Director, Compliance Delegation Oversight Clinical Auditing and Monitoring

The Director, Compliance Delegation Oversight Clinical Auditing and Monitoring serves as a senior leader within the Compliance Department. The Director will manage the Clinical Delegation Oversight Unit and ensure that all audits of plan partners, Participating Provider Groups (PPGs), 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.

Requirements

• 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
• Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.
• Demonstrated ability to make sound and timely decisions.
• Demonstrated ability to adapt to changing situations and adjust strategies accordingly
• Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.
• Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment
• Excellent written and verbal communication, negotiation, and interpersonal skills.
• Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.

Benefits

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