Job Closed
This listing is no longer active.
Risk & Oversight Manager II
Location
United States
Posted
97 days ago
Salary
$54.5K - $87.3K / year
Seniority
Mid Level
Job Description
Risk & Oversight Manager II
CareSource
• Provide oversight for assigned vendors and providers in compliance with state and federal provider agreements, business and accreditation requirements • Maintain direct oversight for assigned vendors and providers • Participate in the development and maintenance of departmental policies and procedures • Support departmental subject matter experts in interpreting vendor and provider contract requirements, business, and compliance and regulatory requirements • Monitor delegated/non-delegated vendor/providers and internal business owner relationships to ensure compliance, optimal delegate/non-delegate performance and achievement of business goals according to service level and other contractual requirements • Document meetings with stakeholders to provide performance metrics feedback and identify opportunities to reduce risk and cure corrective action plans • Support the implementation of strategies to increase delegates/non-delegates engagement in driving toward quality outcomes and cost control initiatives • Support the development, approval and review of delegated/non-delegated contracts; ensure service levels meet current regulatory and quality baseline requirements • Conduct pre-delegation assessments, ongoing delegation oversight, annual audits, deficiencies, and corrective action plans for vendors/providers • Participate in joint operating committee and document quarterly business reviews, strategic partner reviews, and operational meetings with business owners and delegated/non-delegated vendors and providers • Maintain monthly/quarterly/annual reporting and ensure timely receipt of accurate and complete all regulatory and contractually required reports for delegated vendor and provider activities • Support delegated vendor and provider onboarding, including training, reporting and document retention; provide support to departments and business owners to enable effective management of delegates • Stay informed about the latest developments in delegation oversight field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources • Support the development and accomplishment of delegation program activities in support of company strategies, goals and objectives • Coordinate activities with all levels of staff as well as with delegated and potentially delegated external entities through clear and concise verbal and written communication • Assist in managing operational problems by bringing the vendor and departmental ops teams together to develop solutions and implement a chosen course of action • Perform any other job duties as requested
Job Requirements
- Associates degree or equivalent years of relevant work experience is required
- Minimum of two (2) years of experience in corporate compliance, vendor oversight, contract management, internal audit, quality assurance, strategic sourcing or other highly regulated industry is required
- Experience in managing third party compliance and oversight of health-care related delegation activities, vendor audits and contracting is preferred
- Intermediate computer skills in Microsoft Office, specifically Excel and PowerPoint
- Knowledge in developing dashboard/ metrics reporting
- Knowledge of and application of regulatory compliance (Medicare, Health Exchange and/or Duals), quality measures (HEDIS/ STARS) and/or accreditation standards (NCQA/ URAC)
- Basic project management skills with ability to handle multiple projects within time constraints
- Ability to interact with all levels of leadership and support cross-functional teams and initiatives
- Ability to multitask moderate to complex responsibilities with results that may have long-range implications
- Ability to work independently in a fast paced environment with changing priorities
- Knowledge of Federal, State, NCQA and standards preferred
- Certified in Healthcare Compliance (CHC) and Certified Provider Credentialing Specialist (CPCS) preferred.
Benefits
- Bonuses tied to company and individual performance
- Substantial and comprehensive total rewards package
Related Guides
Related Categories
Related Job Pages
More Risk Jobs
• Responsible for management and oversight of key pillars within model risk governance and operation teams • Ensure efficient execution of the model risk management program • Manage and update the Model Risk Management Policy and related materials • Create relevant and effective model risk materials including periodic reporting • Provide, manage, and update enterprise-wide training periodically to stakeholders • Manage centralized reporting to enhance the Issues Management area for MRM
M365 Copilot Governance Lead
CalixTo enable broadband service providers of all sizes to simplify, innovate and grow.
• Enable, govern, and oversee the full lifecycle of M365 Copilot AI solutions • Define and enforce governance policies for Copilot agent development, deployment, and lifecycle management • Onboard and train business makers to safely build Copilot agents • Monitor agent performance, compliance, and user feedback. • Stay current with Microsoft 365, Power Platform, and Copilot Studio updates.
