Director, Compliance Delegation Oversight, Clinical Auditing and Monitoring
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $135,136 - $216,218 per year
Job Level
About the role
- Provide strategic leadership and direction for the Clinical Delegation Oversight program
- Develop and maintain a robust audit and monitoring framework for delegated clinical functions
- Serve as the subject matter expert on clinical delegation oversight requirements
- Partner with Regulatory Compliance, Health Services, Quality Improvement, and Provider Network Management
- Oversee the end-to-end lifecycle of delegated clinical audits
- Direct the monitoring and follow-up process for CAPs (Corrective Action Plans)
- Oversee the preparation and presentation of audit reports
- Foster a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals
- Proactively initiate, build and maintain effective relationships and communication with both internal and external key stakeholders
Requirements
- Bachelor's Degree in Nursing or Related Field
- At least 7 years of experience in managed care, clinical compliance, delegation oversight, or healthcare auditing
- At least 5 years of leading staff or supervisory/management experience
- Experience developing and managing audit programs, corrective action processes, and cross-functional compliance initiatives
- In-depth knowledge of DHCS, DMHC, and CMS regulatory requirements governing delegated clinical functions
- Demonstrated expertise in clinical oversight of delegated entities, including UM, QI, Credentialing, and Case Management functions
- 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
- Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical compliancedelegation oversighthealthcare auditingaudit programscorrective action processescross-functional compliance initiativesclinical oversightcredentialingcase management
Soft Skills
strategic leadershiprelationship buildingcommunicationtransparencycontinuous improvementaccountabilitypresentation skillslong-term thinkingstrategic development
Certifications
Bachelor's Degree in Nursing