Delegation Oversight

Delegation Oversight Long Beach, CA Job Details Full-time From $60,000 a year 3 days ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Life insurance Qualifications Dashboard development Performance dashboards Teamwork Document review (document control) Microsoft Excel Insurance prior authorization LVN Audit report preparation Healthcare Administration Regulatory compliance Regulatory reporting Compliance audits & assessments Corrective and preventive actions (CAPA) Mid-level 3 years Master's degree Public Administration CMS regulatory compliance Bachelor's degree Utilization management Centers for Medicare and Medicaid Services (CMS) Organizational skills Bachelor's degree in public administration Bachelor's degree in healthcare administration LPN Overseeing audit functions Continuous quality improvement (CQI) Productivity software Cross-functional collaboration Communication skills

Full Job Description Delegation Oversight Specialist Position Summary:

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 Pay:

From $60,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Life insurance Paid time off Vision insurance Ability to

Commute:

Long Beach, CA 90815 (Required) Ability to

Relocate:

Long Beach, CA 90815: Relocate before starting work (Required)

Work Location:

In person