MemorialCare · 19 hours ago
Director, Health Plan Program
Fountain Valley, CA
Full-time
Onsite
Director/Executive
$152K/yr - $209K/yr
7+ years expMemorialCare is a nonprofit integrated health system that includes four leading hospitals and over 2,000 physicians throughout Orange and Los Angeles Counties. The Director, Health Plan Program is a senior leader responsible for the strategic direction and operational execution of MemorialCare’s self-funded health plan portfolio, ensuring compliance and optimizing processes for measurable outcomes.
ChildrenHealth CareHospitalMedicalNon Profit
Responsibilities
Set clear program goals and annual/long-range plans that align with MemorialCare’s mission, values, and enterprise strategy
Define the strategy for the self-funded portfolio, including positioning, operating model, service standards, and performance targets (quality, access, service, affordability)
Translate strategy into a prioritized roadmap of initiatives with business cases, success metrics, and expected outcomes
Provide strategic and operational ownership of the MemorialCare self-funded portfolio, ensuring day-to-day reliability and long-term performance improvement
Establish and maintain standard operating procedures, service levels, and escalation paths; monitor process adherence and close gaps quickly
Drive continuous process improvements using Lean/Six Sigma or similar methodologies; track benefits realization and sustain gains over time
Identify situations requiring clinical review teams (e.g., utilization, complex case patterns, quality variance) and assemble, facilitate, and guide multidisciplinary teams for timely decisions and corrective actions
Ensure reviews are evidence-based, documented, and linked to follow-up actions and measurable outcomes
Lead the measurement framework for the portfolio: define KPIs, dashboards, and review cadences (e.g., access, quality, utilization, total cost of care, member experience, operational efficiency)
Use advanced analytics to interpret trends, segment populations, and identify actionable opportunities; recommend priorities and areas of focus grounded in data
Prepare executive-level reports and presentations with clear insights, decisions required, and progress against plan
Closely monitors care and expenses outside of MemorialCare and supports repatriation efforts
Ensure operations adhere to federal, state, and local requirements and accreditation standards, including HIPAA, ERISA, HEDIS, STARS and applicable contractual obligations
Lead quality assurance and improvement activities; embed controls, audit readiness, and remediation plans
Proactively identify operational risks, performance barriers, and failure points; develop mitigation strategies and contingency plans
Develop and manage the program budget, forecasts, and investment plans; ensure resources are allocated to the highest-value priorities
Implement cost containment and value improvement strategies without compromising quality or service
Partner with Finance to validate savings, ROI, and affordability outcomes; maintain transparent financial reporting
Convert strategy into programs and projects with scoped outcomes, timelines, and owners; manage interdependencies and projects
Lead multifunctional project teams to deliver on time and within scope; ensure change management and adoption plans are in place
Serve as the primary liaison among clinical leaders, operations, HR/benefits, finance, IT, and external partners (e.g., plan administrators, provider networks)
Communicate program updates, decisions, and outcomes to senior leadership and impacted teams; maintain alignment and momentum
Represent the portfolio in governance forums; advocate for initiatives that improve quality, equity, access, and affordability
Qualification
Required
7 years of progressive experience in health services management, health plan operations, or program leadership
Demonstrated experience leading self-funded health plan programs or similar payer/health system products with measurable performance results
Proven ability to analyze complex data, set priorities, and convert insights into sustained improvements
Deep knowledge of managed care operations, claims processes, provider networks, utilization management, and regulatory standards (HIPAA, ERISA, HEDIS, STARS)
Hands-on proficiency with program management tools and analytics software (e.g., advanced Excel, SQL; familiarity with EHR ecosystems)
Bachelor's degree in Healthcare Administration, Business, Public Health, or related field
Preferred
Advanced degree (MBA, MHA, MPH) preferred; clinical background (MD/DO/RN) a plus
Formal training/certification in Lean, Six Sigma, or Project Management (PMP/PGMP)
Benefits
High quality health insurance plan options
Shift differentials
Extra shift incentives
Bonus opportunities
Company
MemorialCare
MemorialCare is a healthcare firm that provides joint replacement, blood donation, sports medicine, primary, and surgical care services.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Barry Arbuckle
President & Chief Executive Officer
Marcia Manker
CEO, MemorialCare Orange Coast and Saddleback Medical Centers
Recent News
Morningstar.com
2026-01-03
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