Lead, UM Delegation Oversight

The Lead of UM Delegation Oversight reports directly to the Sr. Supervisor of UM Delegation Oversight. The Lead of UMDO is directly responsible for the oversight and monitoring of the UM audit activities. This includes ensuring audit functions are operating efficiently, focused on continuous improvement, and per the team's strategic goal.

Duties and Responsibilities

· Routinely prioritize, schedule, and communicate assignments with team members

· Oversee the communication between UM, Compliance, and other departments

· Monitor the UM audit requests to ensure consistent accuracy, timeliness, and compliant submissions

· Monitor the data integrity and timeliness of all UM audit requests (pre- and post-audits)

· Support positive collaborative relationships with MPM functional areas (i.e., Compliance, PNO, Claims, etc.) to develop key performance indicators (KPIs) and efficient methods/tools that support accurate and timely UM operational areas and audit submissions

· Support the UM team in developing root cause analysis and potential solutions to corrective action plans (CAPs) requested from auditors/clients

· Maintain monitoring/Quality Assurance (QA) methods and tools to self-identify and correct potential non-compliant UM information (e.g., universes, sampled case files, CAPs)

· Oversee the annual UM audit schedules to ensure audit readiness, including the need to renegotiate audit timing, if warranted

· Create and maintain P&Ps that document UM methods and protocols

· Maintains appropriate audit documentation/artifacts for all UM audit activities

· Responsible for continuous coaching and training team members

· Assist in special projects and compliance audit inquiries and research

· Perform other related duties as assigned

· Attend UM and Compliance meetings as required

Minimum Job Requirements

· High School Diploma (Bachelor’s degree preferred)

· 3+ years’ experience working in UM operations with a focus on compliance/operations

· Strong familiarity with UM, NCQA Standards, DMHC, DHCS, and CMS regulatory requirements

· Proficiency in Microsoft Office (Word, Excel, PowerPoint, Visio, OneNote)

· Ability to navigate EZ-CAP, Tableau, and Smartsheet

Skill and Abilities

· Excellent written and verbal communication skills

· Ability to communicate with all levels of management and influence employees through strong communication and presentation skills

· Excellent organizational skills with the ability to balance several priorities

· Strong interpersonal skills

· Ability to make sound judgments and act professionally under pressure