What are the responsibilities and job description for the Delegation Oversight Specialist position at Champion Health Plan?
About Champion Health Plan
Champion Health Plan is a mission-driven Medicare Advantage organization (HMO) serving beneficiaries across California and Nevada. Through strong provider partnerships and an integrated care model, we deliver high-quality, coordinated care to members, including those with complex chronic conditions.
Our approach combines clinical excellence, operational expertise, and a deep commitment to making healthcare more accessible, affordable, and effective for the communities we serve. Join a collaborative team committed to delivering meaningful, high-impact healthcare solutions.
About the Role
The Delegation Oversight Specialist is responsible for overseeing all components of health plan delegation oversight, including audits, internal reviews, and performance monitoring to ensure compliance with regulatory and contractual requirements. This position plays a critical role in supporting audit readiness, quality initiatives, and interdepartmental collaboration across delegated functions.
Primary Responsibilities:
- Prepare and submit pre-audit documentation in alignment with health plan tools and timelines
- Coordinate, conduct, and document pre-delegation and annual oversight audits to comply with NCQA, CMS, DMHC, DHCS, and other applicable standards
- Facilitate onsite, virtual, and desktop audits to evaluate adherence to plan-specific and regulatory requirements
- Serve as the main point of contact for health plan auditors and regulatory bodies during all audit phases
- Distribute audit result letters, follow-up communications, audit tools, and annual reporting requirements
- Conduct internal audits of the end-to-end departments process and perform focused audits based on trends, CAPs, or new workflows
- Collaborate with internal teams to collect and review required documentation and ensure timely responses to audit requests
- Assist in the preparation of audit summaries, internal dashboards, and reports for Committees and Joint Operations Committees (JOCs)
- Monitor performance of delegated entities and support continuous quality improvement initiatives
Minimum Qualifications:
- Bachelor’s degree in Healthcare Administration, Public Administration, Health Policy, or a related field (Master’s degree preferred)
OR equivalent combination of education and relevant managed care experience
- Experience working in a managed care organization, HMO, MSO, or health plan setting
- Working knowledge of NCQA standards, CMS, DMHC, and DHCS regulatory requirements
- Familiarity with prior authorization and utilization management processes
- Advanced proficiency in Microsoft Office Suite (Excel, Word, PowerPoint)
- Experience with Quick CAP, EZ-CAP, or similar health plan systems is a plus
Preferred Qualifications:
- 3 years of experience in healthcare operations, managed care, utilization management, or quality oversight
- Experience supporting delegated entities such as provider groups, IPAs, or MSOs
- Prior involvement with audit preparation, corrective action plans (CAPs), and regulatory reporting
- Exposure to NCQA accreditation readiness or survey support
- Excellent organizational, analytical, and written/verbal communication skills
- LVN/LPN licensure is a plus but not required
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Vacation and Sick Time
- Holiday Pay
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday