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Central California Alliance for Health · 1 day ago

Health Services Executive Director

California, United States

Full-time

Hybrid

Mid, Senior Level

$237K/yr - $379K/yr

5+ years exp

Central California Alliance for Health is a regional non-profit health plan dedicated to providing accessible, quality health care guided by local innovation. They are seeking a Health Services Executive Director to oversee various health services departments and ensure alignment with strategic goals.

GovernmentHealth CareHealth InsuranceHospital

No H1B

Responsibilities

Provides strategic management, leadership, and accountability for the Alliance Health Services Departments of Quality Improvement and Population Health (QI/PH), Utilization Management (UM), Care Management (CM), Health Services Operations, and Pharmacy to achieve Alliance strategic plan objectives and outcomes

Provides senior leadership in new business plans, policies, programs and projects to ensure high quality results

Organizes and integrates 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

Participates in strategic planning and goal setting for the Alliance

Qualification

Managed care principlesUtilization managementCare managementQuality improvementPharmacy operationsData analysisChange managementSupervisionTrainingStrategic planningProject managementCommunity engagementLeadership

Required

Current and unrestricted license as a Registered Nurse issued by the state of California

Bachelor's Degree in Nursing, Public Health, Health Administration, Behavioral Health, Social Science, 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

Doctor of Medicine, current license to practice medicine issued by the state of California, and 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; or an equivalent combination of education and experience may be qualifying

Thorough knowledge of the principles and practices of managed care

The principles and practices of utilization management and care management

The clinical practices related to license as an MD or RN

Title 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulations

The principles and practices of supervision and training

Promoting and applying change management principles

The principles and practices of program development and project management

National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Centers for Medicare and Medicaid Services (CMS) requirements and standards

Ability to direct, manage, supervise, mentor, train and evaluate the work of staff and assist department directors in doing so

Ability to promote an atmosphere of teamwork and cooperation, convey the mission and values of the organization, and motivate staff to achieve goals and objectives

Ability to develop, plan, organize and direct programs and activities that are complex in nature and regional in scope

Ability to 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

Ability to provide leadership, facilitate meetings, and partner with and guide directors, managers and employees in the resolution of issues

Demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk