What are the responsibilities and job description for the Manager, Delegation Oversight position at Blue Shield of CA?
Your Role
The Delegation Oversight team is responsible for driving continuous quality improvement across delegated functions and ensuring compliance with applicable regulatory, contractual, and accreditation requirements. The team oversees delegated Utilization Management (UM) activities in accordance with CMS, DMHC, DHCS, NCQA, and Blue Shield of California standards, as well as delegation requirements outlined in executed delegation agreements.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
- Bachelor of Science in nursing or advanced degree preferred
- Current, unrestricted CA RN license required
- 7 years prior relevant experience, including 3 years of management experience gained as a team leader, supervisor or project/program manager.
- Indepth knowledge of state, federal, and accreditation standards, including CMS, NCQA, DHCS, and DMHC strongly preferred.
- Advanced skills in business acumen, financial analysis, risk management, delegation oversight, and operational leadership
- Experience supporting or participating in regulatory or accreditation audits preferred
- Advanced knowledge of Utilization Management, delegation oversight, and healthcare regulatory requirements.
- Demonstrated ability to lead and manage teams, processes, and projects within a regulated healthcare environment.
- Strong analytical, critical thinking, and decisionmaking skills, including the ability to interpret performance metrics and identify risk.
- Strong verbal, written, and interpersonal communication skills, including communication with internal and external stakeholders.
- Functional expertise within area of responsibility and recognition as a subject matter expert.
- Understanding of Blue Shield of California's mission, business plan, and healthcare industry environment.
Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
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External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.