Harbor Health
Delegate Oversight Specialist
Remote | Health Plan Operations | Full-Time
POSITION OVERVIEW
Harbor 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 & RESPONSIBILITIES
Delegation Oversight & Compliance
- Conduct pre-delegation assessments and annual audits of delegated entities, including credentialing, utilization management (UM), claims, and member services functions
- Monitor delegate performance against contractual standards, CMS requirements, TDI regulations, and NCQA/URAC accreditation standards
- Maintain a comprehensive delegation oversight calendar, tracking audit cycles, reporting deadlines, and corrective action plan (CAP) milestones
- Review and update delegation agreements in collaboration with Legal and Compliance teams to ensure alignment with current regulatory requirements
Audits & Corrective Action
- Lead on-site and desk audits of delegate operations; document findings with supporting evidence and issue formal audit reports
- Develop, track, and close corrective action plans (CAPs) in response to identified deficiencies; escalate unresolved issues to leadership
- Prepare delegates for CMS program audits (HPMS, IDAG, universe submissions) and TDI market conduct examinations
Reporting & Documentation
- Compile and submit monthly, quarterly, and annual delegation performance reports to the Delegation Oversight Committee
- Maintain organized, audit-ready delegation files including executed agreements, assessment tools, audit reports, CAPs, and attestations
- Track and analyze delegate performance metrics — including UM turnaround times, credentialing cycle times, and claims accuracy rates — and surface trends to leadership
Stakeholder Collaboration
- Serve as the primary point of contact for delegated entities; build collaborative relationships while maintaining appropriate oversight authority
- Coordinate with Quality, Provider Relations, and Network Management teams on overlapping delegate performance issues
- Educate internal stakeholders on delegation requirements and update policies and procedures related to delegation oversight
- Support responses to regulatory inquiries or member complaints related to delegated functions
DESIRED PROFESSIONAL SKILLS & EXPERIENCE
Required:
- Bachelor's degree in Healthcare Administration, Business, Nursing, or a related field; equivalent experience considered
- 3+ years of experience in health plan operations, managed care compliance, audit or delegation oversight
- Demonstrated experience conducting audits, managing CAPs, and producing formal audit reports
- Strong organizational skills with the ability to manage multiple delegate relationships and deadlines simultaneously
Preferred:
- Experience with NCQA accreditation standards or TDI regulatory requirements
- Familiarity with HEDIS, risk adjustment, IBNR, or health plan quality programs
- Certification in Healthcare Compliance (CHC), Managed Care (CMCM), or NCQA Credentials Verification (CVO)
- Payvider or integrated delivery network experience
WHAT WE OFFER
- Competitive salary and incentives
- Generous PTO
- 10 paid holidays
- Medical, Dental, and Vision Insurance
- 401(k) Investment Plan
- Company Equity
At 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