Delegation Management Specialist I

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California 

***This position will be work from home within California.

Position Summary:

The Delegation Management Specialist I supports the Delegation Management Specialist II along with the Delegation Management Department (DOD) in the management and monitoring of delegated health plan compliance which complies with all applicable regulations and statutes in adherence with the Dignity Health MSO (DHMSO) Compliance Framework. The Delegation Management Specialist will possess extensive experience in healthcare compliance, contract management, and delegation management. Will act as a liaison between the contracted provider groups in the delegation management process; to include problem-solving issues for internal and external stakeholders.

Responsibilities may include:
- Manage and evaluate the delegation agreements between DHMSO and contracted entities, ensuring compliance and adherence to contractual obligations.
- Assists with document delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.
- Ensure all compliance requirements are met for the delegated function, including credentialing, training, and auditing.
- Establish and maintain effective communication channels with contracted entities such as healthcare providers, health plans, and service vendors.
- Conduct regular risk assessments and risk management activities to ensure safe and effective delegated functions.
- Participate in the development and implementation of corrective action plans (CAP) to address identified issues. May include the following: CAP responses and timely submission to the health plan as a result of the HP/agency audit findings. This will include close collaboration with various departments within the DHMSO to provide the CAP response in a timely manner to the health plan.
- Will support the DOD and team, preparing and sending the requested information to the health plans prior to the audit.
- Collaborate with delegated entities to improve the quality of services provided.
- Ensure that quality improvement initiatives are effectively implemented and tracked.
- Leverage project management skills to prioritize and complete all assigned tasks, acting as a subject matter expert (SME) supporting assigned areas, and interacts with all levels of internal and external customers to correspond, answer questions and resolve issues as they arise.
- Prepare comprehensive reports for senior management and regulatory agencies.
- Communicate findings and recommendations to stakeholders.
- Ensure that delegated entities are up-to-date with regulatory changes and requirements.
- Collaborate with internal departments to ensure timely and accurate communication regarding provider performance and concerns.
- Assist in the revision of delegation management audit tools in accordance with standards set by NCQA, the Plan’s policies and procedures and other State and Federal guidance tools as required.

Minimum Qualifications:

- 2+ years administrative experience in supporting a compliance, auditing arena, coordination of audits.
- High School Diploma or GED

Preferred Qualifications:

- Several years of experience in delegation Management, compliance management, or a related field preferred.
- Associates Degree or Bachelor’s Degree in a relevant field (e.g., healthcare management, business administration, compliance) preferred.
- Knowledge of DMHC, NCQA, CMS and other regulatory bodies preferred.
- Knowledge of HIPPA, managed care environment preferred.
- Strong technical proficiency in data analysis; database software preferred.
- Certified Compliance Professional (CCP) preferred.
- Certified Professional in Healthcare Quality (CPQH) preferred.
- Certified Healthcare Auditor (CHA) preferred.