Job Details

Senior Manager, Delegation Oversight

Company name

Organization Type

Public Interest

Job Type

Attorney

Years of Experience

Min 4 yrs required

Location

Los Angeles, CA

Date Last Verified

Sep 14,2017

Posted on

Aug 15,2017
Practice Area
Health Care >> Health Care
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Senior Manager, Delegation Oversight DUTIES: Under the general direction of the Director of Oversight & Monitoring, the Senior Manager, Delegation Oversight is an out-of-the-box, critical thinker, who is able to apply developed strategies consistently to daily operations. Responsible for developing, implementing, managing, and updating a monitoring and oversight program for services delivered through contracted, delegated entities (Participating Provider Groups, Management Services Organizations, Vendors, etc.). Responsible for maintaining a subject matter expertise of the operational, reporting, and accrediting requirements for all lines of business (Medicaid, Medicare, and Commercial) that are delegated to external entities, and is responsible to ensure delegated functional performance meets the requirement and standards imposed by its regulating and accrediting agencies while achieving goals associated with clinical outcomes, cost effectiveness, and member satisfaction. Responsible for developing a standardized template to document each delegated requirement and its corresponding authority source(s), and utilize a corresponding standardized template to document a delegated entity’s performance with each requirement identified in the index. The completed form would summarize the manner by which the delegated entity demonstrates compliance with the corresponding requirement, e.g., policy, desktop procedures, workflow(s), and performance measures.

Qualification and Experience

REQUIREMENTS: Bachelor’s in a related field of study; or commensurate work experience. Master's Degree or JD Degree preferred. Certified in Healthcare Compliance (CHC); Certified in Healthcare Compliance Fellow (CHC-F); Certified Compliance Ethics Professional (CCEP). With High School Diploma: 12 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry. 6+ of those years shall include supervisory experience; or, 12 years of experience in external regulatory or governing entity audit preparation. At least six of those years shall include supervisory experience. 12 years of experience in Healthcare Compliance, or other Compliance-related field. With Associate's Degree: 9 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry. At least five of those years shall include supervisory experience; or, 9 years of healthcare experience in external regulatory or governing entity audit preparation. At least five of those years shall include supervisory experience. 9 years of experience in Healthcare Compliance, or other Compliance-related field. With Bachelor's Degree: 6-8 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry. At least four of those years shall include supervisory experience; or, 6-8 years of healthcare experience in external regulatory or governing entity audit preparation. At least four of those years shall include supervisory experience. 6-8 years of experience in Healthcare Compliance, or other Compliance-related field. With Master's Degree: 4 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry. At least two of those years shall include supervisory experience. 4 years of healthcare experience in external regulatory or governing entity audit preparation. At least 2 of those years shall include supervisory experience. 4 years of experience in Healthcare Compliance, or other Compliance-related field.

Additional info

Position Control No. 1830

Company info

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