Job Details

To plan, manage and evaluate clinical department and/or Partnership delegate(s) performance andcompliance under DHCS and NCQA regulations. Responsibilities include annual DHCS Medical. Audits for Care Coordination, delegation oversight and monitoring activities for applicableproviders and entities, and on-going stewardship of NCQA activities to support Partnership's continued. NCQA Accreditation. Responsibilities Responsible for the prioritization, tracking and organization of care coordination policiesfor DHCS and NCQA auditing purposes. Reviews and maintains up-to-date knowledge of DHCS and NCQA regulationsconcerning care coordination activities and programs. Facilitates and completes clinical file review for internal and external DHCS and/or. NCQA activities (ex: Basic Case Management, Complex Case Management, Enhanced. Care Management, etc.) to ensure program goals, quality standards and departmentmetrics are met. When needed, creates evidence-based tools for clinical auditing leve...Manager, Performance, Regulatory, QA, Management, Healthcare, Technology, Audit