Health Services Officer – Lookout Local Santa Cruz

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LOCATION: Scotts Valley, California; Salinas, California; Merced, California

We are looking for our next Health Services Officer (HSO) to lead our Health Services Division. This position is available in our Merced, Salinas or Scotts Valley offices. Success in the position requires a local presence within the community and a connection to a local office.

EFFICIENT WORK: Central California Alliance for Health works in partnership with our contracted providers to promote prevention, early detection, and effective treatment, and to improve access to quality health care for those we serve. This results in the delivery of innovative community health care services, better medical outcomes and cost savings.

We are approximately 500 employees who all work towards our vision of healthy people, healthy communities by living our values ​​of fairness, integrity, improvement and collaboration in pursuit of our mission of accessible health care and of quality guided by local innovation. Learn more about our history, our members and our partnerships here.

WHAT YOU WILL BE RESPONSIBLE: Reporting to the Chief Medical Officer, Dr. Dale Bishop, the Alliance Health Services Officer:

  • Provide executive management, leadership and accountability of the Alliance Health Services Utilization Management (UM) departments, Quality Improvement/Population Health (QI/PH), coordination of community care, behavioral health and pharmacy to achieve Alliance strategic plan goals and outcomes
  • Provide executive leadership in new business plans, policies, programs and projects to ensure high quality results
  • Organize and integrate Health Services Department operations, systems, and programs to ensure policies, procedures, and execution are consistent with contractual obligations, health plan initiatives, and strategic goals
  • Participate in strategic planning and goal setting for the Alliance

MANAGEMENT OF: The HSO leads one of our largest teams (over 175 employees) and has a total of five direct reports. The ASS provides strategic leadership to the following departments and their respective functions:

  • Utilization Management and Complex Case Management
  • Improving the quality and health of the population
  • Community Care Coordination
  • Behavioral health
  • Pharmacy

THE IDEAL CANDIDATE WILL BE:

  • Be a goal-oriented leader with the ability to align with common goals and drive results through collaborative efforts
  • Have a strength in planning and overseeing health plan operations, with expertise in managing change and implementing solutions to improve performance
  • Have a passion for championing system redesign and advancing models of care
  • Lead with accountability, with expertise in performance measurement, identifying areas of opportunity and implementing solutions to improve performance and results
  • Be an effective communicator, promoting authentic, direct and timely communication within your own team and across the organization
  • Commit to health equity
  • A plus: Medicare, NCQA accreditation, CMS audit experience

WHAT YOU WILL NEED TO SUCCEED: To read the full job description and list of requirements Click here.

Knowledge of:

  • Principles and Practices of Managed Care
  • Principles and practices of utilization management and care management
  • Title 22, Knox Keene, Medicaid, Medicare, Entitlement Programs and Related Regulations
  • National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC) and Centers for Medicare and Medicaid Services (CMS), standards, quality improvement studies and HEDIS reports
  • Collection and analysis of data and management practices related to the quality of medical care
  • Health care regulatory processes, as well as state and federal legislative processes

Ability to:

  • Lead, manage, supervise, coach, train and evaluate the work of staff and assist department managers in doing so
  • Promote an atmosphere of teamwork and cooperation, convey the mission and values ​​of the organization and motivate staff to achieve goals and objectives
  • Develop, plan, organize and direct programs and activities of a complex nature and regional scope
  • Review and evaluate the overall function of the division, including the core work, objectives and structure of each department, and oversee the development and implementation by the directors of short and long term planning to achieve the strategic plans and carrying out an annual evaluation of the department
  • Act as a technical resource and explain complex laws, regulations, processes and programs related to area of ​​responsibility

Education and experience:

  • Bachelor’s degree in commerce, public health, health administration, nursing, or related field and a minimum of ten years of experience in the health care field, including a minimum of five years of experience in a management position responsible for managing core health plan operations in utilization management and care management functional areas within a managed care framework, as well as the development and implementation of strategic programs, policies and practices in support of overall operational mission, goals and objectives (a master’s degree can replace two years of general health care experience); or an equivalent combination of education and experience may qualify.

OTHER DETAILS:

  • Although this position is linked to one of our Alliance offices, we are currently in a hybrid remote/office work environment and anticipate that the interview process will be conducted remotely.
  • Our Alliance offices officially reopened on May 2, 2022 and while some employees may work full-time from home, attendance at quarterly company-wide events or department meetings will be expected.
  • Depending on the nature of the work, this position may require on-site presence, which is dependent on business requirements. Details on this can be reviewed during the interview process.

COVID-19 vaccine requirements: This position requires staff to be fully vaccinated and reinforced on their start date as a condition of employment. Proof of vaccination must be presented at time of rental. Fully Immunized is defined as receiving the second dose of a 2-dose series (eg Pfizer & Moderna vaccines) OR receiving a single dose vaccine (eg Johnson & Johnson); AND receipt of the reminder (if eligible); AND a period of 2 weeks having elapsed since the last dose of vaccine was administered.

In addition, all Alliance positions must meet these minimum qualifications.

OUR ADVANTAGES:

  • Medical, dental and vision plans
  • Lots of paid vacation
  • 11 paid holidays per year
  • 401(a) Retirement Plan
  • 457 Deferred Compensation Plan
  • Robust health and wellness program
  • Electric vehicle charging stations on site
  • And much more

HOW TO REGISTER: If you are interested, please submit an online application here.

ABOUT US: We are a group of over 500 dedicated employees, committed to our mission to provide accessible, quality healthcare driven by local innovation. We feel our work is bigger than ourselves. We leave work every day knowing that we have made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance), where you’ll be part of a respectful, diverse, professional, and fun culture, and where you’ll be empowered to do your best. As a nonprofit regional health plan, we serve members in Merced, Monterey, and Santa Cruz counties. To learn more about us, see our Fact sheet.

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