Dir. Delegation Oversight

Job Category:  Management/Executive
Department:  Compliance
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  3872

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Director serves as a senior leader within the Compliance Department. The Director will manage the Delegation Oversight Unit and ensure that all audits of plan partners, providers, IPAs, specialty health plans and other external first tier, downstream and related entities are audited in accordance with Compliance Department policies and procedures and guidance from all applicable regulatory agencies. The Director will prepare executive summaries and reports, develop and conduct training activities for subordinates, peers and L.A. Care business units and lead or participate in interdisciplinary teams. The Director will also advise and support the Chief Compliance Officer on other duties as assigned to support the mission and responsibilities of the Regulatory Affairs and Compliance Department and to support the mission and business operations of L.A. Care Health Plan.

Duties

Prioritizes and manages day to day operations of the Delegation Oversight Unit, including supervision of a staff including but not limited to Compliance Managers and Specialists, including hiring of staff and evaluation of staff performance. Develops, implements and monitors ongoing employee engagement plans.

Manages all delegation oversight audits, corrective action plans, corrective action plan validation and corrective action plan monitoring for providers, IPAs, plan partners and other first tier, downstream and related entities.

Develops and implements annual Delegation Oversight Unit Work Plan.

Serves on internal committees and workgroups. Leads, facilitates and participates in relevant committees and committees as assigned by the Chief Compliance Officer.

Ensures that all policies and procedures, desk level procedures are updated at least annually.

Oversee and Conduct periodic enterprise training regarding delegation oversight.

Performs other duties as assigned.

Education

Bachelor's Degree

Master's Degree

Experience

Required:

With Bachelor's Degree: 6-8 years of experience designing, implementing compliance programs, policies

and practices; and managing audit and/or audit related activities in a health plan/ managed care environment.

At least 5 years of progressive management experience.

Preferred:

With Master's Degree/J.D.: 4 years of experience designing, implementing compliance programs, policies

and practices; and managing audit and/or audit related activities in a health plan/ managed care environment.

Equivalent Experience:

With High School Diploma: 12 years of experience designing, implementing compliance programs, policies

and practices; and managing audit and/or audit related activities in a health plan/ managed care environment.

With Associate's Degree: 9 years of experience designing, implementing compliance programs, policies and practices; and managing audit and/or audit related activities in a health plan/ managed care environment.

 

Preferred:

Certified in Healthcare Compliance

Professional Certifications

Required:

Understanding of the vital importance of commitment to excellence and demonstrating a high regard for

organizational values.

Knowledge of provider contracting process.

Strong organization and planning skills and be flexible to handle multiple assignments, changing priorities, and meeting.

Knowledge of Word and Excel.

Excellent interpersonal, verbal, and written communication skills required.

Must be able to present findings to various levels of management, across all organizations.

Persuasion Skills: Ensuring organizational compliance with regulatory requirements and effectively communicate to L.A. Care staff, external contacts and regulatory agencies. Build relationships with regulatory agencies to communicate compliance activities and deliverables.

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

Job Segment: Medical, Healthcare