Director, Compliance Delegation Oversight

L.A. Care Health Plan•Los Angeles, CA

1d•$135,136 - $216,218

About The Position

The Director, Compliance Delegation Oversight is a senior leader in L.A. Care Health Plan’s Compliance Department. The role directs the Delegation Oversight Unit and ensures risk-based compliance oversight of plan partners, Participating Provider Groups (PPGs), specialty health plans, and other external first-tier, downstream, and related entities. The Director ensures delegated functions comply with applicable regulatory and contractual requirements and oversees oversight planning, execution, governance reporting, and escalations across delegated entities. The Director leads the team’s operations, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. The position develops strategic plans, drives change, influences business outcomes, and oversees departmental operations for efficiency and effectiveness. It also manages the department budget and plans resources to meet current and future departmental and enterprise goals.

Requirements

At least 7 years of experience in managed care, regulatory compliance, delegation oversight, or healthcare auditing.
At least 5 years of experience leading, supervising, and/or managing staff.
Experience leading teams, projects, initiatives, or cross-functional groups.
Bachelor’s degree in Healthcare Administration or a related field; equivalent education and/or experience may be considered in lieu of a degree.
Experience developing and managing audit programs, corrective action processes, and cross-functional compliance initiatives.
In-depth knowledge of DHCS, DMHC, and CMS regulatory requirements governing delegated functions.
Demonstrated expertise in oversight of delegated entities.
Knowledge of Microsoft Word and Excel.
Excellent interpersonal, verbal, and written communication skills, including the ability to present findings to various levels of management across organizations.
Ability to ensure organizational compliance with regulatory requirements and communicate effectively with staff, external contacts, and regulatory agencies.
Ability to build relationships with regulatory agencies to communicate compliance activities and deliverables.
Ability to think strategically and develop plans aligned with organizational goals.
Ability to make sound, timely decisions and adapt strategies to changing situations.
Ability to adapt to a fast-paced, evolving environment and lead others through change.
Ability to analyze data, identify problems, and make informed decisions in complex or ambiguous situations.
Physical requirement: light.

Nice To Haves

Master’s degree in Healthcare Administration or a related field.
Certified HealthCare Compliance (CHC) certification or related certification.

Responsibilities

Provide strategic leadership and direction for the Delegation Oversight program, aligning it with enterprise compliance and quality objectives.
Develop and maintain an audit and monitoring framework for delegated functions across Lines of Business, including Medi-Cal, D-SNP, and LACC.
Serve as a subject matter expert on delegation oversight requirements and advise organizational leaders and departments.
Partner with Regulatory Compliance, Health Services, Quality Improvement, Provider Network Management, and other business units to support delegated entities’ compliance with contractual and regulatory standards.
Oversee the delegated audit lifecycle, including risk assessment, scheduling, tool development, fieldwork, and corrective action validation.
Direct monitoring and follow-up of Corrective Action Plans (CAPs), ensuring deficiencies are resolved timely and verifiably.
Oversee preparation and presentation of audit reports, performance scorecards, and trend analyses for executive leadership and governance committees.
Build and maintain effective relationships and communication with internal and external stakeholders, and report performance and progress to senior leaders and executives.
Set goals, objectives, and action plans for assigned staff; manage hiring, performance reviews, salary reviews, and disciplinary matters for direct reports.
Foster transparency, continuous improvement, accountability, and shared ownership of enterprise goals.
Develop and manage the department budget, monitor expenditures, and support financial sustainability.
Conduct strategic resource planning to meet current and future departmental and enterprise-wide goals.
Lead discussions on policy operationalization, oversee policy perspective sharing, and identify and implement enhancements that support the company vision.
Perform other duties as assigned.