Central California Alliance for Health
June 27, 2017
Central California Alliance for Health (“The Alliance”), Scotts Valley, CA
Do you thrive in a dynamic environment? Are you an innovative, strategic thinker with exceptional leadership skills? Does the opportunity to work collaboratively with a senior management team that strives for excellence in providing superior quality of care appeal to you? If so, Central California Alliance for Health (“The Alliance”) has an exciting opportunity for a senior level Medical Management professional that you may want to consider.
The Alliance is an award-winning regional non-profit health plan, established in 1996, with over 21 years of successful operation. Using the State’s County Organized Health System (COHS) model, they currently serve 355,643 members in Santa Cruz, Monterey and Merced counties and work in partnership with its contracted providers to promote prevention, early detection, effective treatment and improve access to quality health care for its members. This results in the delivery of innovative community-based health care services, better medical outcomes and cost savings. The Alliance is governed with local representation from each county on its Board of Commissioners.The Alliance is a health plan that was developed to improve access to health care for lower income residents who often lacked a primary care “medical home” and so relied on emergency rooms for basic services. The Alliance has pursued this mission by linking members to primary care physicians and clinics that deliver timely services and preventive care, and arrange referrals to specialty care.
Ideally situated, Scotts Valley is a small city in Northern Santa Cruz County about twenty miles south of San Jose and six miles north of the beach in the upland slope of the Santa Cruz Mountains. With a population that ranges around 11,000, Scotts Valley is near Big Basin Redwoods State Park, Henry Cowell Redwoods State Park, and Roaring Camp Railroads. The town is surrounded by redwood forests. The scenic coastal city of Santa Cruz lies to the south.
Santa Cruz County’s 29 miles of beaches offer the perfect setting for nearly every type of activity. However, its beaches are just the beginning of all there is to see and do in Santa Cruz County. Please visit Santa Cruz County Conference & Visitor Council’s website at http://www.santacruzca.org for more information.
SUMMARY DESCRIPTION Reporting to the CEO, this position:
- Provides executive management and leadership to the Health Services Division, to include Utilization Management (UM), Care Management (CM), Quality Improvement (QI), Clinical Informatics (CI) and Behavioral Health (BH);
- Organizes and integrates current Health Services operating systems, programs, initiatives, policies and procedures, and communications on operating issues to ensure high quality results;
- Provides executive leadership on new Health Services programs, operations, projects, policies and procedures to ensure high quality results;
- Participates in strategic planning and goal setting for the Alliance;
- Communicates Health Services operational performance and capabilities;
- Collaborates in managing regulatory audits and inquiries related to Health Services;
- Coordinates relationships with clinical and social service agencies, and documents protocols for agency communications and referrals;
- Provides staff support to the Alliance’s Advisory Groups and clinical committees; and
- Performs other duties as assigned.
DUTIES AND RESPONSIBILITIES
- Provides executive management and leadership to the Health Services Division, to include Utilization Management (UM), Care Management (CM), Quality Improvement (QI), Clinical Informatics (CI) and Behavioral Health (BH), with duties including but not limited to:
- Advancing Alliance mission and operational effectiveness through executive supervision of planning, implementation and monitoring of Health Services operations, work plans and processes;
- Identifying and articulating the vision and strategic direction of the Health Services Division, and collaborating on the implementation of strategies to achieve them;
- Conducting analysis and making strategic recommendations to meet the business needs of the health plan and the needs of plan members regarding UM, CM, QI, CI and BH services;
- Developing and improving UM, CM, QI, CI and BH program performance and outcomes, and ensuring policies and procedures are in alignment with contractual obligations, health plan initiatives, and strategic goals;
- Advising and collaborating with the Chief Executive Officer and the Chief Medical Officer on strategic issues involving current and new Health Services programs;
- Identifying opportunities for efficient and effective operations within and between Health Services departments, and organizing cross-departmental solutions to departmental and company business challenges; and
- Supervising department Directors in setting goals, objectives and standards, implementing work plans, monitoring and evaluating performance, and making corrective actions.