Associate Loss Control/Risk Management Consultant
Zenith Insurance Company (United States)Zenith is the premier specialist in workers’ compensation nationally, and a leader in property and casualty insurance
• Develop working knowledge of Zenith Agribusiness risk evaluation and risk improvement techniques, practices, and procedures. • Participate in and eventually conduct underwriting surveys at prospect and policyholder locations to define business operations, fire protection elements and exposures, liability control measures and commercial auto exposures and controls. • Develop ability to identify and evaluate the following fire protection exposures: fire sprinkler systems, alarm systems, water supplies, hydrant systems for both private and public systems. • Develop ability to evaluate effectiveness of prospect and policyholder food safety programs. • Develop ability to identify lower level complexity engineering and/or administrative controls to reduce property and liability loss potential. • Develop ability to use analyze loss data to identify key trends and prioritize policyholder service needs. • Develop understanding of how to create recommendations that reduce policyholder property and liability exposures. • Learn techniques to influence policyholder safety decision making. • Learn to prepare effective reports for policyholders and internal partners. • Develop basic knowledge of property casualty; including understanding of underwriting, and claims practices. • Learn how to effectively market Zenith Agribusiness and the Risk Management department. • Develop ability to build and maintain productive policyholder work relationships. • Develop basic understanding of key performance measures for a property & casualty insurance carrier. • Develop basic understanding of P&C insurance agent and broker operation. • Learn how to develop effective policyholder training and sales presentations. • Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions. • Works productively and harmoniously with others on a consistent basis. • Respond positively to direction and feedback on performance. • Consistently maintain professional and appropriate demeanor. • Perform other duties as assigned.
External candidates: In order for your application to be correctly processed please sign-in before you apply Internal candidates: Please go to Workday and click "Find Jobs" link under Career Thank you for considering opportunities with us! Job Title Information Architecture Governance Advisor - Remote Requisition Number R7581 Information Architecture Governance Advisor - Remote (Open) Location Arizona - Home Teleworkers Additional Locations Alabama - Home Teleworkers, Alabama - Home Teleworkers, Arkansas - Home Teleworkers, California - Home Teleworkers, Colorado - Home Teleworkers, Connecticut - Home Teleworkers, Delaware - Home Teleworker, District of Columbia - Home Teleworkers, Florida - Home Teleworkers, Georgia - Home Teleworkers, Idaho - Home Teleworkers, Illinois - Home Teleworkers, Indiana - Home Teleworkers, Iowa - Home Teleworkers, Kansas - Home Teleworker, Kentucky - Home Teleworkers, Louisiana - Home Teleworkers, Maine Home Teleworkers, Maryland - Home Teleworkers, Massachusetts - Home Teleworkers, Michigan - Home Teleworkers, Minnesota - Home Teleworkers, Mississippi - Home Teleworker, Missouri - Home Teleworker, Montana - Home Teleworkers {+ 21 more} Job Information CSAA Insurance Group (CSAA IG), a AAA insurer, is one of the leading personal lines property and casualty insurance groups in the United States. Here, every employee shapes our mission. We build innovative, human-centered solutions that help AAA members prevent, prepare for, and recover from life's uncertainties. You will join a collaborative, inclusive culture where your strengths have room to grow and your ideas can drive real impact. Step into a role where you can contribute to our shared success through meaningful work. We are actively hiring for an Information Architecture Governance Advisor - Remote! Your Role: The Information Architecture Governance Advisor owns the design and implementation of an enterprise information model. Establishes and carries out enterprise data and information architecture policies, standards, and processes according to guidelines. Is responsible for structuring, organizing, and communicating information in a way that makes it easy for business users to find, navigate, and understand. Champions and facilitates the review of data-related changes across the organization. Works with business partners and Information Technology (IT) partners to drive consensus around how data should be structured. This business-focused role will reside on the Enterprise Data Governance team but will be expected to closely interact with other architects and data modelers within the IT division. Your Work: · - Define criteria and controls for an authoritative data source (ADS) - Lead the design and implementation of information modeling practices for the enterprise - Define data and information architecture related standards and guidelines - Coordinate and facilitate the review of data-related changes from an enterprise perspective - Organize data within domains and sub-domains to enhance the ability to find, govern, and utilize data across the enterprise - Enhance the company’s data governance