Delegation Oversight Letters Analyst at LSMA Management Inc – san bernardino, California

JOB SUMMARY

The Delegation Oversight Letters Analyst is responsible for supporting delegated oversight compliance by developing, implementing, maintaining, and monitoring Utilization Management (UM), Case Management (CM), and Medical Management correspondence templates in accordance with regulatory, health plan, and organizational requirements. This role ensures delegated entities and internal departments use compliant, accurate, and standardized letter templates to support authorization determinations, denials, appeals, and member and provider communications.

The Delegation Oversight Letters Analyst maintains letter template inventories, validates template compliance, supports audit readiness, and collaborates with Medical Management, Compliance, Claims, Provider Relations, and IT to ensure letter processes are compliant with federal and California regulatory standards, including Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and health plan contractual requirements.

This position plays a critical role in ensuring regulatory compliance, audit readiness, and operational integrity for delegated Utilization Management and Case Management functions.

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Data Analytics, or related field, or equivalent work experience.

Preferred: Master’s degree in Healthcare Administration, Public Health, or related field..

Experience

Minimum: At least five years of experience in healthcare operations, Medical Management, Delegation Oversight, Utilization Management, Case Management, or regulatory compliance. Experience supporting regulatory correspondence, delegated oversight, or compliance reporting.

Preferred: Experience supporting health plan audits and delegated oversight programs.

Experience working in MSO, IPA, or health plan environments. Experience with regulatory correspondence requirements for UM and CM. Advanced Microsoft Excel. Smartsheet or reporting tools. HTML or correspondence template formatting. sFTP submission and reporting processes.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

· Knowledge of DMHC, CMS, DHCS, NCQA, and health plan regulatory correspondence requirements.

· Knowledge of delegation oversight, Utilization Management, and Case Management operations.

· Strong analytical, documentation, and organizational skills.

· Strong written and verbal communication skills.

· Ability to interpret regulatory and contractual requirements.

· Strong attention to detail and template accuracy.

· Ability to manage multiple priorities and meet deadlines.

· Ability to maintain confidentiality and regulatory compliance.

· Ability to collaborate effectively across departments and with external stakeholders.

· Strong problem-solving and process improvement skills.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or remote environment and requires prolonged sitting, computer use, and sustained data and document review. The role requires sustained concentration, analytical thinking, and attention to detail to ensure compliance and regulatory accuracy. The employee must be able to lift, carry, push, or pull items up to approximately 25 pounds. This position requires the ability to manage multiple tasks, meet deadlines, and maintain confidentiality when handling sensitive regulatory and patient-related information.