Delegation Oversight Specialist

About Champion Health PlanChampion Health Plan is a mission-driven Medicare Advantage organization (HMO) serving beneficiaries across California and Nevada. Through strong provider partnerships and an integrated care model, we deliver high-quality, coordinated care to members, including those with complex chronic conditions.Our approach combines clinical excellence, operational expertise, and a deep commitment to making healthcare more accessible, affordable, and effective for the communities we serve. Join a collaborative team committed to delivering meaningful, high-impact healthcare solutions.About the RoleThe Delegation Oversight Specialist is responsible for overseeing all components of health plan delegation oversight, including audits, internal reviews, and performance monitoring to ensure compliance with regulatory and contractual requirements. This position plays a critical role in supporting audit readiness, quality initiatives, and interdepartmental collaboration across delegated functions.Primary Responsibilities:Prepare and submit pre-audit documentation in alignment with health plan tools and timelinesCoordinate, conduct, and document pre-delegation and annual oversight audits to comply with NCQA, CMS, DMHC, DHCS, and other applicable standardsFacilitate onsite, virtual, and desktop audits to evaluate adherence to plan-specific and regulatory requirementsServe as the main point of contact for health plan auditors and regulatory bodies during all audit phasesDistribute audit result letters, follow-up communications, audit tools, and annual reporting requirementsConduct internal audits of the end-to-end departments process and perform focused audits based on trends, CAPs, or new workflowsCollaborate with internal teams to collect and review required documentation and ensure timely responses to audit requestsAssist in the preparation of audit summaries, internal dashboards, and reports for Committees and Joint Operations Committees (JOCs)Monitor performance of delegated entities and support continuous quality improvement initiativesMinimum Qualifications:Bachelor’s degree in Healthcare Administration, Public Administration, Health Policy, or a related field (Master’s degree preferred)OR equivalent combination of education and relevant managed care experienceExperience working in a managed care organization, HMO, MSO, or health plan settingWorking knowledge of NCQA standards, CMS, DMHC, and DHCS regulatory requirementsFamiliarity with prior authorization and utilization management processesAdvanced proficiency in Microsoft Office Suite (Excel, Word, PowerPoint)Experience with Quick CAP, EZ-CAP, or similar health plan systems is a plusPreferred Qualifications:3+ years of experience in healthcare operations, managed care, utilization management, or quality oversightExperience supporting delegated entities such as provider groups, IPAs, or MSOsPrior involvement with audit preparation, corrective action plans (CAPs), and regulatory reportingExposure to NCQA accreditation readiness or survey supportExcellent organizational, analytical, and written/verbal communication skillsLVN/LPN licensure is a plus but not requiredJob Type: Full-timeBenefits:401(k)Dental insuranceHealth insuranceLife insuranceVacation and Sick TimeHoliday PayVision insuranceSchedule:8 hour shiftMonday to Friday