L.A. Care Health Plan is seeking a Director, Compliance Delegation Oversight Clinical Auditing and Monitoring to serve as a senior leader within the Compliance Department. In this role, you will manage the Clinical Delegation Oversight Unit, ensuring all audits of delegated entities meet regulatory and contractual requirements while overseeing the centralized audit lifecycle for delegated clinical functions. L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities.
What You'll Do
- Provide strategic leadership and direction for the Clinical Delegation Oversight program.
- Develop and maintain a robust audit and monitoring framework for delegated clinical functions across all Lines of Business.
- Serve as the subject matter expert on clinical delegation oversight requirements.
- Partner with internal departments to ensure delegated entities adhere to standards.
- Oversee the end-to-end lifecycle of delegated clinical audits, including risk assessment, scheduling, execution, and corrective action validation.
- Direct the monitoring and follow-up process for Corrective Action Plans (CAPs).
- Oversee the preparation and presentation of audit reports, performance scorecards, and trend analyses for leadership.
- Foster a culture of transparency, continuous improvement, and accountability.
- Build and maintain effective relationships with internal and external stakeholders.
- Develop goals, objectives, and action plans for assigned staff, including full management responsibility for hiring, reviews, and discipline.
- Develop and manage the department budget and conduct strategic planning for resource management.
What We're Looking For
- Bachelor's Degree in Nursing or a Related Field (or equivalent education/experience).
- At least 7 years of experience in managed care, clinical compliance, delegation oversight, or healthcare auditing.
- At least 5 years of leading staff or supervisory/management experience.
- 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 clinical functions.
- Demonstrated expertise in clinical oversight of delegated entities, including UM, QI, Credentialing, and Case Management functions.
- Knowledge of Word and Excel.
- Excellent interpersonal, verbal, and written communication skills.
- Ability to present findings to various levels of management.
- Ability to ensure organizational compliance and build relationships with regulatory agencies.
- Demonstrated strategic thinking, sound decision-making, and adaptability.
- Excellent ability to analyze data, identify problems, and make informed decisions.
Nice to Have
- Master's Degree in Nursing or a Related Field.
- Registered Nurse (RN) - Active, current and unrestricted California License.
- Licensed Vocational Nurse (LVN) - Active, current and unrestricted California License.
- Certified HealthCare Compliance (CHC).
Technical Stack
- Word
- Excel
Team & Environment
This role is a senior leader within the Compliance Department and manages the Clinical Delegation Oversight Unit.
Benefits & Compensation
- Compensation Range: $135,136.00 (Min.) - $175,676.00 (Mid.) - $216,218.00 (Max.)
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
L.A. Care Health Plan is an equal opportunity employer.
