Director, Compliance Delegation Oversight Clinical Auditing and Monitoring

Job Description

The Director, Compliance Delegation Oversight Clinical Auditing and Monitoring serves as a senior leader within the Compliance Department. The Director will manage the Clinical Delegation Oversight Unit and ensure that all audits of plan partners,

Participating Provider Groups (PPGs), specialty health plans and other external first tier, downstream and related entities are audited in accordance with Compliance Department policies and procedures and guidance from all applicable regulatory agencies. This role ensures that all delegated clinical functions—are operating in full compliance with all regulatory, and contractual requirements.

The Director oversees the Clinical Auditing and Monitoring Unit, centralizing all activities related to audit planning, execution, monitoring, governance, and reporting for delegated entities including PPGs, Plan Partners, specialty health plans, and other first-tier, downstream, and related First Tier Entities (FDRs).

Qualifications

Education Required

Bachelor's Degree in Nursing or Related Field

In lieu of degree, equivalent education and/or experience may be considered.Education

Preferred

Master's Degree in Nursing or Related Field

Experience Required:

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.

About the Hospital

As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.

Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.