Delegation Management Specialist II

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.

Every day you will support or lead several functional areas, which include health plan audits, administering of letter templates and denial letter responses, and essential reporting for the department. You will also be responsible for in-depth analysis, reporting, collaboration with stakeholders, and the development of strategies to improve the effectiveness of delegation relationships.

To be successful, you will demonstrate outstanding organizational skills, strong analytical capabilities, and a meticulous, communicative demeanor, contributing significantly to the integrity and effectiveness of our delegated functions.

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.

This position is work from home in the Bakersfield, CA region.

• Coordinates, conducts, and documents 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.
• Supports team members, Supervisor, and Director with developing project plans, monitoring, and reporting status of project tasks, and reporting on overall status of projects
• 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.

Required

• 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

Preferred

• 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 HIPPA, 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

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

One Community. One Mission. One California 

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards.

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.