Director, Provider Services

STATUS: FILLED

CENCALHEALTH SANTA BARBARA, CA

Do you thrive in a dynamic environment? Have you had a steady evolution in Managed Care Operations with a focus in Provider Services? Do you possess exceptional communication and leadership skills? Does the opportunity to work collaboratively with a senior management team that strives for excellence in providing superior quality of care 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.

Medi-Cal is CenCal Health’s largest program, 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 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. CenCal Health is dedicated to the community and local residents.

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: 

Under direction of the Chief Operating Officer, this position directs all aspects of provider network strategy to improve member access to care and enhance provider satisfaction with CenCal Health. Plans, organizes, staffs, and leads activities of CenCal Health’s provider network management and contracting functions and oversees access analysis, network development and operations, credentialing, quality improvement, provider training and provider information management.

Serves as a member of CenCal Health’s senior leadership team and develops and implements provider and community engagement strategies. Responsibilities include network growth and retention, provider contracting and provider services, developing strong relationships with physician partners, and implementing operational processes to support the company’s strategic direction.

DUTIES AND RESPONSIBILITIES

Responsible for overall direction of Provider Services, including provider recruitment, relationship development and services, credentialing and contracting, provider quality, compliance and incentive initiatives and provider reporting and information management. Develops CenCal Health’s provider network to result in better quality, service and value and is responsible for ensuring that members have a complete and comprehensive network of providers (physicians, clinics and other services).

• Advances relationships with contracted providers and ensures overall provider satisfaction with health plan services.
• Develops and implements provider network and contract strategies, identifying those specialties and geographic locations on which to concentrate resources for purposes of establishing a broad provider network of providers to serve the health care needs of CenCal Health’s membership.
• Executes provider reimbursement strategy consistent with parameters set by the Executive Team.
• Oversees provider contracting and the development of new reimbursement models. Obtains input from Finance and Legal. Oversees and participates in hospital and large provider group contract negotiation.
• Directs the preparation and negotiations of provider contracts and oversees negotiation of contracts in concert with established company templates and guidelines with physicians, hospitals, and other health care providers
• Drives changes in provider strategies to address provider participation, program integration and to address Medi-Cal expansion and growth
• Provides oversight of Provider Services and coordinates service strategies including Joint Operating Committees and is responsible for provider problem research, resolution and prevention
• Oversees provider operations to ensure accuracy of provider information in support of accurate configuration for claims payment.
• Collaborates with Health Services, Quality, Member Services, Finance and other departments to identify opportunities to improve quality, care coordination and cost efficiency, which would include implementation of programs, reimbursement models and advanced care and quality improvement programs.
• Designs appropriate programs for meeting provider needs and recommends modifications concerning issues related to improvement of provider relations.
• Chairs or oversees several provider-related internal and external committees. Represents the company at various community activities and events.
• Responsible for implementation of quality standards relating to providers and achieving department goals and objectives.
• Contributes as a key member of the Senior Leadership Team and other committees addressing the strategic goals of the department and organization.
• Delegates and monitors work progress on achieving key metrics, key initiatives projects, staff productivity, healthcare costs and expenses.
• Other projects and duties as assigned.

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.

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.
• 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 Degree in Business, Health Services Administration or related field. Master’s Degree preferred.
• Ten plus (10+) years progressive experience in Healthcare Administration, managed care and experience with Medi-Cal and Medicare managed care plans.
• Seven plus (7+) years progressive management experience including leadership within a provider network and healthcare operations area
• Five plus (5+) years’ experience in Provider Contracting
• Demonstrated adaptability and flexibility to changes and response to new ideas and approaches.
• Superior strategic thinking and research skills in order to readily identify problems and get to the root cause. Achieves prompt resolution to problems and issues including analytical skills.
• Excellent leadership skills, communication skills, strategic thinking and proven ability to build strong interpersonal relationships.
• Experience building a provider network function is required.
• Experience developing business plans and experience writing and executing business plans. Comfort with ambiguity.

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, Provider Services will have an opportunity to make a significant contribution to the lives of CenCal’s member population. Share your vision, expertise and skills

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.