Operations Specialist, Experienced

BSC • Los Angeles, CA

90d

About The Position

The Delegation Oversight (DO) team, under the purview of the Delegation Oversight Committee (DOC) which is a sub-committee of the Quality Oversight Committee (QOC), is responsible for oversight of contracted delegated entities. This includes auditing, corrective actions follow-up and monitoring activities. The DO team will coordinate with other internal departments on oversight activities. Reporting to the Manager, Delegation Oversight, this role is responsible for documentation of policies and procedures, and oversight of LA Care audits and quality review along with submission of data to compliance. The Operations Specialist, Experienced, is also responsible for working with colleagues on coordination and submission of state reporting to the Department of Managed Health Care (DMHC). This position is responsible for tracking and monitoring monthly, quarterly, and annual reporting timeliness and Provider Dispute Resolution to provide into the DMHC portal reporting. The Operations Specialist, Experienced position also reviews and provides to the DMHC Corrective Action Plans (CAPs) and requests for information.

Requirements

• Experience in operations or oversight roles within healthcare or managed care environments.
• Strong understanding of compliance and regulatory requirements related to managed care.
• Excellent documentation and policy writing skills.
• Ability to coordinate and collaborate with multiple internal departments.
• Experience with state reporting processes and requirements.

Nice To Haves

• Familiarity with the Department of Managed Health Care (DMHC) regulations and reporting.
• Experience in auditing and quality review processes.
• Knowledge of Provider Dispute Resolution processes.

Responsibilities

• Oversight of contracted delegated entities including auditing and monitoring activities.
• Documentation of policies and procedures related to delegation oversight.
• Coordination with internal departments on oversight activities.
• Oversight of LA Care audits and quality review.
• Submission of data to compliance.
• Coordination and submission of state reporting to the Department of Managed Health Care (DMHC).
• Tracking and monitoring of monthly, quarterly, and annual reporting timeliness.
• Management of Provider Dispute Resolution reporting to the DMHC portal.
• Review and submission of Corrective Action Plans (CAPs) and requests for information to the DMHC.

What This Job Offers

• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees