Remote: Senior Health Plan Delegation & Alignment Lead

52 Limited; Oregon (WI); On-site; USD 120,000 - 170,000; Full time

Benefits offered by this job

Health insurance

Paid sick leave

Voluntary benefits

Job summary

52 Limited seeks a Delegation Project Leader Senior to guide the integration and harmonization of health plan delegation processes across affiliates. You will lead oversight, audits, and gap analyses to ensure regulatory and NCQA accreditation readiness, while coordinating with multiple teams across product lines.

The role requires 6+ years in healthcare administration or project leadership, with strong knowledge of delegation oversight and accreditation standards.

Qualifications

• 6+ years of progressive experience in healthcare administration, project leadership, or a related field.
• 5+ years coordinating and overseeing healthcare delegation activities and related contracting.
• Strong knowledge of healthcare delegation oversight and NCQA Health Plan Accreditation requirements.
• Understanding of delegated functions such as credentialing, utilization management, case management, appeals, and network management.
• Experience managing complex delegation oversight projects.
• Experience with delegation program integration, merger integration, or multi-entity health plan alignment is preferred.
• Medicaid product line accreditation experience is strongly preferred.
• Experience leading organizational change, process standardization, gap analysis, and current‑state/future‑state initiatives.
• Strong facilitation, documentation, stakeholder management, and project communication skills.
• Experience using AI tools and technologies to improve professional productivity and decision‑making is highly desired.

Responsibilities

• Co‑lead the integration of delegation processes from health plan affiliates into established enterprise delegation programs and workflows.
• Assess current delegation oversight processes, policies, procedures, and systems to identify gaps and differences between affiliate and existing approaches.
• Develop and execute alignment plans, transition strategies, and timelines to move delegation activities to a standardized future state.
• Implement harmonized delegation policies, procedures, audit tools, workflows, and oversight processes across multiple health plan entities.
• Perform pre‑delegation assessments, ongoing delegation oversight, and audits of delegated entities.
• Ensure delegation activities remain aligned with regulatory requirements, contractual obligations, and NCQA Health Plan Accreditation standards.
• Develop, revise, and maintain delegation audit tools and documentation supporting ongoing oversight and integration efforts.
• Establish metrics and monitoring processes to track alignment progress, compliance, and readiness.
• Create implementation guides, work plans, gap analyses, progress reports, and integration outcome documentation.
• Facilitate working sessions and planning meetings across affiliate, delegation, and other cross‑functional teams.
• Identify and help resolve challenges related to delegation integration, process alignment, and organizational change.
• Provide regular written and verbal project updates to program leadership and executive stakeholders.
• Provide coaching and guidance to junior team members.

Skills

Healthcare administration

Project leadership

Delegation oversight

NCQA accreditation

Credentialing

Utilization management

Case management

Organizational change

Stakeholder management

Education

Bachelor’s degree in Business Administration/Healthcare Administration

Master’s degree preferred

PMP or CPHQ certification a plus

Job description

52 Limited seeks a Delegation Project Leader Senior to guide the integration and harmonization of health plan delegation processes across affiliates. You will lead oversight, audits, and gap analyses to ensure regulatory and NCQA accreditation readiness, while coordinating with multiple teams across product lines.

The role requires 6+ years in healthcare administration or project leadership, with strong knowledge of delegation oversight and accreditation standards.