Delegate Oversight Specialist

Harbor Health•,

6d•Remote

About The Position

Harbor Health is seeking a detail-oriented Delegate Oversight Specialist to join our Health Plan Operations team. As part of Harbor Health's integrated payvider model — combining a multi-specialty medical group with a health plan across Austin, San Antonio, Dallas, and El Paso — you will be responsible for end-to-end oversight of our delegated entities across Medicare Advantage, Medicaid, and commercial lines of business. You will ensure that delegates meet regulatory and contractual requirements through rigorous pre-delegation assessments, ongoing monitoring, and corrective action planning, partnering closely with Compliance, Quality, Network, and Health Plan Operations to safeguard Harbor Health's delegated functions and maintain audit-ready documentation.

Requirements

Bachelor's degree in Healthcare Administration, Business, Nursing, or a related field; equivalent experience considered
3+ years of experience in health plan operations, managed care compliance, audit or delegation oversight
Demonstrated experience conducting audits, managing CAPs, and producing formal audit reports
Strong organizational skills with the ability to manage multiple delegate relationships and deadlines simultaneously

Nice To Haves

Experience with NCQA accreditation standards or TDI regulatory requirements
Familiarity with HEDIS, risk adjustment, IBNR, or health plan quality programs
Certification in Healthcare Compliance (CHC), Managed Care (CMCM), or NCQA Credentials Verification (CVO)
Payvider or integrated delivery network experience

Responsibilities

Conduct pre-delegation assessments and annual audits of delegated entities, including credentialing, utilization management (UM), claims, and member services functions
Monitor delegate performance against contractual standards, CMS requirements, TDI regulations, and NCQA/URAC accreditation standards
Maintain a comprehensive delegation oversight calendar, tracking audit cycles, reporting deadlines, and corrective action plan (CAP) milestones
Review and update delegation agreements in collaboration with Legal and Compliance teams to ensure alignment with current regulatory requirements
Lead on-site and desk audits of delegate operations; document findings with supporting evidence and issue formal audit reports
Develop, track, and close corrective action plans (CAPs) in response to identified deficiencies; escalate unresolved issues to leadership
Prepare delegates for CMS program audits (HPMS, IDAG, universe submissions) and TDI market conduct examinations
Compile and submit monthly, quarterly, and annual delegation performance reports to the Delegation Oversight Committee
Maintain organized, audit-ready delegation files including executed agreements, assessment tools, audit reports, CAPs, and attestations
Track and analyze delegate performance metrics — including UM turnaround times, credentialing cycle times, and claims accuracy rates — and surface trends to leadership
Serve as the primary point of contact for delegated entities; build collaborative relationships while maintaining appropriate oversight authority
Coordinate with Quality, Provider Relations, and Network Management teams on overlapping delegate performance issues
Educate internal stakeholders on delegation requirements and update policies and procedures related to delegation oversight
Support responses to regulatory inquiries or member complaints related to delegated functions