Delegate Oversight Specialist

Harbor HealthDelegate Oversight SpecialistRemote | Health Plan Operations | Full-Time POSITION OVERVIEWHarbor Health is seeking a detail-oriented Delegate Oversight Specialist to join our Health Plan Operations team. As part of Harbor Health's integrated payvider model — combining a multi-specialty medical group with a health plan across Austin, San Antonio, Dallas, and El Paso — you will be responsible for end-to-end oversight of our delegated entities across Medicare Advantage, Medicaid, and commercial lines of business. You will ensure that delegates meet regulatory and contractual requirements through rigorous pre-delegation assessments, ongoing monitoring, and corrective action planning, partnering closely with Compliance, Quality, Network, and Health Plan Operations to safeguard Harbor Health's delegated functions and maintain audit-ready documentation.POSITION DUTIES & RESPONSIBILITIESDelegation Oversight & ComplianceConduct pre-delegation assessments and annual audits of delegated entities, including credentialing, utilization management (UM), claims, and member services functionsMonitor delegate performance against contractual standards, CMS requirements, TDI regulations, and NCQA/URAC accreditation standardsMaintain a comprehensive delegation oversight calendar, tracking audit cycles, reporting deadlines, and corrective action plan (CAP) milestonesReview and update delegation agreements in collaboration with Legal and Compliance teams to ensure alignment with current regulatory requirementsAudits & Corrective ActionLead on-site and desk audits of delegate operations; document findings with supporting evidence and issue formal audit reportsDevelop, track, and close corrective action plans (CAPs) in response to identified deficiencies; escalate unresolved issues to leadershipPrepare delegates for CMS program audits (HPMS, IDAG, universe submissions) and TDI market conduct examinationsReporting & DocumentationCompile and submit monthly, quarterly, and annual delegation performance reports to the Delegation Oversight CommitteeMaintain organized, audit-ready delegation files including executed agreements, assessment tools, audit reports, CAPs, and attestationsTrack and analyze delegate performance metrics — including UM turnaround times, credentialing cycle times, and claims accuracy rates — and surface trends to leadershipStakeholder CollaborationServe as the primary point of contact for delegated entities; build collaborative relationships while maintaining appropriate oversight authorityCoordinate with Quality, Provider Relations, and Network Management teams on overlapping delegate performance issuesEducate internal stakeholders on delegation requirements and update policies and procedures related to delegation oversightSupport responses to regulatory inquiries or member complaints related to delegated functionsDESIRED PROFESSIONAL SKILLS & EXPERIENCERequired:Bachelor's degree in Healthcare Administration, Business, Nursing, or a related field; equivalent experience considered3+ years of experience in health plan operations, managed care compliance, audit or delegation oversightDemonstrated experience conducting audits, managing CAPs, and producing formal audit reportsStrong organizational skills with the ability to manage multiple delegate relationships and deadlines simultaneouslyPreferred:Experience with NCQA accreditation standards or TDI regulatory requirementsFamiliarity with HEDIS, risk adjustment, IBNR, or health plan quality programsCertification in Healthcare Compliance (CHC), Managed Care (CMCM), or NCQA Credentials Verification (CVO)Payvider or integrated delivery network experienceWHAT WE OFFERCompetitive salary and incentivesGenerous PTO10 paid holidaysMedical, Dental, and Vision Insurance401(k) Investment PlanCompany EquityAt Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!Originally posted on Himalayas