Director, Delegation Oversight (Director II)
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Director, Delegation Oversight (Director II)
CalOptima
CalOptima Health is seeking a highly motivated an experienced Director, Delegation Oversight (Director II) to join our team. The Director II (Delegation Oversight) will oversee and conduct independent audits of CalOptima Health's contracted partners' performance of delegated functions. The incumbent will lead the department in developing audit protocols for all CalOptima Health's delegates to ensure compliance with contractual, statutory and regulatory requirements, as well as accreditation standards and CalOptima Health's policies and procedures as it relates to CalOptima Health's programs. The incumbent will work collaboratively with internal and external partners to promote compliance with requirements. The incumbent will interact with CalOptima Health executives, departmental management, delegates and potential delegates, and legal counsel.
Position Information:
Department: Delegation Oversight
Salary Grade: 321 - $181,257 - $290,011 ($87.14 - $139.4282)
Work Arrangement: Partial Telework
**This position is eligible for telework in California.**
Duties & Responsibilities:
50% - Leadership Functions
Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
Develops and executes an annual audit plan of CalOptima Health's delegates in coordination with the CalOptima Health Network Operations department.
Plans, directs and manages CalOptima Health's Delegation Oversight Committee (DOC) consistent with statutory, regulatory and accreditation requirements.
Manages critical business risks by communicating best practices, promoting process improvement and monitoring remediation activities.
Partners with other CalOptima Health department leaders to administer a closely integrated and coordinated risk management program.
45% - Program Oversight
Plans, develops and implements audit plans and other activities to ensure CalOptima Health's delegated partners are operating within contractual, statutory and regulatory requirements.
Develops and executes an annual audit plan based on an evaluation of risk areas and creation of a risk assessment of CalOptima Health's delegates in coordination with the CalOptima Health Network Operations Department with review and approval by the DOC.
Conducts regular review and updates to delegation agreements to incorporate additional requirements and standards.
Directs updates to audit tools to ensure consistency with delegation agreements.
Conducts regular and ongoing review and analysis of relevant standards, guidelines, contractual provisions or other regulations to which CalOptima Health's delegated partners must comply; coordinates with appropriate departmental staff and delegated partners to maintain CalOptima Health's compliance with all requirements.
Directs focused audits or review activities as appropriate; analyzes results and makes recommendations to executive staff about corrective actions and/or penalties or other activities that may be necessary to address issues.
Ensures at least an annual review of delegated activities and the provision of semiannual review and feedback of delegate reports.
Conducts pre-delegation reviews/audits of new delegates as appropriate.
Identifies benchmarking standards (leading practices) for identifying potential control gaps and/or opportunities for improving efficiency.
Ensures that audit recommendations are practical and appropriate for managing risks identified during individual audit projects.
Obtains corrective action plans from appropriate CalOptima Health delegates addressing these risks including actions to be taken, responsible parties and implementation due dates.
Performs the appropriate follow-up reviews to effectively monitor whether corrective action plan steps were properly implemented.
5% - Completes other projects and duties as assigned.
Minimum Qualifications:
Bachelor's degree in business administration, health care administration or related field required PLUS 7 years of experience of audit process implementation in a managed care organization or health plan required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
5 years of management level experience, including direct supervision of staff, in regulatory audits and/or internal audit and oversight for a Medicare/Medicaid managed care health plan required.
Executive experience which includes working relationships with senior members of management and significant experience making presentations to organizational boards and committees required.
Experience in contracting, monitoring and enforcing contract provisions and quality management required.
Preferred Qualifications:
Master's degree in business administration, health care administration, management science/operations research or related field.
Required Licensure / Certifications:
n/a
Knowledge & Abilities:
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Work Environment:
If located at the 500, 505 Building or a remote work location:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
There are no harmful environmental conditions present for this job.
The noise level in this work environment is usually moderate.
If located at PACE:
Work is typically indoors in a clinical setting serving the frail and elderly.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
If located in the Community:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
Employee will occasionally work outdoors in varied temperatures.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto "Better. Together. is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the alliantbenefits.cld.bz/24caloptimacabenguide regarding our comprehensive benefits and wellness package.
IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 14, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.
Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: apptrkr.com/5680902
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