Clinical Delegation Oversight Manager - REMOTE
M
Molina Healthcare
📍 United States, United States, United States
Job Description
JOB DESCRIPTION
**Job Summary**
Provides advanced clinical and operational expertise to ensure delegated clinical functions – such as Utilization Management (UM), Care Management (CM), Behavior Health (BH), Disease Management (DM), and Quality programs – meet expected financial and clinical outcomes, organizational contractual, regulatory, and accreditation (NCQA, CMS, State) requirements.
Leads end-to-end oversight activities, including performance monitoring, audits, corrective action management, risk identification, process improvement, and continuous performance optimization across delegated clinical entities. Partners with HCS clinical leaders, Finance, Medical Economics and other internal business owners, Compliance, Quality, Legal and Executive Leadership to ensure vendors deliver high-quality, cost-effective, and compliant services to members. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential J...
**Job Summary**
Provides advanced clinical and operational expertise to ensure delegated clinical functions – such as Utilization Management (UM), Care Management (CM), Behavior Health (BH), Disease Management (DM), and Quality programs – meet expected financial and clinical outcomes, organizational contractual, regulatory, and accreditation (NCQA, CMS, State) requirements.
Leads end-to-end oversight activities, including performance monitoring, audits, corrective action management, risk identification, process improvement, and continuous performance optimization across delegated clinical entities. Partners with HCS clinical leaders, Finance, Medical Economics and other internal business owners, Compliance, Quality, Legal and Executive Leadership to ensure vendors deliver high-quality, cost-effective, and compliant services to members. Contributes to overarching strategy to provide quality and cost-effective member care.
**Essential J...