Description
Reporting to the Associate Director of Delegation Oversight and Systems,
the Delegation Oversight Manager will lead the day-to-day management and
execution of our health plan’s Delegation Oversight program. This critical role
ensures that delegated entities, including Independent Physician Associations
(IPAs), medical groups, and supplemental benefit vendors, comply with CMS,
DMHC, and NCQA regulations while meeting contractual, operational, and
performance standards.
Key Responsibilities:
Lead
regulatory monitoring, audit readiness, and corrective action planning for
delegated functions.
Manage
the full oversight cycle, including performance monitoring, data
submission compliance, Joint Operations Committee facilitation,
remediation tracking, and risk escalation.
Collaborate
with internal teams such as Data Integration & Reporting, Performance
& Engagement, Compliance, Network Management, Supplemental Benefit
Management, and Operations to maintain delegated entity accountability.
Interpret
regulations, identify risks, and develop corrective actions independently.
Supervise
and develop the delegation oversight team, including the Delegation
Oversight Account Manager.
Provide
functional reporting to the Corporate Compliance Committee on oversight
activities, risk posture, and program performance.
Salary Range: $105,700 - $234,500/annually Qualifications We’re seeking a talented leader with:
Required:
• A Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a related field, and/or equivalent experience
• 5 or more years of experience in healthcare operations, regulatory compliance, or health plan operations
• 3 or more years of experience in delegation oversight, compliance monitoring, or delegated vendor/IPA management
• 2 or more years of supervisory or lead experience overseeing professional staff or program execution
• CMS, NCQA, or healthcare compliance training at hire or within reasonable timeframe
• Knowledgeable of Medicare Advantage delegation oversight requirements and regulatory drivers (CMS, DMHC, NCQA)
• Knowledgeable of Delegated operational functions and how oversight is performed across functions
• Able to design, execute, and maintain delegation oversight monitoring activities
• Able to identify compliance, operational risks and synthesize findings and recommend corrective action/remediation plans
• Able to plan, manage, and track corrective action plans (CAPs), including follow-up validation and documentation
• Strong written communication skills to develop oversight documentation (reports, audit artifacts, committee materials, executive summaries)
• Strong verbal communication and stakeholder management skills across technical and technical audiences (IPA/vendors, Compliance, Operations, clinical leaders)
• Ability to facilitate and coordinate governance forums (e.g. JOCs/workgroups), document decisions, and ensure action-item follow-through
• Supervisory skills, including coaching, work assignment, prioritization, feedback, performance support)
• Interpret and apply regulatory guidance and contractual requirements, exercising independent judgement and appropriate escalation
• Proficiency with data-informed performance monitoring (scorecards/dashboards, KPIs, trend review) to support oversight decisions
• Experience with delegation oversight or performance monitoring systems (e.g. Inovaare) and standard documentation repositories (e.g. Sharepoint/Teams)
Preferred:
• A Master’s degree in a related field
• 2 or more years of experience supporting CMS, DMHC, or NCQA audits and regulatory reviews
• Minimum of 1 year using data, dashboards, or performance metrics to support oversight activities
• PMP or project management certification
$105700-234500 Annually Monday-Friday, 8:00am - 5:00pm PST
Salary : $105,700 - $234,500
