JOB DESCRIPTION

Job Summary

The Manager, Delegation Oversight position is responsible for the management of staff and oversight of delegated activities, ensuring compliance with State, Federal, NCQA, and Molina delegation standards and requirements. Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities including as applicable, but not limited to, Health Plan on-boarding activities, management of oversight activities and audits, issuance, and management of corrective action plans, escalating as necessary delegate services issues, performing ongoing risk monitoring, and ensuring proper off-boarding when delegates are no longer being utilized.

This position will support our California HealthPlan. We are looking for a candidate with a CA  LVN, LPN or RN Nursing license, managed care Utilization Management (UM), Medi-Cal knowledge, and Marketplace experience. This position will manage Delegation Oversight direct reports. Candidates with Medi-Cal knowledge/ experience and previous leadership experience are strongly preferred. 

Remote position with field travel

Hours: Monday - Friday 8:00am- 5:00pm PST

Duties and Responsibilities

• Manages and directs Delegation Oversight staff including hiring, training, evaluating performance and/or auditing activities.
• Chairs monthly meetings of the Delegation Oversight Committee, including scheduling, preparation of agendas, meeting minutes, and supporting documents for committee review and discussion during each meeting.
• Prepare Delegate performance reports for presentation to Health Plan and Senior Management and to ensure compliance with contractual and regulatory SLAs.
• Creates audit schedules for existing delegates and ensures adherence to specified timeline requirements of audit completion.
• Manages department processes of auditing the performance of delegated entities on an annual basis and assigns/reviews corrective action plans when deficiencies are identified.
• Collaborates with Sr. leadership in the development of new and updates to existing delegation audit tools and policies/procedures.
• Responsible for performance management of Molina's most complex and high-risk, high maintenance delegated subcontractors. 
• Administration of corrective action plans to remediate deficiencies, and administration of change management process, 
• May be assigned special projects and representation of Delegation Oversight on interdisciplinary teams.
• Manages data and reporting for existing delegates and ensures reporting is compliant pursuant to contractual and regulatory standards.
• Creates and manages delegate KPI trend reporting used to support Delegation Oversight Program oversight activities.  
• Prepares and submits regulatory/contractually required delegate reporting. 
• Identifies, reports and escalates data or delegate key performance indicator non-compliance. 

JOB QUALIFICATIONS

REQUIRED EDUCATION:

Bachelor Degree in related field or equivalent experience.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 

• 7 + years related auditing experience
• Previous lead experience
• Strong relationship building and management experience
• Ability to manage multiple stakeholders and competing priorities
• Excellent communication skills, time management, organizational and prioritization skills
• Strong project management skills and knowledge of project management tools/processes
• Detail oriented and organized
• Excellent verbal and written communication skills

PREFERRED EDUCATION:

Graduate degree or course of studies in nursing, business, or health care management

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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Pay Range: $76,425 - $149,028 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.