- Organizes and integrates current Health Services operating systems, programs, initiatives, policies and procedures, and communications on operating issues to ensure high quality results, with duties including but not limited to:
- Organizing and optimizing current departmental business operations, systems and programs;
- Organizing departmental policies and procedures, and ensuring compliance with Board policy and regulatory requirements;
- Establishing and promoting effective internal and external communication protocols for departmental work; and
- Designing and implementing standard and ad hoc reports to measure performance and analyze Health Services business issues.
- Provides executive leadership on new Health Services programs, operations, projects, policies and procedures to ensure high quality results, with duties including but not limited to:
- Designing and developing new Health Services programs based on business initiatives;
- Organizing the approach to implementation of new Board policies and business plans, including operational feasibility analyses, work plan implementation and overall evaluation;
- Developing, interpreting, recommending, implementing and evaluating Board and operational policies; and
- Providing leadership in goal-setting, work plan development, resource budgeting and allocation, monitoring of progress and evaluation of outcomes, and corrective actions and communication of results and agreements.
- Participates in strategic planning and goal setting for the Alliance, with duties including but not limited to:
- Anticipating and forecasting industry trends affecting Health Services and Alliance operations;
- Setting proactive goals and developing opportunities to improve efficiency and effectiveness of operations to benefit customer service, administrative quality, and operating efficiency;
- Participating in new business planning and development; and
- Developing and maintaining analytic reports and performance metrics related to Health Services goals and projects.
- Communicates Health Services operational performance and capabilities, with duties including but not limited to:
- Developing and presenting reports and information to customers, regulators, agencies, staff and the governing board as needed.
- Collaborates in managing regulatory audits and inquiries related to Health Services.
- Coordinates relationships with clinical and social service agencies, and documents protocols for agency communications and referrals.
- Provides staff support to the Alliance’s Advisory Groups and clinical committees.
- Performs other duties as assigned.
EDUCATION AND EXPERIENCE
- PhD or Master’s Degree in Business, Public Health or Health Administration or a related field and a minimum of ten (10) years of recent management experience in a health care organization, including a minimum of six (6) years at the senior leadership level.
JOB SPECIFIC KNOWLEDGE, SKILLS AND ABILITIES
- Thorough knowledge of health care fiscal principles and operations;
- Thorough knowledge of the principles and practices of program development and management and strategic planning;
- Working knowledge of the California Medi-Cal program and entitlement programs and related regulations;
- Working knowledge of Utilization Management, Care Management, Quality Improvement, Clinical Informatics and Behavioral Health programs and procedures;
- Working knowledge of managed care provider payment methods and contracting;
- Working knowledge of the principles and practices of public policy and the regulatory issues in health care;
- Working knowledge of the principles and practices of customer service, provider relations, and quality improvement methods;
- Working knowledge of the principles and practices of supervision and training;
- Some knowledge of health care information systems and MIS applications in health care systems;
- Ability to develop and implement strategic programs, policies and practices in support of the overall operational mission, objectives and goals;
- Ability to oversee operations to ensure regulatory compliance; and
- Ability to plan, assign, direct, supervise and evaluate the work of others.
ALLIANCE STANDARD KNOWLEDGE, SKILLS AND ABILITIES
- Ability to communicate effectively, both orally and in writing;
- Ability to establish and maintain effective and cooperative working relationships with Alliance staff and others contacted in the course of the work;
- Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position;
- Ability to think and work effectively under pressure and accurately complete tasks within established times;
- Ability to prioritize tasks and meet deadlines;
- Ability to maintain confidentiality; and
- Valid California Driver License, transportation and automobile liability insurance in limits acceptable to the Alliance.
- Current license as a Registered Nurse (RN) issued by the State of California.
- Experience in a managed care or prepaid health system environment.
The Chief Health Services Officer will have an opportunity to make a significant contribution to the lives of The Alliance’s members and to grow with a company that offers a unique and compassionate approach to patient care. Share your enthusiasm, experience, and skills with a company that is on the cutting edge of innovative healthcare in California!
For further information, please contact:
Mary Niccum or Susan Pisarik
The Job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The Employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change