Senior Manager, Clinical Compliance Delegation Oversight

Salary Range

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

About the role

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Responsibilities

• Lead the clinical delegation oversight program strategy, annual workplan, and operating cadence to ensure effective oversight of delegated clinical activities.
• Establish standardized processes, tools, and documentation requirements for delegation monitoring, audits, reporting, and issue remediation.
• Serve as a key compliance partner to clinical operations and enterprise compliance leadership on delegated oversight risks, trends, and priorities.
• Implement and provide guidance to the departmental and organizational processes and policies and work with senior and/or executive management to define, prioritize, and develop projects and programs.
• Manage staff and day-to-day activities in the department. Participates in the department budgeting process. Responsible for scheduling, training, performance, corrective actions, mentoring, and developing of the team(s).
• Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentors and develop staff, building technical and problem-solving skills across the team.
• Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.
• Lead the development and execution of delegated clinical oversight programs that integrate monitoring, auditing, remediation, education, and performance improvement activities to ensure compliance with regulatory, contractual, accreditation, and organizational requirements.
• Direct development and monitoring of Corrective Action Plans (CAPs), including root cause analysis, timelines, deliverables, validation steps, and closure criteria.
• Partner with delegated entities and internal clinical leadership to drive sustainable remediation and performance improvements.
• Partner with Health Services and cross-functional stakeholders to standardize oversight methodologies, identify risks and performance trends, strengthen delegate accountability, and drive continuous improvement and regulatory readiness.
• Track repeat findings and trends; implement enhanced oversight where performance indicates increased risk.
• Lead cross-functional workgroups, committees, and strategic initiatives that promote enterprise alignment and support organizational objectives.
• Maintain effective working relationships with delegated entities, provider organizations, and vendors; support governance meetings and performance reviews.
• Collaborate with internal stakeholders to align oversight findings with operational improvements.
• Monitor emerging regulatory requirements and industry best practices, leading implementation of new and revised federal, state, contractual, and accreditation requirements affecting delegated clinical operations.
• Interpret and operationalize new or changing regulatory guidance impacting delegated clinical activities; communicate requirements to internal stakeholders and delegated entities.
• Leverage technology and data analytics to enhance operational performance, audit management, executive reporting, and strategic decision-making.
• Ensure adherence to organizational, contractual, regulatory, and accreditation standards relevant to the team's functions.
• Establish and maintain quality assurance processes that promote regulatory compliance, operational consistency, and continuous improvement.
• Develop and deliver executive-level reporting summarizing oversight activity, risk levels, findings, corrective action plan (CAP) status, and emerging trends.
• Present results and recommendations to senior management.

Requirements

• At least 6 years of healthcare experience in delegated clinical operations, compliance, monitoring and auditing, or managed care operations supporting Medicare, Medicaid, and/or commercial health plans.
• Experience designing and implementing clinical programs, monitoring methodologies, or regulatory compliance initiatives within complex healthcare environments.
• At least 5 years of leading, supervising and/or managing staff.
• Proven experience leading organizational change, operational process improvement, and implementation of standardized workflows, governance structures, and supporting documentation.
• Experience managing clinical regulatory and compliance risks, corrective action plans, remediation activities, and enterprise regulatory readiness.
• Experience collaborating with regulatory agencies and cross-functional business partners to implement regulatory requirements and improve clinical operations.
• Experience leveraging technology, analytics, and reporting tools to improve operational performance, decision-making, and organizational effectiveness.
• Experience leading teams, projects, initiatives, or cross-functional groups.

Qualifications

• Bachelor's Degree in Nursing or Related Field.
• Master's Degree in Nursing or Related Field preferred.

Skills

• Strong expertise developing and continuously improving risk-based delegated clinical oversight programs, including monitoring, auditing, corrective action management, delegate education, and performance improvement that drive scalable, sustainable outcomes.
• Advanced knowledge of delegated clinical operations, including Utilization Management, Care Management, Population Health, and delegated medical management functions within a managed care environment.
• Strong analytical and critical thinking skills with the ability to identify emerging risks, evaluate performance, and implement practical, sustainable solutions.
• Demonstrated ability to build collaborative partnerships with delegated entities, regulators, auditors, executive leadership, and cross-functional stakeholders while maintaining independent oversight and driving accountability.
• Advanced knowledge of CMS, DHCS, DMHC, NCQA, and other applicable regulatory requirements, with the ability to interpret, implement, and support regulatory examinations, accreditation reviews, and audit readiness activities.
• Proven ability to drive team performance, foster professional development, and align staff with organizational objectives.
• Skilled in leveraging technology and data solutions to enhance performance monitoring, auditing, reporting, and operational effectiveness.
• Strong knowledge of managed care clinical operations across Medicare, Medicaid, and Commercial lines of business.

Benefits

L.A. Care Offers a Wide Range Of Benefits Including:

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retail Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)

Pay

The salary range is $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.).

Schedule

N/A