Health Services Officer
Central California Alliance for Health
Location: Merced, California; Salinas, California; Scotts Valley, California
We are looking for our next Health Services Officer (HSO) to lead in our Health Services Division. This position is available in our Merced, Salinas or Scotts Valley office. In order to be successful in the position, it requires a local presence within the community and connection to a local office.
Central California Alliance for Health works in partnership with our contracted providers to promote prevention, early detection and effective treatment, and improve access to quality health care for those we serve. This results in the delivery of innovative community-based health care services, better medical outcomes and cost savings.
We are 500-ish employees who are all working towards our vision of Healthy People, Healthy Communities by living out our values of Equity, Integrity, Improvement and Collaboration in the pursuit of our mission of accessible, quality health care guided by local innovation. Learn more about our history, members, and partnerships here.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Chief Medical Officer, Dr. Dale Bishop, the Alliance’s Health Services Officer will:
- Provide executive management, leadership, and accountability for the Alliance Health Services Departments of Utilization Management (UM), Quality Improvement/Population Heath (QI/PH), Community Care Coordination, Behavioral Health, and Pharmacy to achieve Alliance strategic plan objectives and outcomes
- Provide executive leadership in new business plans, policies, programs and projects to ensure high quality results
- Organize and integrate Health Services departmental operations, systems, and programs to ensure policies, procedures, and execution are in alignment with contractual obligations, Health Plan initiatives, and strategic goals
- Participate in strategic planning and goal setting for the Alliance
The HSO leads one of our largest teams (175+ employees) and has a total of five direct reports. The HSO has strategic leadership of the following departments and their respective functions:
- Utilization Management and Complex Case Management
- Quality Improvement and Population Health
- Community Care Coordination
- Behavioral Health
THE IDEAL CANDIDATE WILL
- Be a purpose-driven leader, and adept at achieving alignment towards shared goals, and delivering results through collaborative efforts
- Have strength in the planning and oversight of health plan operations, with expertise in change management and implementing solutions to improve performance
- Have a passion for championing system redesign and the advancement of models of care
- Lead with accountability, with expertise in performance metrics, identifying areas of opportunity, and implementing solutions to improve performance and outcomes
- Be an effective communicator, promoting authentic, direct and timely communication within your own team and across the organization
- Be committed to health equity
- A plus: Medicare, NCQA Accreditation, CMS Audits experience
WHAT YOU'LL NEED TO BE SUCCESSFUL
- Principles and practices of managed care
- Principles and practices of utilization management and care management
- Title 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulations
- National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Centers for Medicare and Medicaid Services (CMS) requirements, standards, quality improvement studies, and HEDIS reporting
- Data collection and analysis, and management practices related to quality of medical care
- Healthcare regulatory processes, as well as State and Federal legislative processes
- Direct, manage, supervise, mentor, train and evaluate the work of staff and assist department directors in doing so
- Promote an atmosphere of teamwork and cooperation, convey the mission and values of the organization, and motivate staff to achieve goals and objectives
- Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
- Review and assess overall division function, including the core work, goals and structure of each department, and oversee the directors’ development and implementation of short- and long-term planning to achieve strategic plans and completion of an annual department assessment
- Act as a technical resource and explain complex laws, regulations, processes, and programs related to area of responsibility
Education and Experience:
- Bachelor’s Degree in Business, Public Health, Health Administration, Nursing or a related field and a minimum of ten years of experience in healthcare which included a minimum of five years of experience in a leadership position responsible for running core health plan operations across utilization management and care management functional areas in a managed care setting, as well as the development and implementation of strategic programs, policies and practices in support of the overall operational mission, goals and objectives (a Master’s degree may substitute for two years of the general healthcare experience); or an equivalent combination of education and experience may be qualifying.
- While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
- Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
- Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.
COVID-19 Vaccine Requirement: This position requires staff to be fully vaccinated and boosted upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated is defined as receipt of the second dose in a 2-dose series (ex: Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (ex: Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.
Additionally, all positions at the Alliance are required to meet these minimum qualifications.
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 11 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
- And many more
For a complete position description and to apply online, please visit our careers website
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet.
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.