Delegation Oversight Specialist

Champion Health Plan; Long Beach (CA); Sur place; USD 70 000 - 90 000; Plein temps

Résumé du poste

Champion Health Plan is looking for a Delegation Oversight Specialist in Long Beach, California. This role involves overseeing health plan delegation oversight and compliance through audits and performance monitoring. Candidates should have a Bachelor’s degree in a relevant field and experience in a managed care environment. Proficiency in Microsoft Office and familiarity with NCQA standards is essential. Join a mission-driven team focused on improving healthcare accessibility and effectiveness.

Qualifications

• Bachelor’s degree in Healthcare Administration, Public Administration, Health Policy, or a related field.
• Experience working in a managed care organization, HMO, MSO, or health plan setting.
• Working knowledge of NCQA standards, CMS, DMHC, and DHCS regulatory requirements.

Responsabilités

• Prepare and submit pre-audit documentation.
• Coordinate and conduct oversight audits for compliance.
• Serve as the main contact for auditors during audits.

Connaissances

Experience in healthcare operations

Organizational skills

Analytical skills

Written/verbal communication skills

Advanced proficiency in Microsoft Office Suite

Formation

Bachelor’s degree in Healthcare Administration or related field

Master’s degree preferred

Outils

Microsoft Office Suite

Quick CAP

EZ-CAP

Description du poste

Champion Health Plan is a mission-driven Medicare Advantage organization (HMO) serving beneficiaries across California and Nevada. Through strong provider partnerships and an integrated care model, we deliver high-quality, coordinated care to members, including those with complex chronic conditions.

Our approach combines clinical excellence, operational expertise, and a deep commitment to making healthcare more accessible, affordable, and effective for the communities we serve. Join a collaborative team committed to delivering meaningful, high-impact healthcare solutions.

About the Role

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)
• 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

OR equivalent combination of education and relevant managed care experience

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