Delegation Oversight Coordinator

JOB SUMMARY  

The Delegation Oversight Coordinator supports the Delegation Oversight program by assisting with the monitoring, coordination, and documentation of delegated functions to ensure compliance with regulatory, accreditation, and health plan requirements. This role helps maintain compliance with CMS, DMHC, DHCS, and NCQA standards by coordinating oversight activities, tracking delegated entity performance, supporting audits, and ensuring timely processing of required documentation including authorization determinations, denial and deferral letters, corrective action plans, and delegation reporting. The Coordinator serves as a liaison between internal departments, delegated entities, and health plans to support regulatory compliance and operational   effectiveness within a Managed Services Organization (MSO).

MINIMUM & PREFERRED QUALIFICATIONS:

Education/Training

Minimum: High School Diploma or equivalent.

Preferred: Medical Assistant diploma or Associate’s degree in healthcare administration, business administration, or related field preferred.

Experience

Minimum: At least one year of experience in healthcare operations, utilization management, delegation oversight, medical management, compliance, or related healthcare administrative role. Basic knowledge of healthcare operations, authorization   processes, or managed care workflows.

Preferred:  Two or more years of experience in delegation oversight, utilization management, medical management, or managed care environment (MSO, IPA, health plan, or medical group). Knowledge of CMS, DMHC, DHCS, and NCQA regulatory standards   preferred. Knowledge of medical terminology, CPT, ICD-10, and HCPCS coding.

Experience supporting regulatory audits or compliance activities.

Experience with electronic medical records, utilization management systems, or compliance tracking systems preferred.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

None 

Skills, Knowledge   & Abilities

· Knowledge of managed care, utilization   management, and delegation oversight principles.

· Understanding of healthcare regulatory   requirements including CMS, DMHC, DHCS, NCQA, and HIPAA.

· Ability to follow policies, procedures, and   regulatory requirements.

· Strong organizational and documentation   management skills.

· Ability to maintain accurate records and   tracking systems.

· Proficiency in Microsoft Office applications   (Word, Excel, Outlook).

· Ability to learn and use healthcare and   compliance-related systems.

· Strong written and verbal communication   skills.

· Ability to communicate professionally with   internal and external stakeholders.

· Strong customer service skills.

· Ability to review documents for completeness   and accuracy.

· Ability to identify potential compliance   issues and escalate appropriately.

· Ability to manage multiple priorities and   deadlines.

· Strong attention to detail and accuracy.

· Ability to maintain confidentiality and   professionalism.

· Ability to work independently and   collaboratively.

· Strong time management and organizational   skills.

PHYSICAL, MENTAL   & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented of those that must be met by an employee to successfully perform the   essential functions of this job. Prolonged sitting and computer work. Frequent use of keyboard, mouse, and office equipment. Occasional standing, walking, bending, and lifting up to 25 pounds. Ability to concentrate and review detailed compliance documentation. Ability to manage multiple tasks and deadlines. Ability to work in a fast-paced, deadline-driven regulatory   environment. Office-based or remote work environment within an MSO healthcare organization. Frequent interaction with internal departments, delegated entities, and health plans. Low to moderate noise level typical of office or remote environment.