Director, Delegation Operations

Job Description

Job Description

Description:

OUR PHILOSOPHY

Blue Zones Health is creating a Well-Being Services Organization built around a complete and integrated understanding of each member's health, needs, goals, and circumstances. Clinical Management plays a critical role in ensuring members—particularly those with chronic conditions, complex medical needs, and recent transitions of care—receive coordinated, proactive, and personalized support.

POSITION SUMMARY

The Director, Delegation Operations runs the delegation operations side of BZH’s relationships with its health plans. That means everything a health plan needs from BZH to keep entrusting it with utilization management, claims processing, risk and quality, credentialing, and other associated areas outside of the functional work itself: the calendar of submissions and committee cycles, questions that show up out of nowhere, and the templates and communication that keep it all moving on time. Every one of those touchpoints is a chance to advance the health plan relationship. It's the difference between a health plan that tolerates BZH and one that trusts it.

The Director partners cross-functionally within BZH: with functional leaders to deliver on department requirements; Product and Data to deliver requirements for automation and visibility; and with Compliance to on how requirements get interpreted and ensure that the Corporate governance model is followed in operations.

The Director is the one person thinking about the full delegation calendar across functions, every day. Success looks simple: plan by plan, cycle by cycle, on time and accurate, and a little more confident in BZH than the cycle before.

WHY THIS ROLE EXISTS

This Director exists to run a good shop, one that BZH and health plans find predictable and accurate. Setting expectations early, knowing requirements before they’re due, and keeping cadences and templates ready well ahead of deadlines means BZH is never caught by surprise and health plans aren’t left wondering what’s coming. That discipline sends a signal: how tightly BZH runs its delegation operations is what a health plan reads as a preview of how well BZH manages its providers and members. Done well, this earns a health plan’s confidence cycle after cycle; done poorly, it leads to health plans reconsidering whether to keep delegating to BZH at all.

Budgeted Compensation: $160,000-$170,000

KEY RESPONSIBILITIES

The first year carries a heavy, one-time lift to stand up the delegation operations calendar, templates, and reporting workflow across every health plan and function. Once that is running, the day-to-day of this role shifts to the four areas below.

Delegation Operations Cadence and Data Quality

• Operate delegation operations on a disciplined, recurring cadence comparable to a monthly financial close, providing functional leaders and the data partner (Calibrated, or BZH in the future) with a fixed calendar of due dates, formats, and owners to ensure predictability across cycles
• Conduct quality assurance on all data prior to distribution, serving as the business reviewer who confirms that reported results are consistent with what functional leaders have observed during the period and with the direction those results need to move, beyond a purely technical validation
• Obtain functional leader sign-off prior to submission to a health plan, presentation to a committee, or inclusion in a scorecard
• Own the correction process for any returned items: resolve the issue, revalidate, and resubmit
• Hold functional leaders accountable to established KPIs; monitor performance trends and track corrective actions when results decline

Health Plan Communication & Relationship Continuity

• Serve as the primary point of contact when a health plan auditor or operations contact introduces a new template, report correction, or timeline change, and act on it before it becomes time-sensitive
• Understand each health plan's priorities and identify where BZH should focus its attention, including which relationships require greater engagement and which risks require proactive mitigation before they materialize
• Maintain a consistent narrative with each health plan across cycles, connecting individual touchpoints into a coherent, ongoing account of BZH's performance and summarizing for BZH leadership 
• Coordinate BZH's delegation committees (QM, UM, Credentialing, and others) and operational committees (JOC); own the calendar and agendas 

Annual Delegation Audits

• Manage annual (and interim) health plan audits from start to finish, including readiness, submission, response, and corrective action closure
• Review all submissions personally prior to release; oversee compilation of universe data, files, and documentation from credentialing, UM, claims, and network functions in time to meet deadlines
• Track audit findings and partner with Corporate Compliance to bring corrective actions to closure, maintaining an ongoing audit history for each health plan

Governance Adherence, Compliance & Team

• Operate within the established delegation governance model and ensure ongoing adherence to it
• Escalate policy interpretation questions and required filings to Compliance/Regulatory Affairs; compliance decisions, filings, and workforce/corporate compliance matters remain the responsibility of Compliance and Corporate Compliance
• Support growth of the delegation operations team as it scales, including onboarding, development, and, for direct reports, hiring and performance management
• Comply with all applicable federal, state, and local laws, as well as all Employer policies, procedures, and standards, including but not limited to codes of conduct and ethics requirements, as amended from time to time

REQUIRED QUALIFICATIONS

• Bachelor's degree in Healthcare Administration, Business, Nursing, or related field
• 7+ years of progressive experience in managed care operations, health plan delegation oversight, or MSO/RBO/IPA compliance and reporting
• Demonstrated experience running point on health plan or regulatory audits and reporting, including preparation, submission, and corrective action management
• Strong working knowledge of delegated functions (credentialing, UM, claims) and the reporting/audit obligations tied to each
• Working knowledge of NCQA, CMS, and applicable state regulatory requirements (e.g., DMHC, DIFS) sufficient to operationalize delegation reporting and audit requirements into calendars, templates, and workflows
• Proven ability to build and operate recurring, deadline-driven reporting processes across multiple stakeholders

PREFERRED QUALIFICATIONS

• Master's degree (MHA, MBA, MPH) or equivalent advanced experience
• Experience with NCQA delegation oversight standards 
• Experience building or administering compliance/reporting calendars or workflow tools
• Proficiency with managed care platforms such as EZ-CAP or Crystal Reports, including report configuration and scheduling