Manager, Delegation Oversight Audit

Gold Coast Health Plan will not sponsor applicants for work visas.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.

POSITION SUMMARY

Under the direction of the Privacy Officer, the Delegation Oversight Audit Manager, is responsible for providing leadership, direction and management of all aspects of the delegation oversight audit function through a systematic and disciplined approach to identify risks, monitor compliance, and educate and train staff.  The Delegation Oversight Audit Manager will provide continuous assessment and development and maintenance of the delegation audits, in coordination with the Privacy Officer.  

Work Schedule: Full time position. Occasional travel to multiple sites and different locations. Flexibility to work beyond normal business hours as needed.

Amount of Travel Required: 10%

ESSENTIAL FUNCTIONS

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.  The incumbent performs a variety of administrative duties that require a degree of analytical, organizational, and technical skills and exercises a level of discretion and judgment appropriate for the scope of the position. 

Major Duties and Responsibilities:

•    Develop and maintain a delegation oversight audit program.

•    Attend and present at the Compliance Committee and any other required Committee.  Direct and create memos, presentations and applicable charts/graphs for committee presentation.

•    Lead coordination and performance of all delegation audits for GCHP.  The Manager is responsible for the coordination of creating audit tools, audit summaries and reporting requirements.

•    Oversees the delegation oversight auditors to ensure compliance with the performance of the audits.

•    Conduct staff development and training.

•    Work with delegates and vendors to implement corrective action plans in situation of non-compliance.  Monitor progress and ensure completeness.

•    Maintain a delegation oversight audit dashboard to identify all audits, both future and completed.

•    Communicate results of audits and any issues to the Privacy Officer.

•    Maintain accurate recordkeeping of all audits and ensure deadlines are met.

•    Analyze, update and modify procedures and processes to continually improve audit operations; provide recommendations to the Privacy Officer.

•    Stay informed about the latest developments in delegation oversight, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars and other information sources.

•    Develop and accomplish delegation oversight audit activities in support of company strategies, goals and objectives.

•    Coordinate activities with all levels of staff through clear and concise verbal and written communications.  Negotiate and resolve complex and sensitive project and team issues with diplomacy and persuasiveness.  Identify problems, develop solutions and implement a chose course of action.

•    Ability to analyze and interpret legal and contractual language.

•    Ability to define issues, interpret data and evaluate options.

•    Ability to establish and maintain effective and cooperate working relationships with GCHP staff and others contacted in the course of the work.

•    Ability to create forms and letters, compile reports and various information as required.

•    Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position.

•    Ability to effectively prioritize multiple tasks and deadlines.

•    Ability to effectively, clearly and independently document, summarize and resolve complex issues.

•    Ability to accurately complete tasks within established times.

•    Other related duties as assigned.

•    Responsible for coverage when Privacy Officer is offsite

POSITION QUALIFICATIONS 

Competency Statements

•    Management Skills - Ability to organize and direct oneself and effectively supervise others.

•    Technical Aptitude - Ability to comprehend complex technical topics and specialized information.

•    Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

•    Customer Oriented - Ability to take care of the customers’ needs while following company procedures.

•    Communication, Oral - Ability to communicate effectively with others using the spoken word.

•    Communication, Written - Ability to communicate in writing clearly and concisely.

•    Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

•    Analytical Skills – Ability to use thinking and reasoning to solve a problem

SKILLS & ABILITIES

Education:                           

•    High School Graduate or General Education Degree (GED): Required

•    Bachelor's Degree (four-year college or technical school) Required, Field of Study: BA/BS degree in Business, Health Science, Managed Care

•    Master’s Degree Preferred, Field of Study Healthcare Administration or equivalent

Experience:                        

•    Minimum 5 years of management experience.

•    5 plus years of experience in auditing, compliance or delegation oversight, preferably in a managed care environment.

Computer Skills:              

•    Demonstrated proficiency included in the MS Office products; Outlook, Teams, Word, Excel, Access, Power BI and PowerPoint

Certifications & Licenses:

•    None required

Other Requirements:     

•    Demonstrates effective general writing skills and business report writing skills.

•    Ability to establish, nurture and maintain strong and effective working relationships with the GCHP staff.

•    Ability to maintain detailed and accurate records, follow oral and written directions, prepare written agendas, and transcribe minutes;

•    Ability to work independently with minimal supervision or within a team environment.

•    Ability to utilize conflict resolution and problem solving techniques

•    Ability to operate a keyboard and sit for long periods. 

•    Ability to read close-up and do close-up work. 

•    Ability to perform repetitive motion (keyboard); writing (notetaking). 

•    Ability to hear normal speech, hear and talk on telephone.

•    Ability to think and work effectively under pressure. 

•    Ability to deal with public contact.

•    Decision making, concentration.