Delegation Management Specialist II

***This position is remote within California.

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.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

***This position is remote within California.

Position Summary:

As a 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 In this role you will report to leadership within the Delegation Management Department. This role will support or lead several functional areas within the DOD, which includes health plan audits, administering of letter templates and denial letter responses and essential reporting for the department. Will also include in-depth analysis, reporting, collaboration with stakeholders, and the development of strategies to improve the effectiveness of delegation relationships.

Responsibilities may include:
- 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.
- Will lead and/or support, preparing and sending the requested information to the health plans prior to the audit. May include and/or portions of the following functions: Intake and coordinate health plan oversight audits and ensures the audit date & method is on the HP or state agency Audit Schedule. Prepares for health plan or state agency audits and provides the health plan/agency with the pre-audit documentation needed. This may include: Policies/procedures & practice guidelines, Contact Sheets, Biographical and Demographic Sheets, Authorization Review detail- memo notes, criteria, denial letters, Medical director review notes, etc., Committee minutes, Organizational Charts, UM Staffing Lists, Inter-Rater Reliability Audit Results, Member/Provider handbooks, Staff Training Logs, Etc.
- Review and analyze compliance reports, documentation, and data to identify areas of non-compliance or potential risks.
- Participate and/or lead the development and implementation of corrective action plans (CAP) to address identified issues. May include the following: CAP responses and timely submission to the health plan as a result of the HP/agency audit findings. This will include close collaboration with various departments within the Dignity Health MSO to provide the CAP response in a timely manner to the health plan.
- Partners as needed with the appeals and grievances functions of the department.

Minimum Qualifications:

- 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 3 years of related job or industry experience in lieu of degree.

Preferred Qualifications:

- Knowledge of DMHC, NCQA, CMS and other regulatory bodies preferred
- Knowledge of HIPPA, managed care environment preferred
- S everal years of experience in delegation Management, compliance management, or a related field preferred
- Strong technical proficiency in data analysis; database software preferred
- Managed care experience preferred
- Delegation management experience preferred
- Regulatory audit experience preferred
- Bachelor's degree in a relevant field (e.g., healthcare management, business administration, compliance) preferred
- Certification CPHQ preferred
- Certified Compliance Professional (CCP) preferred
- Certified Healthcare Auditor (CHA) preferred