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!
Skills 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 corrective action plans (CAPs), and producing formal audit reports
- Strong organizational skills with the ability to manage multiple delegate relationships and deadlines simultaneously
- 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 Do
Why Harbor? Here, flourishing is everything. Simply put: you’re a person, not a patient. And we all want to get and stay healthy — but the current way doesn’t make us feel part of the process. Start your health journey with us and you won’t have to go it alone. We’ll collaborate to make the right choices along the way — from where you get your care (a clinic, your office, your home, a mobile office) to how we help you get and stay well. That’s the co-creation of health.
