Central California Alliance for Health
June 12, 2019
CENTRAL CALIFORNIA ALLIANCE FOR HEALTH (“THE ALLIANCE”)
Do you thrive in a dynamic environment? Are you a self-starter with exceptional analytical, organization and communication skills? Does the opportunity to apply your background and experience to a position with a company that will value your contribution appeal to you? If so, Central California Alliance for Health (“The Alliance”) has an exciting opportunity that you may want to consider!
The Alliance is an award-winning regional non-profit health plan, established in 1996, with over 22 years of successful operation. Using the State’s County Organized Health System (COHS) model, they currently serve 340,000 members in Santa Cruz, Monterey and Merced counties. They work in partnership with their contracted providers to promote prevention, early detection and effective treatment, and improve access to quality health care for those they serve. 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 our 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.
The company’s 2018-2020 Strategic Plan Report is available @ http://www.ccah-alliance.org/aboutus.html and identifies the Alliance’s priorities, strategies and building blocks that set a clear direction for the organization and serves as the foundation for how they will fulfill their mission.
The Alliance’s members represent a combined average of 36% of the population in Santa Cruz, Monterey and Merced counties. They serve seniors, persons with disabilities, low-income mothers and their children, children who were previously uninsured, pregnant women, home care workers who are caring for the elderly and disabled and low-income, childless adults ages 19-64.
Their programs currently include Medi-Cal Managed Care serving Santa Cruz, Monterey, and Merced counties and Alliance Care In-Home Supportive Services (IHSS) in Monterey County.
The Alliance partners with over 7,900 providers to form its provider network, with 72.9% primary care physicians and 78.3% specialists within its service area contracted to provide services to its members.
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 City of Santa Cruz in the upland slope of the Santa Cruz Mountains. As of the 2010 census, the city population was 11,580. Scotts Valley is also 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 air quality has been recognized by the American Lung Association as being among the cleanest in the nation. 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 the Santa Cruz County Conference & Visitor Council’s website for more information.
Reporting to the Provider Services Director, this position:
- Manages provider network evaluation and development, reporting, and compliance-related activities
- Manages, supervises, mentors and trains assigned staff
- Oversees operational work for Provider Services, including regulatory reporting, policy review, project participation, and training
- Identifies and implements unit and department-level goals, objectives and performance metrics in coordination with the Provider Services Director and other department leadership
- Performs other duties as assigned
DUTIES AND RESPONSIBILITIES
1. Manages provider network evaluation and development, reporting, and compliance-related activities, with duties including but not limited to:
- Identifying and monitoring opportunities for access, quality, and regulatory improvement, including analyzing the adequacy of the Alliance provider network in meeting member needs
- Analyzing data and identifying member needs in order to develop annual and ad hoc network expansion plans for execution by the Provider Relations unit
- Developing network gap analyses for new programs or lines of business for recruitment execution by the Provider Relations unit
- Developing and auditing regular reporting at the individual provider and network levels to evaluate adequacy of individual providers, the Alliance provider network, and Alliance delegated networks
- Managing the delegate oversight process to ensure network adequacy and overseeing efforts to ensure network access standards are met
- Preparing network development strategies and utilizing data to advance and develop the provider network and ensure excellence in core business operations
- Ensuring compliance with regulatory standards through the assessment of key access indicators, overseeing the completion of network corrective action plans, and preparation of responses to comment letters from regulatory entities
- Managing the administration and analysis of the Provider Satisfaction, Provider Appointment and Availability, and Secret Shopper surveys, as well as the annual Market Share analysis, and utilizing data to inform future efforts in response to member needs
2. Manages, supervises, mentors and trains assigned staff, with duties including but not limited to:
- Managing and supervising staff, setting goals and objectives, delegating and assigning work
- Providing mentoring, coaching, and development and growth opportunities to staff
- In conjunction with the Provider Services Director, interviewing and participating in the selection of staff
- Evaluating employee performance, providing feedback to staff, and coaching and counseling or disciplining staff when performance issues arise
- Overseeing or conducting staff training, including the development and maintenance of training materials, in conjunction with the Training and Development team
- Identifying training gaps and opportunities for improved performance
