Your Role

The Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC) which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities. This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities. Reporting to the Manager, Delegation Oversight, this role is responsible for documentation of policies and procedures, uploading to the DORMS database, and oversight of LA Care audits and quality review along with submission of data to compliance. The Operations Specialist, Experienced is also responsible for working with colleagues on coordination and submission of state reporting to the Department of Managed Health Care.

Your work

In this role, you will:

• Act as a subject matter expert (SME) to review operational workflows of high degree of complexity and/or for multiple departments, identifying problems and developing improvements, modifications, and enhancements
• Develop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff
• Develop and generate reports ranging from routine to moderately complex for management review
• Track and communicate workflow and system changes to appropriate resources
• Participate as a SME in the development of written guidelines and documents problems
• Assist with documentation needs as needed
• Maintain databases required for business operations
• Perform other duties as assigned

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires 3 years of prior relevant experience. Experience working in or with IPA/Medical Groups is preferred
• Strong verbal and written communication skills
• Strong knowledge of Microsoft Office products
• Strong organizational and attention to detail skills

Pay Range:

The pay range for this role is: $66,770.00 to $93,390.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.