Compliance Delegation Oversight Clinical Auditing and Monitoring Data Analyst III

Job Summary

The Compliance Delegation Oversight Clinical Auditing and Monitoring Data Analyst III is a senior analytical role responsible for supporting the design, execution, and reporting of delegated clinical auditing and monitoring activities across all Lines of Business. This position plays a critical role in ensuring that delegated entities such as Independent Physician Associations (IPAs), Plan Partners, and specialty health plans operate in full compliance with all regulatory requirements. This position provides advanced data analysis, audit support, and performance reporting, ensuring that audit outcomes, monitoring metrics, and corrective actions are accurately tracked, validated, and reported through enterprise compliance dashboards and governance structures.

The Data Analyst III is responsible for the maintenance, configuration, and optimization of the delegation audit platform and associated software systems used to conduct clinical audits and monitoring activities. This includes ensuring data integrity, maintaining audit workflows, and leveraging system outputs to derive meaningful data analytics, performance reports, and trend insights that support regulatory readiness, operational decision-making, and continuous improvement within the Delegation Oversight program. Acts as a Subject Matter Expert, (SME) serves as a resource and mentor for other staff.

Duties

Collect, validate, and analyze data related to all delegated clinical functions.

Collaborate with auditors to ensure data integrity and completeness during pre-audit preparation, fieldwork, and post-audit validation.

Maintain and monitor key performance indicators (KPIs) for delegated clinical functions in alignment with California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Centers for Medicare and Medicaid Services (CMS) oversight expectations.

Prepare datasets and summary reports for internal review, regulatory submissions, and executive dashboards.

Maintain documentation and data repositories that demonstrate compliance with regulatory requirements for delegated oversight.

Conduct root cause and trend analyses of audit results to identify patterns, systemic issues, or compliance risks among delegated entities.

Maintain documentation and data repositories that demonstrate compliance with regulatory requirements for delegated oversight.

Contribute to audit and monitoring policy and procedure updates, particularly those involving data validation and reporting protocols.

Provide analytical support for strategic initiatives led by management.

Apply subject matter expertise in evaluating business operations and processes. Identify areas where technical solutions would improve business performance. Consult across business operations, provide mentorship, and contribute specialized knowledge. Ensure that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provide training and recommend process improvements as needed.

Performs other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 4 years of experience in data analysis in healthcare compliance, managed care operations, delegation oversight or clinical auditing.

Experience maintaining, configuring, and optimizing audit management software or data tracking systems.

Skills

Required:

Strong quantitative and qualitative analysis skills with the ability to interpret complex datasets and translate findings into actionable insights.

Strong statistical and analytical skills, including multivariate analyses, regression, and control charts to identify drivers of operational, clinical, and financial performance.

Knowledge of version control (Git, GitHub) and collaborative development workflows, including peer review, continuous integration, and reproducible analytic practices.

Ability to develop and maintain reusable analytic frameworks, templates, and processes that support recurring reporting and performance monitoring.

Proficiency in data validation, reconciliation, and adherence to governance standards, including data lineage tracking and quality control.

Working knowledge of DHCS, DMHC, and CMS oversight requirements for clinical delegation and managed care operations.

Knowledge of SQL queries, relational databases, and system integration concepts. Advanced proficiency in tools such as Power BI, Tableau, or Smartsheet for building dashboards and visual reports.

Excellent written and verbal communication skills with the ability to quickly gather, summarize, and meaningfully communicate dense, complex content clearly to all levels of the L.A. Care organization, and external regulating bodies.

Strong elicitation and process documentation skills.

Ability to respond resourcefully to change and ambiguity, generates and champions ideas and initiatives, and thoughtfully identifies the connections within the organization to effectively integrate efforts across units and functions.

Ability to translate complex business problems into structured analytic requirements and actionable insights.

Ability to interpret analytic results in the context of organizational performance, operational priorities, and enterprise goals.

Ability to apply critical thinking to identify patterns, opportunities, and risks across multiple data domains.

Ability to collaborate effectively with cross-functional stakeholders to operationalize analytic outputs.

Demonstrated knowledge of healthcare concepts, such as quality measures, utilization patterns, and key operational drivers in a managed care environment.

Ability to lead analytic projects end-to-end, including business case definition, requirements gathering, analysis, and post-implementation assessment.

Ability to manage multiple projects simultaneously, prioritize tasks, and escalate issues appropriately.

Preferred:

Strong knowledge of Governance, Risk and Compliance (GRC) Systems, Tableau, Visio

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information