Director, Member Services

STATUS: FILLED

CENCALHEALTH SANTA BARBARA, CA

Would you thrive in a highly regarded, mission driven organization that is dedicated to ensuring quality, cost effective care for the underserved? Does your background include a steady progression in Managed Medi-Cal Operations with a focus on Member Services, Call Center Management, Member Rights oversight such as Appeals and Grievance, Cultural and Linguistics or Customer Service? Do you possess exceptional communication and leadership skills? Does the opportunity to work collaboratively with a senior management team that strives for excellence appeal to you? If so, CenCal Health has an exciting opportunity that you may want to consider.

COMPANY OVERVIEW

CenCal Health (formerly The Santa Barbara Regional Health Authority) is the Medi-Cal Managed Care Program for low income residents of Santa Barbara and San Luis Obispo counties. Since its inception in 1983, CenCal Health has, among other things, created access to high quality health care for its members through contracts with local providers and through a primary care provider case management network in addition to Health Education and Disease Management programs and activities. The program that began at CenCal is now acknowledged to be the oldest Medicaid managed care program of its kind in the country and has since become a demonstration program for other counties and states which is a model for Medicaid reform.

CenCal Health is dedicated to the community and local residents. Medi-Cal is CenCal Health’s largest program that is currently serving approximately 178,000 residents in their service areas of Santa Barbara and San Luis Obispo counties. Once members are in the CenCal Health system, they are able to choose (or have assigned) a Primary Care Physician (PCP), which will serve as their “medical home”. Cen Cal Health’s mission is to improve the health and well-being of the communities they serve by providing access to high quality health services, along with member education and outreach. There is a dedicated bilingual, bi-cultural Member Services Department that is able to assist with member questions, appointment scheduling, arranging non-emergency transportation if required, interpreter services at provider offices when needed at no cost and numerous other services.

LOCATION

Santa Barbara is a 2-hour drive north from Los Angeles or a short hop from any corner of the world via the Santa Barbara airport. The city lies between the sleepy Santa Ynez Valley and the Pacific Ocean with a population of 88,410, making it the second largest city in the county after Santa Maria, while the contiguous urban area, which includes the cities of Goleta and Carpinteria, along with the unincorporated regions, have a population of 220,000.

The city economy includes a large service sector, education, technology, health care, finance, agriculture, manufacturing and local government. Education in particular is well represented with five institutions of high learning on the south coast. Behind the city is the Los Padres National Forest, which contains several remote wilderness areas. Santa Barbara’s harbor is home to the world-famous Stern’s Wharf and visiting the Wharf and the zoological gardens makes a scenic and educational day trip. From the city, you are just minutes away from the world-famous Santa Barbara wine country. The gorgeous Santa Ynez Valley, with its breath-taking vistas is home to such notable attractions as Solvang and the Chumash Reservation. Santa Barbara’s climate is often described as Mediterranean and it is sometimes referred to as the American Riviera. Its beautiful beaches, majestic mountains, and colorful culture make Santa Barbara a premier place to live and work. Please visit the Santa Barbara Conference & Visitor Council’s website for more information.

Summary Description: 

Reporting to the Chief Operating Officer, this position is responsible for the planning, organizing and managing all the function and activities of the Member Services Department. This includes the Call Center, Eligibility, Grievance & Appeal process and Quality Improvement processes that include the Member Support Committee, the Community Advisory Board and the Cultural and Language Access Program.

Collaborates with Department Management to establish department service quality goals and develops processes to monitor the achievement of those goals subject to Quality Committee and Executive Approval.

DUTIES AND RESPONSIBILITIES

Serves as senior management and strategic planner for the Member Services Department, including personnel, fiscal and operational functions, with duties including but not limited to:

• Providing leadership and direction to the Member Services staff. Develops and maintains internal controls in the Member Service Department. This includes managing the department through change initiatives, system changes, benefit changes, work environment changes and other process changes.
• Providing leadership to the call center queue, overall member relations and satisfaction, training of staff, establishing service level goals and required reporting.
• Providing leadership and oversight of CenCal Health’s membership/eligibility system information and its functionality as it relates to enrollment and disenrollment data and all other elements of information provided from the state for the Plan’s HIS which is utilized by various departments within their operational needs.
• Leadership and oversight of the Member Grievance and Appeal System, Quality Improvement and its associated activities and interventions that include the Member Billing Process, the supervision of its Manager and reporting staff. All protocols and outcomes directly affecting member satisfaction; and all regulatory and state DHCS, DMHC contract and federal guidelines compliance.
• Provides leadership and oversight of the Cultural and Language Access Program, its Policies and Procedures, including the translation team regarding vital document translation, readability with appropriate literacy levels for all member materials and ensures all new employees receive an overview of the Plan’s C&L Program, services, and annual trainings on cultural sensitivity training; supervision of the C&L Resources Coordinator that provides for the provision of interpreter services coordination for face to face services including ASL services and telephonic; the contracting of such services and the evaluations of interpreters and bilingual staff.
• Oversight and direction of the department’s Training Manager, providing guidance and support to the development and maintenance of all departmental functional area training manuals, resources guides both electronic and paper formatting.
• Current direct reports include Associate Director, Grievance/Quality Improvement Manager, Training Manager, Cultural Language Program and Resource Coordinator and Data Analyst.

