At WelbeHealth, we make the impossible, possible for underserved seniors. We do this through utilizing and developing cutting-edge healthcare and well-being service products especially for seniors and their families. Now is your chance to join our talented team that delivers unparalleled creative healthcare, insurance, social support and more to seniors. We create senior well-being through our courage to love, pioneering spirit and shared intention. These values permeate everything we do. At WelbeHealth, you’ll help inspire that magic by enabling our teams to push the limits of healthcare and well-being experiences and create the never-before-seen!
The Oversight, Monitoring, and Auditing (OMA) Specialist will be responsible for identifying, assessing, correcting and monitoring important aspects of Welbe Health Plan operations, to include oversight of sub-delegates. The ideal candidate for this role will demonstrate aptitude towards detail orientation, problem identification and resolution, possess the ability to communicate clearly and effectively both verbally and in writing to multiple audiences, and have strong knowledge of the healthcare industry. Our initiatives are designed to enhance participant care, increase operational efficiency, ensure regulatory compliance, and transform organizations in meaningful ways. The OMA Specialist collaborates effectively with colleagues and stakeholders to promote the WelbeHealth values, team culture and mission.
What you’ll do:
Establish and execute monitoring and auditing processes for evaluating internal WelbeHealth Plan Services (HPS) and its First Tier, Downstream or Related Entities’ (FDR) compliance with Federal and State laws, PACE program requirements and company
policies and procedures.
Correct actual or potential HPS or FDR performance issues related to operational performance, regulatory compliance or ethical conduct to reduce risk of recurrence and promote a culture of continuous improvement.
Establish and execute HPS & FDR plans and/or recommendations to address risk areas and conduct risk assessments on at least an annual basis.
Research, analyze, and interpret statistical data to determine process improvement areas and present findings to HPS leadership
Monitor and maintain documentation of all deficiencies and corrective actions of HPS or FDRs to ensure effectiveness.
Develop and maintain HPS policies and procedures.
Collaborate with Welbe’s regulatory team and provide contributions to the annual Quality Improvement report.
Ensure FDRs comply with federal regulations prohibiting the employment of, contracting with, or payment to any individual or entity that has been sanctioned, debarred, suspended, excluded, or otherwise deemed ineligible from participation in federal health care programs.
Coordinate Facility reviews to be conducted upon receipt of a member complaint within 15 days.
Conduct due diligence or pre-delegation audits on potential new FDRs.
Provide input on appropriate short and long term departmental KPI targets and periodically provides objective evidence of progress towards achieving the desired result(s).
Complete all required documentation in a timely and accurate manner.
Protect privacy and maintain confidentiality of all company procedures and information about team members, participants, and families.
Other duties as assigned.
Your qualifications:
Bachelor’s Degree required, or a combination of relevant and education experience in leu of degree
Minimum of three years’ experience leading or working all aspects of a Health Plan, Quality program.
Experience working with regulatory bodies including responding to audits and inquiries.
Strong organizational, analytical, time management, and communication skills.
Aptitude for critical thinking in complex situations, ability to synthesize ambiguous data into concrete results.
Consistently demonstrates professionalism and ability to effectively problem solve and choose appropriate course of action.
High attention to detail.
Intermediate proficiency in MS Word, Excel and PowerPoint.
Ability to work independently with minimal supervision.
Demonstrated ability to prioritize in a fast-paced environment.
Experience and competency working with people from diverse backgrounds and cultures.
Deep commitment to helping unlock the potential of our most vulnerable seniors.
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all of our employees and proof of vaccination prior to employment is required.