L.A. Care Health Plan · 11 hours ago
Director, Compliance Delegation Oversight Clinical Auditing and Monitoring
Los Angeles, CA
Full-time
Onsite
Director/Executive
$135K/yr - $216K/yr
7+ years expL.A. Care Health Plan is the nation’s largest publicly operated health plan, established to provide health coverage to low-income Los Angeles County residents. The Director of Compliance Delegation Oversight Clinical Auditing and Monitoring will manage the Clinical Delegation Oversight Unit, ensuring audits of plan partners and external entities are compliant with regulatory standards.
FitnessGovernmentHealth Care
Responsibilities
Provide strategic leadership and direction for the Clinical Delegation Oversight program, ensuring alignment with enterprise compliance and quality objectives
Develop and maintain a robust audit and monitoring framework for delegated clinical functions, ensuring consistency, accuracy, and regulatory alignment across all Lines of Business (Medi-Cal, D-SNP, LACC, and others)
Serve as the subject matter expert on clinical delegation oversight requirements, providing guidance to leadership and departments across the organization
Partner with Regulatory Compliance, Health Services, Quality Improvement, and Provider Network Management to ensure delegated entities adhere to contractual and regulatory standards for clinical performance and compliance
Oversee the end-to-end lifecycle of delegated clinical audits, including risk assessment, audit scheduling, tool development, fieldwork execution, and corrective action validation
Direct the monitoring and follow-up process for CAPs (Corrective Action Plans), ensuring timely and verifiable resolution of identified deficiencies
Oversee the preparation and presentation of audit reports, performance scorecards, and trend analyses for executive leadership and governance committees
Foster a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals
Proactively initiate, build and maintain effective relationships and communication with both internal and external key stakeholders
Communicate with senior leadership and executives, provide reports on performance and progress towards objectives
Develop goals, objectives and action plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews, training, and disciplinary matters for direct reports
Develops, and manages department budget, monitors expenditures and ensures financial sustainability
Conduct strategic planning for resource management in order to meet current and future departmental and enterprise-wide goals
Performs other duties as assigned
Qualification
Required
Bachelor's Degree in Nursing or Related Field
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 Required
Must be able to present findings to various levels of management, across all organizations
Ensuring organizational compliance with regulatory requirements and effectively communicate to L.A. Care staff, external contacts and regulatory agencies
Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization
Demonstrated ability to make sound and timely decisions
Demonstrated ability to adapt to changing situations and adjust strategies accordingly
Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change
Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment
Excellent written and verbal communication, negotiation, and interpersonal skills
Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations
Preferred
Master's Degree in Nursing or 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)
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Company
L.A. Care Health Plan
L.A. Care’s mission is to provide access to quality health care for L.A.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Melanie Rainer
Chief Strategy and Transformation Officer
Recent News
2026-01-17
MarketScreener
2025-08-27
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