivery for new large customers and significant changes to current customer benefits.&lt;/li&gt;&lt;li&gt;Leads customer implementations across the enterprise.&lt;/li&gt;&lt;li&gt;Develops and improves customer implementation processes&lt;/li&gt;&lt;li&gt;Oversees customer implementation processes for designated accounts&lt;/li&gt;&lt;li&gt;Manages cross-functional teams in the end-to-end complex implementation process (matrix model)&lt;/li&gt;&lt;li&gt;Serves as lead resource for Sales, Marketing, Operations and IS Management&lt;/li&gt;&lt;li&gt;Serves as primary customer interface and sole point of contact for all business areas that touch customer implementation for the implementation process&lt;/li&gt;&lt;li&gt;Directs dedicated functional experts (billing, customer service, claims, EDI etc…) on corrective action steps/ issue resolution to ensure end-to-end resolution of issues.&lt;/li&gt;&lt;li&gt;Leads, directs, and communicates the results of the customer implementation.&lt;/li&gt;&lt;li&gt; Root Cause Analysis:&lt;/li&gt;&lt;li&gt; Responsible for the identification of issues in the Implementation process and determination of root cause.&lt;/li&gt;&lt;li&gt;Responsible for the identification of alternative solutions to issues that are complex and require an understanding of how the outcome will affect the customer, other stakeholders, and multiple internal areas/ departments. h&lt;/li&gt;&lt;li&gt; Communication&lt;/li&gt;&lt;li&gt;Responsible for the implementation communication plan for customers and all stakeholders (internal and external)&lt;/li&gt;&lt;li&gt;Communicates effectively with customers, technical systems associates, sales and marketing, and all business areas involved in the customer implementation process.&lt;/li&gt;&lt;li&gt; Risk Mitigation Planning&lt;/li&gt;&lt;li&gt; Responsible for risk mitigation planning for the customer implementation process.&lt;/li&gt;&lt;li&gt; Understands the issues that may be potential roadblocks to a smooth successful customer implementation and develops mitigation plans to ensure successful execution&lt;/li&gt;&lt;li&gt; Customer Implementation Point Person&lt;/li&gt;&lt;li&gt; Acts as an implementation consultant to the customer and across the organization&lt;/li&gt;&lt;li&gt; Maintains on-going knowledge of the organization and the customer implementation process and capabilities&lt;/li&gt;&lt;li&gt; Acts as resource for understanding the implementation process&lt;/li&gt;&lt;li&gt; Acts as a resource to the customer and Sales for understanding the options and capabilities available to the customer&lt;br&gt;&lt;br&gt;&lt;/li&gt;&lt;/ul&gt;Bachelor’s degree in business administration, Health Care Administration or related field or an equivalent combination of education and experience.&lt;br&gt;&lt;br&gt;&lt;strong&gt;Preferred&lt;br&gt;&lt;br&gt;&lt;/strong&gt;Master's Degree or MBA&lt;br&gt;&lt;br&gt;Project Management Certification&lt;br&gt;&lt;br&gt;8 or more years' experience in one or more of the following areas within the healthcare industry: account services, sales, service installation/ implementation, health plan operations such as claims, enrollment, benefits administration or group set-up&lt;br&gt;&lt;br&gt;&lt;strong&gt;Knowledge&lt;br&gt;&lt;br&gt;&lt;/strong&gt;&lt;ul&gt;&lt;li&gt;Demonstrated experience managing complex project implementations&lt;/li&gt;&lt;li&gt;Experience with Optum RX Claim and RX Operational activities &lt;/li&gt;&lt;li&gt;Working knowledge of Self-Funding and Fully Insured Health Plans&lt;/li&gt;&lt;li&gt;Understanding of healthcare insurance products and processing&lt;/li&gt;&lt;li&gt;Expertise in billing and claims administration functional areas&lt;/li&gt;&lt;li&gt;Ability to educate and influence complex, cross-functional business partners on Self-Funded products and services&lt;/li&gt;&lt;li&gt;Ability to define, develop, document, and implement formal Policies and Procedures related to Self-Funded products and services&lt;/li&gt;&lt;li&gt;Strong interpersonal skills to include persuasion and negotiation&lt;/li&gt;&lt;li&gt;Demonstrated ability to influence operational management&lt;br&gt;&lt;br&gt;&lt;/li&gt;&lt;/ul&gt;&lt;strong&gt;Hybrid&lt;br&gt;&lt;br&gt;&lt;/strong&gt;Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday &amp;amp; Thursday) and remotely 2 days a week (Monday &amp;amp; Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.&lt;br&gt;&lt;br&gt;&lt;strong&gt;&lt;em&gt;Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.&lt;br&gt;&lt;br&gt;&lt;/em&gt;&lt;/strong&gt;&lt;strong&gt;&lt;em&gt;Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.&lt;/em&gt;&lt;/strong&gt;

Independence Blue Cross

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