• Manager Delegation Oversight Monitoring

    Dignity Health (Bakersfield, CA)


    Job Summary and Responsibilities

     

    The Manager, Delegation Oversight Monitoring (DOM) reports directly to the Director of Delegation Oversight Performance Monitoring (DOPM). This manager will partner with the director to establish a specifically designed delegation audit program that effectively prevents and/or detects violation of applicable laws, regulations, and contractual requirements, which will protect the organization from liability. This position will provide oversight of the team's leading health plan audits, core function of letter templates and denial letter responses, and essential reporting for the department. Educate and ensure assigned team members understand and comply with applicable laws, regulations, and contractual requirements.

     

    The Manager, Delegation Oversight Monitoring is responsible for conducting routine internal audits, providing follow-up, and overseeing timely resolution of identified deficiencies. Specifically, this will include health audit planning, supervising the review of audit files during fieldwork, oversighting and making determination about compliance findings, essential reporting and oversight of letter template functions. This position will be responsible for providing leadership, guidance, and oversight to a small team when directions and expectations are unclear.

     

    Additionally, in this role, you will serve as a super user for Policy Manager, the organization's internal P&P document depository. You will partner closely with the CommonSpirit (CSH) Compliance team on this function and oversight responsibilities. You will assist the CSH Compliance team and organization in meeting privacy expectations of the compliance program, including: controls, policies & procedures, communications, and training.

     

    ***This position is remote, with a preference for California residents. PST business hours will be expected.

    Job Requirements

    Minimum Qualifications:

    - 5+ years of experience working in compliance, health plan oversight, auditing, and/or state agency, within the health care industry.

     

    - 2 years minimum of supervisory, team lead or experience leading projects/training

     

    - Bachelors degree or 5+ years equivalent experience will be considered

    Preferred Qualifications:

    - Direct experience in a California MSO environment to support delegation oversight services preferred

     

    - Experience with claims preferred

     

    Where You'll Work

     

    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 (https://youtu.be/RrPuiSnALJY?si=pvQgPZ6ZWZM60TPV)

    Pay Range

    $45.26 - $67.32 /hour

     

    We are an equal opportunity/affirmative action employer.