[Hiring] Delegation Management Specialist II @Dignity Health Management Services

Role Description

As our Delegation Management Specialist II, you will play a critical role in managing and monitoring the performance of delegated entities within our organization. You will be responsible for ensuring that these entities meet all contractual, regulatory, and quality compliance requirements.

• Support or lead several functional areas, including health plan audits, administering letter templates, denial letter responses, and essential reporting for the department.
• Conduct in-depth analysis, reporting, collaboration with stakeholders, and development of strategies to improve the effectiveness of delegation relationships.
• Demonstrate outstanding organizational skills, strong analytical capabilities, and a meticulous, communicative demeanor.
• Coordinate, conduct, and document delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
• Oversee and manage relationships with delegated entities, including healthcare providers, contractors, or service vendors.
• Ensure that all delegated functions and services are in compliance with applicable laws, regulations, and contractual agreements.
• Support team members, Supervisor, and Director with developing project plans, monitoring, and reporting status of project tasks.
• Conduct regular audits and assessments of delegated entities' operations, processes, and performance.
• May be the point of contact for health plans wishing to perform Management audits for any of the medical groups or IPAs managed by Dignity Health MSO.

This position is work from home in the Bakersfield, CA region. As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

Qualifications

• Five or more (5+) years administrative experience in leading a compliance, auditing arena, coordination of audits and/or leading compliance activities.
• Associates Degree in a relevant field (e.g., healthcare management, business administration, compliance) or three (3) years of related job or industry experience in lieu of degree.

Requirements

• Experience with Utilization Management (UM) strongly preferred.
• Experience in an MSO environment strongly preferred.
• Bachelor's degree in a relevant field (e.g., healthcare management, business administration, compliance) preferred.
• Certified Professional in Healthcare Quality (CPHQ), Certified Compliance Professional (CCP), or Certified Healthcare Auditor (CHA) preferred.
• Knowledge of DMHC, NCQA, CMS and other regulatory bodies preferred.
• Knowledge of HIPAA, managed care environment preferred.
• Several years of experience in delegation management, compliance management, or a related field preferred.
• Strong technical proficiency in data analysis; database software preferred.
• Regulatory audit experience preferred.