platform to include data and information architecture components, definitions, and relationships - Support enterprise data strategy and data governance programs by providing a structured approach to architectural decision-making, ensuring changes are evaluated based on their impact across the enterprise - Identify and mitigate risks associated with architectural decisions and implementations - Establish guidelines and standards to minimize risks while ensuring compliance with regulations and policies - Act as liaison between business and IT to translate business data requirements into logical data architecture design - Engage in the development of policies, standards and procedures and coordinate with stakeholders through the approval process - Ensure compliance with established standards for development and management of data - Ensure compliance to data-related regulatory rules - Perform regular peer review of information models used across the enterprise Required Experience, Education and Skills - Bachelor of Arts (B.A.) or Bachelor of Science (B.S.) or in the absence of 4-year degree, an additional 4 years of experience in addition to the minimum experience will be considered - 6 years of related professional experience with transferable skills with a focus on using data modeling tools to implement and support information architecture / data governance capabilities - Strong data analytical skills - Defining high-level application and data-related requirements - Experience in the insurance domain - Experience creating conceptual or information models - Familiarity with logical and physical data modeling - Experience with defining data domains, data dictionaries, and business glossaries - Experience with data modeling methods such as UML - Familiarity with business architecture frameworks such as Zachman and TOGAF - Experience with one or more data and/or information modeling tools - Ability to communicate to senior and executive level management - Ability to successfully collaborate and influence stakeholders at all levels cross-functionally - Familiarity with enterprise data governance concepts - Experience making recommendations for information and data architecture solutions - Actively shapes our company culture (e.g., participating in employee resource groups, volunteering, etc.) - Lives into cultural norms (e.g., willing to have cameras when it matters: helping onboard new team members, building relationships, etc.) - Travels as needed for role, including divisional / team meetings and other in-person meetings - Fulfills business needs, which may include investing extra time, helping other teams, etc Please note we are hiring for this role remote anywhere in the United States with the following exceptions: Hawaii and Alaska. Why Choose a Career at CSAA IG? At CSAA IG, we are a mission-driven organization proudly committed to empowering our members, our employees, and our communities to thrive. Recognition: We offer a total compensation package, annual bonus eligibility for most roles, 401(k) with a company match, and so much more! Read more about what we offer and what it is like to be a part of our dynamic team at https://careers.csaainsurance.aaa.com/us/en/benefits. Career Growth: We believe in growth for everyone. Here at CSAA IG, leaders and mentors partner with employees to align interests, unlock development opportunities, and support long‑term success. Flexible Workplace: We embrace a remote-first culture through our Flexible Workplace. Most employees hold Home-Flex roles, working primarily from home, often with the flexibility to work from various locations including CSAA offices. Our flexible workplace empowers you to balance remote work with intentional in‑person moments that deepen connection and collaboration. Inclusion and Belonging: An inclusive and welcoming workplace is the cornerstone of our success. By fostering an environment where people feel valued and heard, we deepen our ability to understand and meet the unique needs of our members. This strengthens innovation and enhances our products and services, giving us a competitive edge in the market. Sustainability: As climate change leads to more frequent and severe weather events, we are taking bold action to build more resilient communities and reduce our environmental impact. Submit your application to be considered. We communicate via email, so check your inbox and/or your spam folder to ensure you don’t miss important updates from us. CSAA is committed to providing reasonable accommodations to qualified applicants and employees with disabilities or other limitations. If you would like to request an accommodation to participate in the job application or interview process, please contact TalentAcquistion@csaa.com If you apply and are selected to continue in the recruiting process, we will schedule a preliminary call with you to discuss the role and will disclose during that call the available salary/hourly rate range based on your location. Factors used to determine the actual salary offered may include location, experience, or education. CSAA does not provide visa sponsorship for this role. Applicants must have authorization to work indefinitely in the US. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). CSAA Insurance Group is an equal opportunity employer. #LI-JR1 .