- Overseeing staff in field office locations
3. Oversees operational work for Provider Services, including regulatory reporting, policy review, project participation, and training, with duties including but not limited to:
- Overseeing the coordination and management of the regulatory reporting process, including coordination and creation of deliverables for audits and the annual Medi-Cal network certification
- Auditing routine and regulatory reports, with a focus on quality to ensure completeness and accuracy
- Managing the annual policy review process for Provider Services, including All Plan Letter review, and working with other units to assess policy changes needed in response to regulatory requirements or network need
- Participating in high-level workgroups and projects and serving as a Provider Services resource and subject matter expert in cross-functional Alliance projects
- Overseeing or conducting effective and informative department-level training for all Provider Services staff to ensure shared understanding of key operational processes
- Overseeing the development and maintenance of training materials in conjunction with the Training and Development team
4. Identifies and implements unit and department-level goals, objectives and performance metrics in coordination with the Provider Services Director and other department leadership, with duties including but not limited to:
- Identifying unit- and department-level issues and potential solutions
- Conducting research and making recommendations
- Preparing reports and making presentations
- Informing staff of unit and department-goals, objectives and performance metrics and supporting staff in meeting expectations
- Representing the department internally and externally at meetings and on committees, as assigned
5. Performs other duties as assigned
EDUCATION & EXPERIENCE
Bachelor’s degree in Healthcare Administration, Business Administration, Public Administration or a related field and a minimum of six years of experience (or a Master’s degree and a minimum of four years) in Managed Care, which includes a minimum of two years of supervisory or management level experience related to program evaluation and/or data evaluation; or an equivalent combination of education and experience may be qualify for this position.
KNOWLEDGE, SKILLS & ABILITIES
- Working knowledge of the principles and practices of provider network evaluation, analysis, and reporting
- Working knowledge of the healthcare industry and healthcare planning
- Working knowledge of the California Medi-Cal program and entitlement programs
- Working knowledge of the tools and techniques of gap analysis and survey administration
- Working knowledge of research, analysis and reporting methods Working knowledge of the tools and techniques of program and project management
- Working knowledge of the principles and practices of supervision and training
- Working knowledge of and proficiency with Windows based PC systems and Microsoft Word, Outlook, PowerPoint and Excel
- Ability to manage, supervise, mentor, train, and evaluate the work of staff
- Ability to organize and prioritize the work of others, delegate effectively, and follow up on work assignments
- Ability to interpret and apply complex principles, policies, terms and procedures
- Ability to act as a technical resource and explain regulations, processes, and programs related to area of assignment
- Ability to provide leadership and facilitate meetings
- Ability to foster effective working relationships, influence others, and build consensus with individuals at all levels in the organization
- Ability to identify issues, conduct research, gather and analyze information, reach logical and sound conclusions, and make recommendations for action
- Ability to effectively, clearly and independently document, summarize and resolve complex issues
- Ability to work independently, manage assigned workload, make decisions related to areas of functional responsibility, and recognize issues requiring escalation
- Ability to manage the development and implementation of projects, systems, programs, policies and procedures
- Ability to analyze data and prepare written and oral reports and make effective presentations
- Ability to develop work plans and workflows and organize and prioritize activities
- Ability to present strategic information, data and results in a clear and understandable manner utilizing methods appropriate to various forums
- Some knowledge of provider networks in Santa Cruz, Monterey and Merced counties.
- Some knowledge of the methods and techniques of training curriculum development and training delivery.
- Some knowledge of the principles and practices of customer service.
- Ability to analyze and interpret legal, regulatory and contractual language
- Ability to utilize good judgment and tact when interacting with health care providers, members and other stakeholders
- Ability to sit in front of and operate a video display terminal for extended periods of time.
- Ability to bend, lift and carry objects of varying size weighing up to 10 pounds
- Ability to travel to different locations in the course of work
The Provider Quality & Network Development Manager will have an opportunity to make a significant contribution and to grow with a company that offers a unique and compassionate approach to ensuring quality, cost effective care to the underserved. 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 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.