Manager, Delegation Oversight

Job Summary

The Manager, Delegation Oversight position is responsible for the management of staff and oversight of delegated activities, ensuring compliance with State, Federal, NCQA, and Molina delegation standards and requirements. Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities including, but not limited to, Health Plan onboarding activities, management of oversight activities and audits, issuance and management of corrective action plans, escalating as necessary delegate services issues, performing ongoing risk monitoring, and ensuring proper offboarding when delegates are no longer being utilized.

This position will support our California HealthPlan. We are looking for a candidate with a CA Nursing license and experience with managed care Utilization Management (UM) and Medi-Cal and Marketplace. This position will manage Delegation Oversight direct reports. Candidates with Medi-Cal knowledge/experience and previous leadership experience are strongly preferred.

Hours: Monday - Friday 8:00am-5:00pm PST

Duties and Responsibilities

• Manages and directs Delegation Oversight staff including hiring, training, evaluating performance and/or auditing activities.
• Chairs monthly meetings of the Delegation Oversight Committee, including scheduling, preparation of agendas, meeting minutes, and supporting documents for committee review and discussion during each meeting.
• Prepare Delegate performance reports for presentation to Health Plan and Senior Management and to ensure compliance with contractual and regulatory SLAs.
• Creates audit schedules for existing delegates and ensures adherence to specified timeline requirements of audit completion.
• Manages department processes of auditing the performance of delegated entities on an annual basis and assigns/reviews corrective action plans when deficiencies are identified.
• Collaborates with Sr. leadership in the development of new and updates to existing delegation audit tools and policies/procedures.
• Responsible for performance management of Molina's most complex and high-risk, high maintenance delegated subcontractors.
• Administration of corrective action plans to remediate deficiencies, and administration of change management process.
• May be assigned special projects and representation of Delegation Oversight on interdisciplinary teams.
• Manages data and reporting for existing delegates and ensures reporting is compliant pursuant to contractual and regulatory standards.
• Creates and manages delegate KPI trend reporting used to support Delegation Oversight Program oversight activities.
• Prepares and submits regulatory/contractually required delegate reporting.
• Identifies, reports, and escalates data or delegate key performance indicator non-compliance.

Job Qualifications

Required Education:
Bachelor Degree in related field or equivalent experience.

Required Experience/Knowledge, Skills & Abilities:

• 7 + years related auditing experience
• Previous lead experience
• Strong relationship building and management experience
• Ability to manage multiple stakeholders and competing priorities
• Excellent communication skills, time management, organizational and prioritization skills
• Strong project management skills and knowledge of project management tools/processes
• Detail oriented and organized
• Excellent verbal and written communication skills

Preferred Education:
Graduate degree or course of studies in nursing, business, or health care management

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.