The Health Plan of San Joaquin is now hiring an experienced and dedicated Executive Director, Health Services! RN license required. Health Plan experience is required for this role.

(Must reside in California.)

Remote: This is a remote position; however, must be able to attend monthly onsite meetings, and as needed for business and community purposes.

What You Will Be Doing:

Under limited supervision, the Executive Director of Health Services is responsible for overseeing the strategic direction across HPSJ Health Services consistent with contractual and regulatory requirements, and HPSJ strategies and objectives. Health Services functions include Utilization Management, Case Management, Behavioral Health & Social Work, Quality Management, Quality Improvement, Health Equity, Health Education, HEDIS & NCQA, Credentialing, and Grievance and Appeals. Work is varied, complex and requires a high degree of discretion and independent judgment.

Supervises

Directors of Health Services

Managers of Health Services

Essential Functions:

Oversee operational objectives and plans; ensures the development and implementation of associated business plans and tactics
Anticipates the need for, develops, and implements relevant and effective programs for health services, based on regulatory requirements, opportunities, issues, and trends.
Oversee the development of relevant, timely and accurate internal and external reports.
Supports implementation of targeted interventions designed to eliminate health inequities
Assists the Chief Health Services Officer in identifying medical service issues that have an impact on plan benefits and their administration; assists subordinate managers in resolving grievances, appeals, quality and other health equity related issues.
Oversee the review of quality concerns identified through the QI process and the implementation and monitoring of corrective action plans.
Oversee the preparation of and participate in regulatory audits and external review activities; oversee the development, implementation and monitoring of corrective action plans.
Oversee routine and ad hoc internal audits and corrective action plans to ensure practices adhere to applicable guidelines and HPSJ criteria.
Ensures collaboration among the health services team with a focus on the member care.
Promotes strong collaboration across Health Services, Medical Management and other departments to ensure that the Quality program meets or exceeds NCQA and CMS, DHCS and DMHC regulatory standards.
Collaborate with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding HPSJ’s Quality Improvement and Health Equity Transformation Program goals and activities.
Serves as a representative and spokesperson for HPSJ in support of Quality and Health Equity with key county partners.
Participate in State and industry work groups such as DHCS, DMHC, CHCF, NCQA, ACAP and CAHP to expand HPSJ’s influence on benefit design, regulations, and policy direction.
Leads or participates in internal and external committees.
Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission, and values.
Hires, develops, retains, and ensures that subordinate managers hire, develop and retain competent staff, coach and support staff development.
Promotes, and ensures that direct reports promote an environment that supports and encourages the adoption of HPSJ’s stated values.
Oversee the development and management of select Health Services department budgets.

What You Bring:

Knowledge, Skills, Abilities and Competencies

Required

Expert knowledge of and proficient skills in administering clinical operations protocols.
Expert knowledge of regulatory requirements for Medi-Cal and Medicare pertaining to utilization management, case management and behavioral health.
In depth knowledge of and ability to identify, implement, monitor and analyze relevant metrics models, and implement effective interventions based on results.
In-depth knowledge of standard contract components and contract language specific to healthcare.
In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
In-depth knowledge of medical management information systems and their interrelationships.
Strategic mindset: ability to translate strategic concepts into actionable business plans.
Very strong project management skills, with the ability to function as a sponsor and owner on complex projects; a track record of successful large project implementations.
Very strong facilitation, negotiation and conflict resolution skills.
Strong skills in budget development and management.
Very strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, maintain effective, high-performance teams, and organize people and resources to solve problems and identify business opportunities.
Very strong interpersonal skills, with the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ.
Very strong oral and written communication skills, with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups inside and outside of HPSJ; includes the ability to effectively explain complex information.
Very strong presentation skills, with the ability to tailor presentations to a specific audience, and address and interact with large groups.
Strong customer service skills.
Intermediate mathematics skills, including basic algebra.
Intermediate skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs.
Ability to articulate and embrace organizational values, integrate into management practices, and foster their manifestation among staff.
Very strong coaching/counseling skills, including the ability to function as a mentor to management and employees.
Ability to handle confidential information with appropriate discretion.

What You Have:

Education and Experience

Required

Bachelor’s Degree in nursing from an accredited nursing school; and
At least six years in clinical operations in a healthcare setting; and
At least six years progressively responsible leadership positions in healthcare setting; and
Experience in an HMO or managed care setting; and
Experience with government sponsored programs.

Preferred

Master’s Degree in Nursing
Master’s Degree in Business, Public Health or similar.

Licenses, Certifications

Valid California RN license is required.

What You Will Get:

HPSJ Perks:

Competitive salary
Robust and affordable health/dental/vision with choices in providers
Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
Two flexible spending accounts (FSAs)
Employer-Paid Term Life and AD&D Insurance
Employer-Paid Disability Insurance
Employer-Paid Life Assistance Program
Health Advocacy
Supplemental medical, legal, identity theft protection
Access to exclusive discount mall
Education and training reimbursement in addition to employer-paid elective learning courses.
A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
A shorter commute – if you’re commuting from the Central Valley to the Bay Area.
Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

Health Plan of San Joaquin/Mountain Valley Health Plan jobs

Executive Director, Health Services

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