Director, Delegation Oversight (California Utilization Management) - REMOTE

Job Summary Leads and directs team responsible for multi-state delegation oversight activities including monitoring of delegation oversight to ensure compliance with state, federal, National Committee for Quality Assurance (NCQA), and Molina requirements. Collaborates closely with internal business owners to manage and administer the relationships and performance of delegated entities including health plan onboarding and offboarding activities, management of oversight activities, audits and corrective action plans, issuance and service issue escalations, and ongoing risk monitoring. Essential Job Duties • In collaboration with senior leadership, sets the strategic direction for Molina’s delegation oversight responsibilities and partnerships. Responsible for coordinating delegated vendor activities between contracted entities and Molina Healthcare; this includes claims, contact center, credentialing, appeals and grievances, care management, utilization management, pharmacy, and ...