Health Plan of San Joaquin/Mountain Valley Health Plan · 9 hours ago
Executive Director, Health Services
French Camp, CA, US
Full-time
Hybrid
Mid, Senior Level
$254K/yr - $383K/yr
6+ years expHealth Plan of San Joaquin is now hiring an experienced and dedicated Executive Director, Health Services. The Executive Director will oversee the strategic direction of Health Services, ensuring compliance with regulatory requirements and implementing effective health programs.
Health CareHealth InsuranceInsurance
Responsibilities
Oversee operational objectives and plans; ensures the development and implementation of associated business plans and tactics
Anticipates the need for, develops, and implements relevant and effective programs for health services, based on regulatory requirements, opportunities, issues, and trends
Oversee the development of relevant, timely and accurate internal and external reports
Supports implementation of targeted interventions designed to eliminate health inequities
Assists the Chief Health Services Officer in identifying medical service issues that have an impact on plan benefits and their administration; assists subordinate managers in resolving grievances, appeals, quality and other health equity related issues
Oversee the review of quality concerns identified through the QI process and the implementation and monitoring of corrective action plans
Oversee the preparation of and participate in regulatory audits and external review activities; oversee the development, implementation and monitoring of corrective action plans
Oversee routine and ad hoc internal audits and corrective action plans to ensure practices adhere to applicable guidelines and HPSJ criteria
Ensures collaboration among the health services team with a focus on the member care
Promotes strong collaboration across Health Services, Medical Management and other departments to ensure that the Quality program meets or exceeds NCQA and CMS, DHCS and DMHC regulatory standards
Collaborate with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding HPSJ’s Quality Improvement and Health Equity Transformation Program goals and activities
Serves as a representative and spokesperson for HPSJ in support of Quality and Health Equity with key county partners
Participate in State and industry work groups such as DHCS, DMHC, CHCF, NCQA, ACAP and CAHP to expand HPSJ’s influence on benefit design, regulations, and policy direction
Leads or participates in internal and external committees
Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission, and values
Hires, develops, retains, and ensures that subordinate managers hire, develop and retain competent staff, coach and support staff development
Promotes, and ensures that direct reports promote an environment that supports and encourages the adoption of HPSJ’s stated values
Oversee the development and management of select Health Services department budgets
Qualification
Required
Expert knowledge of and proficient skills in administering clinical operations protocols
Expert knowledge of regulatory requirements for Medi-Cal and Medicare pertaining to utilization management, case management and behavioral health
In depth knowledge of and ability to identify, implement, monitor and analyze relevant metrics models, and implement effective interventions based on results
In-depth knowledge of standard contract components and contract language specific to healthcare
In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them
In-depth knowledge of medical management information systems and their interrelationships
Strategic mindset: ability to translate strategic concepts into actionable business plans
Very strong project management skills, with the ability to function as a sponsor and owner on complex projects; a track record of successful large project implementations
Very strong facilitation, negotiation and conflict resolution skills
Strong skills in budget development and management
Very strong collaboration skills with demonstrated ability to create and foster a collaborative work environment, maintain effective, high-performance teams, and organize people and resources to solve problems and identify business opportunities
Very strong interpersonal skills, with the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ
Very strong oral and written communication skills, with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups inside and outside of HPSJ; includes the ability to effectively explain complex information
Very strong presentation skills, with the ability to tailor presentations to a specific audience, and address and interact with large groups
Strong customer service skills
Intermediate mathematics skills, including basic algebra
Intermediate skills in Word, Excel and Outlook, including the ability to develop spreadsheets, formulas, and create tables and graphs
Ability to articulate and embrace organizational values, integrate into management practices, and foster their manifestation among staff
Very strong coaching/counseling skills, including the ability to function as a mentor to management and employees
Ability to handle confidential information with appropriate discretion
Bachelor's Degree in nursing from an accredited nursing school
At least six years in clinical operations in a healthcare setting
At least six years progressively responsible leadership positions in healthcare setting
Experience in an HMO or managed care setting
Experience with government sponsored programs
Valid California driver license and reliable transportation or, the ability to obtain transportation on demand in the counties served by HPSJ if prohibited from getting a driver license due to a medically documented disability
Preferred
Strong clinical skills
Knowledge of the economic or healthcare issues, or issues affecting the underserved in California or San Joaquin County and/or surrounding areas
Knowledge of Medi-Cal and/or Medicare programs
Basic knowledge of the principles and practices of managed care
Deep content knowledge of diversity, equity, and inclusiveness research base and best practices for organizations striving to become more diverse, equitable, and inclusive
Ability to develop and monitor indicators of organizational culture and engage employees and senior leadership to create organizational change
Master's Degree in Nursing
Master's Degree in Business, Public Health or similar
Current unrestricted California RN license
Benefits
Competitive salary
Robust and affordable health/dental/vision with choices in providers
Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
Two flexible spending accounts (FSAs)
Employer-Paid Term Life and AD&D Insurance
Employer-Paid Disability Insurance
Employer-Paid Life Assistance Program
Health Advocacy
Supplemental medical, legal, identity theft protection
Access to exclusive discount mall
Education and training reimbursement in addition to employer-paid elective learning courses.
Company
Health Plan of San Joaquin/Mountain Valley Health Plan
Health Plan of San Joaquin/Mountain Valley Health Plan (not-for-profit health plan) is the leading Medi-Cal managed care provider in San Joaquin in Stanislaus Counties, now serving Medi-Cal members in Alpine in El Dorado Counties.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Lizeth Granados
Chief Executive Officer
Michelle Tetreault
Chief Financial Officer | Interim Chief Executive Officer (2019)
Company data provided by crunchbase