The Director of Member Services chairs two committees:

• The Quality Committee Member Support Committee responsible for the oversight and reporting of established goals and service levels, CAHPS survey with analysis and findings, assigned HEDIS measures with interventions and all other quality activities relating to Member Rights as noted within the state contract and NCQA Standards.
• Board of Directors liaison community committee pursuant to CenCal Health’s contract known as the Community Advisory Board (CAB). The CAB is responsible for providing direct feedback and reporting to the Board of Directors relating to Member Rights, advocacy and services provided to Plan members from CenCal Health and its provider network.
• Prepares annual department budget, goals and objectives consistent with organization’s goals.
• Participates in the organization’s strategic planning process.

Other duties and projects as assigned by the Chief Operations Officer or other Plan executive leadership.

SKILLS/KNOWLEDGE/ABILITIES

• Able to solve unique and complex problems that have a broad impact on the organization.
• Ability to build key relationships at all levels of the organization.
• Excellent written and oral communication skills.
• Excellent knowledge of core operation functions of a managed care organization.
• Experience with Federal and California managed care regulations and mandates.
• Ability to forecast and manage project budgets.
• Strong organization, time management and project management skills and multi-tasking abilities.
• Advanced analytical skills and problem-solving skills with the ability to formulate and communicate recommendations for improvement.
• Knowledge of continuous quality improvement techniques.
• Strong Management experience in a managed healthcare environment with a minimum of ten (10) years’ experience.
• Excellent management & supervisory skills with extensive knowledge of how to grow and maintain a positive work environment.
• Knowledge of, and ability to utilize, conflict resolution and problem-solving techniques.

Thorough understanding and ability to provide data collection and analysis.

COMPETENCIES

• Management Administration Skills: Manages and/or facilitates employees, budgets and equipment assigned to them, while helping employees maintain a clear picture of their roles and responsibilities to achieve organizational objectives. Helps to develop employee performance by delegating responsibilities and providing accurate feedback and assessments on a timely basis.
• Leadership Skills: Able to assume a role of formal or informal authority as necessary; advocate new ideas, even when risk is involved; delegate responsibility and empower associates to make decisions; capable of providing constructive feedback to others; able to receive constructive feedback from others; makes personal commitment to mentor and grow others.
• Strategic Thinking: Formulates objectives and priorities, and implements plans consistent with the long-term interest of the organization in a global environment, Capitalizes on opportunities and manages risks.
• Communication Skills-Oral, Listening & Written: Communicates both verbally & in writing in such a manner that it is easy to understand and interpret what and why information is being communicated. Listens attentively without interrupting and/or being distracted by other things.
• Collaboration & Teamwork: Utilizes communication techniques & methods that generate trust, collaboration, open two-way communication and a supportive work environment. Develops and generates team momentum, enthusiasm, and camaraderie to obtain maximum team performance. Values diverse talents of team members and works to include various points of view in decision making.
• Human Capital Management: Builds and manages workforce based on organizational goals, budget considerations, and staffing needs. Ensures employees are appropriately recruited, selected, appraised, and rewarded; takes action to address performance problems. Manages a multi-sector workforce and a variety of work situations.
• Conflict Management: Encourages creative tension and differences of opinions. Anticipates and takes steps to prevent counter-productive confrontations. Manages and resolves conflicts and disagreements in a constructive manner.
• Decisiveness: The ability to make difficult decisions in a timely manner.

EDUCATION AND EXPERIENCE

• Bachelor’s Degree in Health Administration, Social Sciences, Business or related field or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities necessary.
• Ten plus (10+) years progressive experience in Healthcare Administration, managed care and experience with Medi-Cal and Medicare managed care plans.
• Seven-Ten years progressive management experience in a managed healthcare environment
• Must have a familiarity with the County Welfare Offices known as Department of Social Services (DSS), Social Security Administration (SSA); county public health departments; FQHCs; local CBOs and experience with quality standards such as NCQA, JACHO and extensive knowledge of regulatory standards such as Knox-Keene, Titles 22, and 28.

Understanding and experience in Health Information Systems as well as working with programmers and analysts.

ESSENTIAL FUNCTIONS

• Physical requirements needed to perform the essential functions of this job, with or without accommodation.
• Must be able to travel outside the office and attend meetings during and after regular work hours
• Possess a current, valid driver’s license with a clean driving record

The Director, Member Services will have an opportunity to make a significant contribution to the lives of CenCal’s member population. Share your vision, expertise and skills with a company that is committed to improving the quality and cost of healthcare for the underserved!

For further information, please contact:

Mary Niccum or Susan Pisarik

Phone: 949.721.8250
Fax: 949.721.8259
Email: exec.search@esrg.com

Disclaimer

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 Alliance reserves the right to revise this job description at any time.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.

Applicants must be currently authorized to work in the United States on a full-time basis.