March 3, 2020
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 Utilization and Care Management or Quality in Managed Medi-Cal, Medicaid and/or Managed Care settings? Do you possess exceptional leadership, organization and communication skills? Does the opportunity to work collaboratively with a 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”. 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.
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, has 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 breathtaking 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.
Job Summary (General Overview, reporting to, work environment)
As a direct report to the Chief Medical Officer (CMO), the Director of Health Services is the equivalent to a Vice President within CenCal’s organizational structure and is an operational leader with deep experience leading clinical operations. This position is responsible for clinical operations performance and delivery, cross-functional collaboration, developing and monitoring department budget, forecasting the development or improvement of clinical programs and building a high performing team. Utilization Management, Care Management, and Social Work programs are under the direction and responsibility of the Director of Health Services. This position is also responsible for overseeing the development of quality, effective programs that enhance the members’ experience, access to care, improve their wellbeing, and provide continuity of care, while decreasing care fragmentation and adhering to regulatory requirements
DUTIES AND RESPONSIBILITIES
- Provide leadership and strategic direction to Health Services leadership team and larger operations organization.
- Develop and ensure delivery of performance goals for all areas of responsibility
- Develop key performance indicators to monitor performance and adjust as needed to address needs and trends.
- Develop and execute a strategic roadmap to optimize talent, processes and technology.
- Ensure operations are efficient, effective, and provide value to members and provider community.
- Develop standard operational processes and procedures that promote quality, compliance, and consistency.
- Develop and execute talent strategy to support growth and development of leaders and team within Health Services.
- Develop and drive programs and initiatives within Health Services, and actively engage in organization-wide projects as a collaborative partner.
- Provide leadership and strategic direction for vendor partnerships.
- Collaborate with the CMO and larger CMO organization to develop and support Quality Improvement Programs.
- In collaboration with direct report team and with input from larger Health Services operations organization, develop and execute an engagement strategy that promotes communication, active participation, accountability, growth and development.
- Build strong cross-functional relationships throughout the organization that are collaborative and productive.
- Responsible for ensuring CenCal Health meets all regulatory and licensing requirements.
- Develop and maintain understanding of applicable regulatory initiatives, requirements and industry trends related to utilization management, case management, and quality improvement to evaluate impact on organization; and develop plans for program changes as indicated; support regulatory compliance; participating on committees as appropriate.
- Fiduciary responsibility for department costs, as well as supporting reserves. Prepare annual department budget plans, monitor expenses and document variances from approved budgets
- Oversight of the members’ health services programs on an organization-wide basis.
- Ensure departmental readiness for all DHCS, DMHC, etc. audits.
- Represent and support CenCal Health’s benefit decisions at administrative hearings as needed.
- Prepare reports and make presentations at various internal quality committees and occasionally to the governing board.
- This position works collaboratively with Claims, Member Services, Provider Services, Legal, and other departments, as well as the Health Services team to educate, train and implement effective health services operations.
- Other duties and projects as assigned by the Chief Executive Officer and/or Chief Medical Officer.
SKILLS, KNOWLEDGE & ABILITIES
- Experienced leader and operator with experience leading clinical operations; utilization management, case management, disease or population management.
- Experience building high performing teams.
- Experience leading operations through change and increasing employee engagement.
- Strategic mindset with ability to execute and deliver results.
- Current working knowledge of the California Medi-Cal program.
- Knowledge of the California Children Services.
- Deep knowledge of managed care in a health plan setting.
- Demonstrated leadership skills with the ability to establish and motivate team members to achieve person and professional goals and objectives.
- Ability to develop and design medical management programs that are member-centered.
- Strong communication and presentation skills.
- Leading and participating in internal and external committees and meetings.
- Complying with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
- Strong problem-solving skills, facilitation skills, and analytical skills.
Preferred, not required:
- Knowledge of Medicare and Commercial lines of business.
- Certification in Case Management
- 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.
- Walk the Talk: Do what you say you are going to do. Be accountable for your actions.
- World Class Mindset: Behaves in an honest, fair, and ethical manner. Shows consistency in words and actions. Models high standards of ethics. Punctual, exhibits professional email etiquette. Adhere to company and department standards. Commitment to excellence.
EDUCATION AND EXPERIENCE
- Bachelor’s Degrees in a related field
- Master’s degree in related field, Nursing, Business, Health Care, Health Administration, etc., preferred
- An active and unrestricted California clinical license or other acceptable licensed healthcare professional preferred
- Seven – ten (7-10) years of relevant experience in either managed care and/or insurance industry
- Seven – ten (7-10) years of people leadership experience working with utilization management, case management, and/or disease management
ESSENTIAL FUNCTIONS (Consider sitting, standing, travel, working at computer for long periods of time, lifting etc.)
- Physical requirements needed to perform the essential functions of this job, with or without accommodation:
- Mobility Requirements: ability to operate a keyboard and sit for long periods; stand, sit, reach, bend, crawl, stoop, lift up to 10 lbs.
- Visual Requirements: ability to read close-up and do close-up work.
- Dexterity Requirements: ability to perform repetitive motion (keyboard); writing (note-taking)
- Hearing/Talking Requirements: ability to hear normal speech, hear and talk on the telephone
- Emotional/Psychological Requirements: ability to deal with public contact, in person and Normal office environment. Must be able to sit and work at a computer for long periods of time
- Must be able to travel outside the office and attend meetings during and after regular work hours
- Regular attendance is essential to perform this job
- Must be able to work full time
- Possess a current, valid driver’s license with a clean driving record
The Director, Health 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
The above information on this description has been designed to indicate the general nature and level of work performed by CenCal Health employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.