Manager, Regional Delegation Oversight

Molina Healthcare; United States; Remote; USD 120,000 - 160,000; Full time

Job summary

Molina Healthcare seeks a seasoned leader to head a regional delegation oversight team across multiple states, ensuring compliance with state, federal, NCQA, and Molina requirements.

The role partners with internal owners to manage onboarding/offboarding of delegated entities, oversee audits, CAPs, and risk monitoring, and to develop tools and policies. Strong leadership and cross-functional collaboration are essential.

Qualifications

• 7+ years auditing/vendor/data management experience.
• 1+ year management/leadership experience.
• Ability to build relationships and manage a team.
• Strong critical-thinking and problem-solving/analytical abilities.
• Strong time-management, organizational, detail orientation and prioritization skills.
• Strong project management skills and knowledge of project management tools/processes.
• Strong data processing/analysis experience.
• Ability to interpret error reports and identify remediation steps.
• Ability to collaborate cross-functionally across a highly matrixed organization.
• Strong interpersonal and verbal/written communication skills.
• Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs.

Responsibilities

• Oversees and manages the day-to-day operations of the delegation oversight program for assigned states in a designated region.
• Chairs monthly region/state delegation oversight committee meetings and prepares agendas/minutes.
• Coordinates and reviews delegation audit assessment tools to meet NCQA/state/federal requirements.
• Manages department processes and monitors performance of delegated entities, issuing CAPs as needed.
• Prepares delegation oversight document evidence for state regulatory audits.
• Collaborates with senior leadership to update audit tools and policies.
• Prepares delegation oversight performance reports for health plans and leadership.
• Hires, trains, mentors, and manages the delegation oversight team.

Skills

Auditing

Vendor management

Leadership

Analytical thinking

Time management

Project management

Data analysis

Cross-functional collaboration

Communication

Excel

Job description

***Remote and must live in the United States***

JOB DESCRIPTION

Job Summary

Leads and manages a regional team responsible for multi-state delegation oversight activities including monitoring of delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities including health plan onboarding and offboarding activities, management of oversight activities, audits and corrective action plans, issuance and service issue escalations, and ongoing risk monitoring.

Essential Job Duties

• Oversees and manages the day-to-day operations of the delegation oversight program for assigned states and respective state delegates within a designated region.
• Chairs monthly meetings of region and/or state (where contractually required with the state regulator) delegation oversight committee, including review of agendas and meeting minutes, and documents for committee oversight of delegated functions.
• Coordinates, evaluates, and reviews delegation audit assessment tools as necessary to comply with state, federal, National Committee for Quality Assurance (NCQA), and any other applicable requirements.
• Manages department processes, monitors performance of delegated entities on regulars intervals, and assigns corrective action plans (CAPs) when deficiencies are identified.
• Prepares delegation oversight document evidence for state regulatory audits.
• Collaborates with national delegation oversight senior leadership in the development of new and updates to existing delegation audit tools and policies/procedures.
• Prepares delegation oversight performance reports for presentation to health plans and senior leadership.
• Hires, trains, mentors, develops, and manages delegation oversight team, and demonstrates accountability for team performance.

Required Qualifications

• At least 7 years of related auditing/vendor/data management experience, preferably in delegation oversight, or equivalent combination of relevant education and experience.
• At least 1 year management/leadership experience.
• Ability to build relationships and manage a team.
• Strong critical-thinking and problem-solving/analytical abilities.
• Strong time-management, organizational, detail orientation and prioritization skills.
• Strong project management skills and knowledge of project management tools/processes.
• Strong data processing/analysis experience.
• Ability to interpret error reports and identify remediation steps.
• Ability to collaborate cross-functionally across a highly matrixed organization.
• Strong interpersonal and verbal/written communication skills.
• Microsoft Office suite proficiency (including Excel), and ability to learn/navigate new software programs.

Preferred Qualifications

• Delegation oversight experience.

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