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Health Services Director, Santa Barbara, CA


Organization: CenCal Health
Category: Director
Location: Santa Barbara, CA
Date Job Posted: January 22, 2020
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Health Services Director

Director HEALT01243
Posted: January 13, 2020
Full-Time
Santa Barbara, CA, USA

Job Details

Description

  • Provide leadership and strategic direction to Health Services leadership team and larger operations organization
  • Develop and ensure delivery of performance goals for all areas of responsibility
  • Develop key performance indicators to monitor performance and adjust as needed to address needs and trends
  • Develop and execute a strategic roadmap to optimize talent, processes, and technology
  • Ensure operations are efficient, effective, and provide value to members and provider community
  • Develop standard operational processes and procedures that promote quality, compliance, and consistency
  • Develop and execute talent strategy to support growth and development of leaders and team within Health Services
  • Develop and drive programs and initiatives within Health Services, and actively engage in organization-wide projects as a collaborative partner
  • Provide leadership and strategic direction on vendor partnerships
  • Collaborate with the Chief Medical Officer (CMO) and larger CMO organization to develop and support Quality Improvement Programs
  • In collaboration with direct report team and with input from larger Health Services operations organization, develop and execute an engagement strategy that promotes communication, active participation, accountability, growth and development
  • Build strong cross-functional relationships throughout the organization that are collaborative and productive
  • Responsible for ensuring CenCal Health meets all regulatory and licensing requirements
  • Develop and maintain understanding of applicable regulatory initiatives, requirements and industry trends related to utilization management, case management, and quality improvement to evaluate impact on organization; and develop plans for program changes as indicated; support regulatory compliance; participating on committees as appropriate Fiduciary responsibility for department costs, as well as supporting reserves. Prepare annual department budget plans, monitor expenses and document variances from approved budgets
  • Oversight of the members’ health services programs on an organization-wide basis
  • Ensure departmental readiness for all DHCS, DMHC, etc. audits
  • Represent and support CenCal Health’s benefit decisions at administrative hearings as needed
  • Prepare reports and make presentations at various internal quality committees and occasionally to the governing board
  • This position works collaboratively with Claims, Member Services, Provider Services, Legal, and other departments, as well as the Health Services team to educate, train and implement effective health services operations

Qualifications

Behaviors

Required

Thought Provoking: Capable of making others think deeply on a subject
Team Player: Works well as a member of a group
Leader: Inspires teammates to follow them

Motivations

Preferred

Self-Starter: Inspired to perform without outside help
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

Education

Required

  • Bachelors or better in Health Administration or related field.

Preferred

  • Masters or better in Business Administration or related field.

Experience

Required

  • Compliance with regulatory and contractual requirements
  • Knowledge of the California Children Services program
  • Knowledge of the Medi-Cal program
  • 7-10 years: Leadership experience working with Utilization Management, Case Management and/or Disease Management
  • 7-10 years: Experience in either managed care and/or insurance industry

Preferred

  • Certification in Case Management
  • Knowledge of Medicare and commercial lines of business

Licenses & Certifications

Preferred

  • Registered Nurse

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