September 18, 2019
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 experience in Medical Management such as Utilization and Care Management or Quality in Managed Care or Managed Medi-Cal settings? Do you possess exceptional organization and communication 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!
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”. CenCal 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 bi-lingual, 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.
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 at http://www.santabarbaraca.com for more information.
Reporting to the CEO, the CMO will provide medical leadership to the organization by ensuring medical quality and adherence to professional and ethical medical standards by the plan and its network of providers.
DUTIES AND RESPONSIBILITIES
- Provide medical leadership by balancing clinical decisions, health care trends and business necessities through:
- New program development;
- Peer Review process;
- Member grievances and appeals;
- Corrective Action;
- Quality Programs for a Health Plan vs. hospital;
- Clinical reviews for the UM Process; and,
- Making recommendations to CenCal Health leadership and management regarding provider competencies.
- Directly supervise the Health Services Department Director, the Pharmacy Director and four Medical Directors; Director, Quality Measurement & Improvement and assist department staff in understanding the broad and deep issues of the healthcare environment both locally and nationally.
- Participate in strategic planning efforts and ongoing management meetings by communicating business strategies from a clinical perspective. Provide proactive medical leadership consistent with CenCal Health’s Strategic Plan around business transformation.
- As a member of the Executive team, participate in executive-level meetings, by objectively and constructively expressing opinions in an open and honest manner to support CenCal Health’s mission statement.
- Serve as a leader in the San Luis Obispo and Santa Barbara County medical communities by promoting high quality and cost effective health care amongst:
- Underserved and disenfranchised populations;
- CenCal Health members:
- By communicating the goals, objectives and business principles of CenCal Health; and,
- By supporting and vigorously promoting CenCal Health policies, procedures, decisions and explaining to the communities our limited financial federal and state resources.
- Responsible for: developing, implementing and monitoring the Health Services Quality Improvement Plan, including quality of care, utilization management and peer review functions; supervising the administration of the CenCal Health’s prospective, concurrent and retrospective review of health care program benefits; assist in implementing and monitoring health management programs; developing clinical policies related to the use of the formulary and therapeutics; and overseeing the management of the pharmacy benefit program
- Development and implementation of quality of care policies and clinical guidelines for CenCal Health’s members; monitor provider compliance, with emphasis on utilization management and quality of care.
- In conjunction with the Medical Directors, the Health Services Director and Pharmacy Director, oversee the administration of Agency’s prospective, concurrent and retrospective reviews of inpatient and long-term care services; issue denial of services when appropriate; review other medical claims and appeals as necessary.
- Oversee the management of the pharmacy benefit program, including the development and implementation of programs to promote efficient prescribing practices.
- Serve on appropriate committees as delineated in the plan’s Quality Assessment and Improvement Plan; work with community provider committees and advisory boards; maintain an active status with the Authority medical community.
- Participate in the grievance process regarding quality of care issues; have the ultimate responsibility for the resolution of medically related grievances
- Consult on the development of plans and policies related to health promotion for CenCal Health members and continuing education for providers.
- Ensure that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management, as allowed within CenCal Health’s organization structure
- Develop and monitor budgetary process for Health Services, Pharmacy and Quality Departments.
- Develop and mentor various direct reports
- Overall accountability for structure and organization of the Health Services Department to ensure appropriate maximization of staffing resources
- Champion change in Health Services and develop plans to meet both regulatory and company needs.
- Other duties as assigned by Chief Executive Officer.
REQUIRED SKILLS, KNOWLEDGE & ABILITIES
- Demonstrated and recognized employment history of visionary clinical and business leadership in recent health care systems through:
- Experienced interaction with safety net providers and provider networks;
- Community & clinical input, using broad executive skills that show an adept understanding of multiple interests and fiscal accountability;
- An employment history navigating human dynamics involving inter-departmental and community politics; and,
- Use of data and analytics to identify clinical trends and outcomes that may require further understanding or investigation (with a preference to NCQA accreditation standards and/or HEDIS quality measurement use).
- Understanding of regulatory and funding challenges – deep understanding of medical economics; must be comfortable in an environment where resources are limited and demand for services exceeds the supply.
- Skilled at assertive and non-judgmental interaction with physician peers and other practitioners to motivate improvements in clinical practice to increase compliance with established clinical guidelines.
Critical Skills Summary:
- Outstanding clinician with strong clinical references.
- Team Player as demonstrated through supporting staff, mentoring staff, demonstrating mutual respect and acknowledging staff value.
- Excellent verbal and business written communication skills (both for clinicians and non-clinicians).
- Knowledge of the California Medi-Cal program and the Santa Barbara and San Luis Obispo county medical community preferred;
- The Chief Medical Officer has the ability and obligation to inform the CEO and, if necessary, the Board of Directors, if she/he believes their clinical decision-making ability is being adversely hindered by administrative or financial considerations
- Excellent leadership skills to provide strategic direction to CenCal Health and to establish short- and long-range goals.
- Excellent written and oral communication skills; excellent interpersonal skills to develop and maintain critical internal and external relationships and motivate staff to achieve goals and objectives
- Ability to handle varying situations with tact and diplomacy.
- Ability to mentor and develop his/her direct reports and their teams.
- Continue to develop and grow the Health Services Department
- Participates in carrying out the organization’s mission, goals, objectives and continuous quality improvement.
- Provide medical leadership and strategy for clinical operations.
- Develop and advocate for programs/new product that provide high quality, cost effective services.
- Develop and implement medical policy.
- Provide strategic and focused provider communications and enhance provider relations.
- Ensure that a quality improvement process is followed and is compliant with applicable state and federal regulations
- Develop budget, strategic and operational plans
- Build community support.
- Oversee the development and implementation of the health plan’s clinical guidelines and protocols.
- Represents the health plan in the medical community and in general community public relations
- Strong, motivated leader.
- Develop a succession plan for the department.
- Understands the use of data in exploring opportunities for improvements without rushing to judgment. (Preference to experience with NCQA accreditation process and/or HEDIS quality measurements.)
- Stays abreast of latest “Pay for Performance” initiatives that align with CenCal Health’s clinical and business objectives.
EDUCATION AND EXPERIENCE
- Board certified physician, preferably in a primary care specialty
- An unrestricted license to practice medicine in California A minimum five-ten years’ experience in a managed care plan and experience administering medical programs, or equivalent combination of education and experience
- Preference to an employment history serving the medically underserved and disenfranchised members of our society.
- Strong preference to recent employment as a Chief Medical Officer or Medical Director in a Medi-Cal or Medicaid managed care health plan, or community-based health care system. Preference to knowledge of the Santa Barbara or San Luis Obispo medical communities.
- Must be able to travel outside the office and/or attend meetings during and after work hours; must have a current valid license with a clean driving record.
- Requires sitting at a computer for periods of time
The Chief Medical Officer will have an opportunity to make a significant contribution to the lives of CenCal’s patient 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
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. CenCal Health reserves the right to revise this job description at any time.
CenCal Health 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.