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Director, Delegation Oversight Performance Monitoring and Account Management

Job Category:  Management/Executive
Department:  Delegation Oversight
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  6190

 

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 of Delegation Oversight Performance Monitoring & Account Management is solutions oriented, critical thinker, who is able to develop and apply strategies to daily operations consistently. The Director is responsible for developing and maintaining the operations of the Performance Monitoring vertical of the Delegation Oversight department while partnering with Clinical Assurance, Financial Compliance, Credentialing, Provider Network Management (PNM), Compliance, Pharmacy, Cultural & Linguistic Services, Quality Improvement, Health Education,  Provider Training and other internal departments to develop and operationalize a provider oversight and monitoring framework, data aggregation and reporting, and risk assessments of performance in accordance with contractual and regulatory requirements.  

 

With the focus on contractual and regulatory compliance of delegated and non-delegated provider functions, the Director is responsible for developing key performance indicators, and supporting metrics, to proactively inform the L.A. Care (LAC) PNM, Utilization Management, Quality, and Compliance departments, and the Internal Compliance Committee (ICC) of possible risks and issues with compliance, and develop remediation and corrective action plans as appropriate. The Director thinks both strategically, identifying and implementing, directly or through a vendor, state of the art programs and processes, and systemically, bringing together the multiple departments and/or vendors involved in program design and implementation.

 

The Director of Performance Monitoring & Account Management is responsible for strategy, implementation, day to day operations, and supervising employees of both the Delegation Oversight Monitoring team and the Account & Communications management team. The Director is responsible for maintaining a subject matter expertise of the operational, reporting, and accrediting requirements for all lines of business (Medicaid, Medicare, and Commercial) within LAC, and work with his or her team to ensure LAC, and LAC contracted providers, are compliant.  The Director is the single point of contact for all performance monitoring issues related to delegates, and is responsible for maintaining strong lines of the communication with the leads for delegation oversight in the Compliance and Health Services Delivery (Case Management, Utilization Management, and Disease Management) organizations, and is responsible for the reporting to the ICC. The Director is required to use strong organizational and communication skills to build and foster effective relationships, and to use critical thinking and problem solving skills to help ensure successful delegation partnerships and department quality.

Duties

Overseeing the implementation and effectiveness of the L.A. Care delegate monitoring plan to measure monthly and quarterly performance and score against contractual and regulatory requirements.

 

Overseeing and executing the operational effectiveness of the Account and Communications management program while measuring the success of the program against milestones and industry standard measures.

 

Leadership and direction of a department of managers and analysts that are developing, implementing, and executing work plans, monitoring plans, and communications plans. Provides leadership to the teams for the ingestion of performance data, triaging to business units, aggregation of results, and reporting of overall performance of the delegated network at ICC and the Delegation Oversight Committee.  

 

Partners with internal L.A. Care departments including Compliance, Quality Assurance, Provider Network Management, Health Services Delivery, and others to ensure delegates are compliant with all requirements.  

 

Providing to senior leadership analytical performance metrics on all task performance requirements. Taking proactive preventative steps to resolve issues and manage risk.  Partners with the business leaders to coordinate reviews and prepare  for annual oversight and regulatory audits of delegated provider groups; examining monitoring findings and responding to citied deficiencies; and, making recommendations for corrective actions and monitoring internal and external corrective action plans.

 

Manage staff, including, but not limited to, recruiting, selecting, orienting, and training new staff,,monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training and cross-training, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

 

Perform other duties as assigned.

Education Required
Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Master's Degree
Experience

Required:
At least 7 years of experience in contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry. 

 

At least 5-7 years shall include supervisory/management experience.

Skills

Required:
Demonstration of both qualitative and quantitative analytical skills.

 

Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.

 

Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.

 

Demonstrated critical thinking and problem solving skills.

 

Strong written and verbal communication skills.

 

Strong elicitation and process documentation skills.

 

Strong organizational and communication skills to build and foster effective relationships.

Licenses/Certifications Required
Licenses/Certifications Preferred
Certified HealthCare Compliance (CHC)
Certified in Healthcare Compliance Fellow (CHC-F)
Certified Compliance & Ethics Professional (CCEP)
Required Training
Additional Information

Required:
Active & Current Driver's License and Auto Insurance Required.

 

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, Pharmacy, Medicaid, Medicare, Performance Management, Healthcare, Human Resources