Jason Clarke

JOHN DOE MANAGER & DELEGATION COMPLIANCE AUDITOR Laurel, MD | - |-| Linkedin.com/in/ Delivering Comprehensive Delegation Oversight & Ensuring Regulatory Compliance Excellence Persistent, adaptable Manager with substantial experience as a Delegation Compliance Auditor, specializing in overseeing delegated sub-contractors to ensure strict compliance with state and federal regulations. Proven ability to coordinate and lead comprehensive audits, manage corrective action plans, and ensure adherence to contractual and regulatory requirements. Adept at collaborating with stakeholders, driving quality improvements, and enhancing operational efficiencies. Recognized for meticulous attention to detail and a commitment to upholding the highest standards of compliance and service excellence. Delegation Audits | Credentialing | Human Resources | Business Administration | Provider Relations | Compliance | Educational Training | Project Management | Operations Management | Delegation Oversight | Regulatory Compliance | Quality Management | Contract Management | Stakeholder Communication | Corrective Action Planning TECHNICAL TOOLKIT Microsoft Office Suite: Excel, Word, PowerPoint, Outlook | Audit Management Software: AuditBoard, TeamMate, MetricStream | Regulatory Compliance Tools: Sentry, Compliance 360 | Data Analysis and Reporting Tools: Tableau, Power BI | Risk Management Software: RiskWatch, LogicManager | Project Management Tools: Asana, Trello, Microsoft Project | Credentialing Software: Symplr, Verity | Customer Relationship Management: (CRM) Tools Salesforce, HubSpot | Quality Management Systems: (QMS) MasterControl, QT9 | Enterprise Resource Planning: (ERP) Systems, SAP, Oracle | Electronic Health Records: (EHR) Systems, Epic, Cerner | Document Management Systems: SharePoint, M-Files | Collaboration Tools: Slack, Microsoft Teams | Database Management: SQL, Microsoft Access | Workflow Automation Tools: Zapier, Nintex PROFESSIONAL EXPERTISE Health Net Federal Services/TRICARE (a wholly-owned subsidiary of Centene Corporation) 09/2023 - Current Manager, Provider Network Operations       Monitored provider network operations, achieving a 98% compliance rate with internal standards by developing and implementing corrective action plans for non-compliance. Managed department operations, maintaining 100% adherence to Health Net, state, and federal regulatory requirements, and accrediting entity standards. Ensured delegation compliance and oversight, resulting in a 15% reduction in compliance issues within six months. Trained and hired over 30 staff members for internal operations such as credentialing and contract administration, increasing team efficiency by 20%. Managed document requests from legal counsel, regulatory bodies, and internal fraud and abuse investigators, reducing response time by 40%. Led process improvement activities for the industry collaboration effort (ICE), enhancing collaborative efforts between health plans and medical groups/entities by 25%. JOHN DOE          Coached and mentored team members, leading to a 30% increase in job performance and a 10% increase in employee retention. Developed and executed plans that boosted customer satisfaction by 15%, contributing to increased customer loyalty. Maintained accurate and up-to-date records of employee attendance and payroll, achieving a 99% accuracy rate. Led annual audits of 50+ delegated sub-contractors, achieving a 100% on-time completion rate and reducing corrective action plan closure times by 30%. Oversaw the development and implementation of corrective action plans, resulting in a 20% decrease in compliance issues within the first six months. Ensured timely receipt and accuracy of over 100 monthly regulatory and contractual reports, maintaining a 98% compliance rate with state and federal requirements. Reviewed and enhanced executive summaries of audit results, leading to a 15% improvement in the clarity and accuracy of reported data. Acted as a primary liaison to delegated contractors, successfully resolving 95% of compliance-related inquiries and issues within 48 hours. Spearheaded participation in state stakeholder committees, contributing to a 25% improvement in delegated function performance through quality management and improvement initiatives. Health Net Federal Services/TRICARE (a wholly-owned subsidiary of Centene Corporation) 12/2010 - 09/2023 Delegation Compliance Auditor            Enforced customer service standards, leading to a 20% improvement in customer satisfaction scores. Established and monitored KPIs that resulted in a 15% increase in departmental performance and a 10% reduction in operational costs. Conducted performance evaluations and provided feedback that improved team development, increasing overall team efficiency by 25%. Successfully managed the TRICARE network delegation audit process for over 50 groups across different locations in the US, achieving a 100% compliance rate. Developed and implemented corrective action plans, ensuring 95% compliance with delegated entities. Monitored a network of 75,000 individual and ancillary providers, maintaining compliance with credentialing standards set by URAC, NCQA, and state/federal regulations, achieving a 99% compliance rate. Coordinated and scheduled audits in alignment with URAC standards, reducing audit preparation time by 30%. Responded to inquiries from government agencies concerning organizational compliance issues, achieving a 100% resolution rate. Prepared comprehensive audit reports, which led to a 20% improvement in management’s decision-making process. Recommended and implemented process improvements that streamlined operational efficiency by 15% while ensuring legal compliance. Managed and trained team members, enhancing audit department performance and increasing operational efficiency by 20%. PRIOR EXPERIENCE Manager, Provider Relations at The Center for Vein Restoration Manager, Credentialing and Provider Relations at Johns Hopkins Community Physicians EDUCATION & CERTIFICATIONS B.S. in Health Service Management | The University of Maryland Global Campus, Maryland Associates of Arts in Business Administration | Strayer University, Virginia Basic Supervision Certification The Data Science of Healthcare, Medicine, and Public Health Certification Children's Developmental Clinic Clinician Certification - |-| Linkedin.com/in/ | Page 3 Expected in 12/2024