Delegation Oversight Specialist

Job Locations US-CA-San Francisco
Job ID
Regular Full-Time


Established in 1997, San Francisco Health Plan (SFHP) is a an award winning,  managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.




The Delegation Oversight Specialist supports the Manager, Delegation Oversight in maintaining an effective oversight program that ensures contractual compliance of all delegates. The Specialist serve as the primary contact to oversee all SFHP’s delegated functions by performing pre-delegation assessments, ongoing delegation oversight and auditing to ensure that delegates policies and procedures, documentation, systems, staffing, and other activities follow regulatory/statutory and as applicable accreditation guidelines. The Specialist coordinates annual-oversight audits, writes audit reports, and follows up on plans for corrective actions (CAPs) that result from the oversight audit and/or monitoring activities.




  • Overall responsibility for leading and coordinating the audit process, including communication with delegates and internal stakeholders.
  • Coordinate oversight efforts with all delegated activities to ensure compliance with state, federal, and NCQA requirements.
  • Monitor issues pertaining to delegated entities, such as tracking, analyzing and trending, and other management reporting.
  • Write audit reports.
  • Coordinate the review and update of Audit Tools.
  • Maintain audit Work Plan.
  • Monitor delegated groups’ responses to the oversight audits requests for corrective action (CAP).
  • Review delegates’ CAP responses with SMEs and Manager, Delegation Oversight and prepare response to delegates.
  • Ensure that CAP follow up with delegated medical groups is documented.
  • Present audit results and recommendations to Provider Network Oversight Committee.
  • Help conduct annual audit of non-clinical functions (credentialing, grievances, claims, etc.) and provide recommendations for corrective action.
  • Assist with the development of training materials for SMEs.
  • Assist with the review of Delegation Oversight policies and procedures.
  • Perform and/or assist with certain non-clinical audits
  • Maintain annual audits process flow documents and desktop procedures.
  • Maintain Delegation Oversight readiness for DHCS audits, DMHC regulatory surveys, and NCQA accreditation (prepare reports/documents, assist with onsite reviews and post-survey follow-up activities).
  • Represent Provider Network Operations Department at internal cross-functional meetings as needed.
  • Represent SFHP at external meetings as needed.
  • Other duties as assigned.




  • BA/BS in Business Administration, Compliance, Social Sciences, or related field required
  • Minimum two years of experience working in compliance and audit
  • Preferred minimum two years of experience with health care audits; knowledge of health care compliance in managed care systems or provider organizations
  • Experience with writing audit reports and taking meeting minutes
  • Experience with presentations and leading diverse groups
  • Ability to work with multiple departments within the organization and external clients
  • Knowledge of managed care and Medi-Cal and other state-sponsored health programs strongly preferred
  • Demonstrated working ability using a total managed care system
  • Ability to communicate effectively (spoken and written) with a variety of professionals, including physicians and other health providers, administrators and others
  • Detail-oriented and organized with the ability to interpret policy and make decisions
  • Experience with presentations and leading diverse groups
  • Demonstrated ability to learn quickly; versatility, flexibility, and professionalism
  • Strong computer and Web aptitude, solid understanding of how to use common platforms and applications to set up templates and streamline reporting and communications
  • Very strong MS Office skills: Outlook, Word, Excel, and PowerPoint
  • Experienced with electronic file management, SharePoint preferred




San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V 
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.


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