Delegation Oversight: Meeting Regulatory Expectations Through Effective Performance Monitoring
Meeting regulatory expectations from CMS and accreditation organizations through effective performance monitoring of delegated functions, with utilization management as the model.
You can delegate the function. You can’t delegate the accountability. Join Inovaare’s compliance and operations leaders for a practical hour on monitoring delegates with a focus on utilization management before small issues become audit findings.
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About this webinar
This webinar will explore regulatory expectations from CMS and accreditation organizations, best practices for monitoring delegated performance, and practical approaches to identifying, addressing, and documenting compliance issues before they become audit findings. Participants will also gain insights into performance metrics and monitoring strategies that can be applied to delegated Utilization Management activities to support quality outcomes and regulatory readiness.
Delegated functions
- UM
- Claims
- Appeals
- Credentialing
Where findings start
Left unmonitored, these drift into audit issues
- Late decisions
- Misapplied criteria
- Missing IRR
- Undocumented
- Incomplete data
- Open CAPs
Continuous oversight and performance monitoring
The interception layer, run continuously
- Set thresholds
- Monitor KPIs
- Flag early
- Correct and document
With monitoring
Caught and corrected
Issues fixed and documented before audit season. Oversight you can prove. Predictable audits.
Without monitoring
Missed and unmonitored
A small slip becomes a CMS program-audit finding, a CAR, and rework under deadline.
Monitoring turns oversight into early warning, so problems surface as trends, not findings.
What you’ll learn
- Understand the regulatory requirements governing delegated functions, including utilization management.
- Identify the key components of an effective delegation oversight program.
- Develop meaningful performance monitoring strategies using operational and compliance metrics focused on UM.
- Prepare for regulatory and accreditation audits.
- Recognize common compliance gaps and industry best practices, and how AI can assist in the process.
Speakers
Brenda Wade
Chief Compliance Officer, Inovaare
Brenda Wade is chief compliance officer at Inovaare, a role she has held since 2017. She brings more than 20 years of healthcare management and regulatory compliance leadership, with particular depth in Medicare Part C and Part D. Before Inovaare, she served as a compliance risk advisor at Humana and compliance manager at MD Care Health Plan. At Inovaare she oversees regulatory adherence across the Health Cloud Platform and leads the company’s task force on ethical AI guidelines for Medicare compliance. Brenda holds degrees in business administration from Western Michigan University and California State University, Long Beach.
Gabe Viola
SVP, Customer Relations & Implementations, Inovaare
Gabe Viola is senior vice president of customer relations and implementations at Inovaare, where he has led client success and implementation delivery since 2015. He brings more than 20 years of health plan operations and compliance experience, including senior roles at Blue Shield of California, where he directed Medicare operations spanning enrollment, customer service, and appeals and grievances, and at MD Care Health Plan as vice president of operations. Gabe partners with U.S. health plans through every phase of platform adoption, with deep expertise in claims administration, delegated entity management, and CMS regulatory readiness.