[Hiring] Chief Health Services Officer @SAN JOAQUIN COUNTY HEALTH COMMISSION

Role Description

This is a remote position. Must reside in California.

Under limited supervision, the Chief Health Services Officer is responsible for providing strategic direction across HPSJ Health Services functions, consistent with contractual and regulatory requirements, and HPSJ strategies and objectives. Health Services functions include:

• Utilization Management
• Case Management
• Behavioral Health & Social Work
• Quality Management
• Quality Improvement and Health Equity
• Health Education
• HEDIS & NCQA
• Grievance and Appeals

Work is varied, complex and requires a high degree of discretion and independent judgment.

Supervises:

• Executive Director of Health Services
• Directors of Health Services (select)
• Director of Special Projects Quality
• Director, Strategic Initiatives and Programs
• Managers of Health Services (select)
• Executive Assistant

Essential Functions:

• Oversees 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 care for utilization management, care management, social work and behavioral health programs.
• Anticipates, identifies, analyzes and reports on care opportunities, issues and trends; makes appropriate recommendations; develops and implements agreed upon changes.
• Collaborates with the Chief Medical Officer in the strategic planning, implementation and oversight of the Quality Improvement and Quality Management Programs.
• Collaborates with the Chief Medical Officer and Medical Director(s) in identifying medical service issues that have an impact on plan benefits and their administration; provides direction in resolving medical claims review, grievances, appeals, and other Health Services issues.
• In collaboration with the Chief Medical Officer, will ensure consistent application of medical criteria to utilization management decision making.
• Collaborates 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.
• Ensures collaboration among Health Services teams and other teams with a focus on Member care.
• Works collaboratively with all departments across the organization to achieve health equity goals established by NCQA, CMS, DHCS and DMHC, and partners with the Quality team to ensure that the QIHETP program is implemented and monitored to meet or exceed CMS, DHCS, DMHC and NCQA requirements.
• Ensures organizational policies, procedures, and programs consider health inequities and are designed to promote health equity where possible.
• Oversees the development and implementation of policies and procedures aimed at improving health equity and reducing health disparities.
• Oversees the development of targeted interventions designed to eliminate health inequities.
• Develops quantifiable metrics that can track and evaluate the results of the targeted interventions designed to eliminate health inequities.
• In collaboration with Compliance and other responsible business areas, ensures staff, subcontractor, downstream subcontractor and network provider staff receive mandatory diversity, equity and inclusion training.
• Co-chairs the Quality Improvement and Health Equity Transformation Committee and oversees the development of a Health Equity Annual Report.
• Serves as a representative and spokesperson for HPSJ in support of Quality and Health Equity with key county partners.
• Participates in State and industry work groups to expand HPSJ’s influence on benefit design, regulations, and policy direction.
• Conducts or oversees the preparation, implementation, and corrective action plans for internal and external audit activities.
• Develops or oversees the development of relevant, timely and accurate internal and external quality and health equity reports.
• Oversees quality concern trends identified through the QI process, including corrective action plans.
• In collaboration with the Chief Medical Officer, will identify medical delivery system quality issues; develops and oversees implementation of corrective action plans.
• Oversees the preparation of and participates in regulatory audits and external review activities.
• Oversees routine and ad hoc internal audits and corrective action plans.
• Oversees the development of relevant, timely and accurate internal and external reports.
• Develops and manages department budgets; implements appropriate interventions.
• Oversees the collection, storage and retrieval of relevant data and information.
• Oversees the development, implementation and maintenance of appropriate and required records, documents, policies and procedures.
• Promotes, and ensures that direct reports promote an environment that supports and encourages the adoption of HPSJ’s stated values.
• Hires, develops and retains a competent staff; coaches and mentors the leaders on the Health Services team.

Qualifications

• 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.
• In-depth knowledge of standard contract components and contract language specific to healthcare.
• In-depth knowledge of audit, control and monitoring processes.
• In-depth knowledge of medical management information systems and their interrelationships.
• In-depth knowledge of health equity and diversity principles, concepts and best practices.
• Strong knowledge of general medical policy benefits and exclusions.
• Strategic mindset: ability to translate strategic concepts into actionable business plans.
• Very strong project management skills.
• Very strong facilitation, negotiation and conflict resolution skills.
• Strong skills in budget development and management.
• Very strong collaboration skills.
• Very strong interpersonal skills.
• Very strong oral and written communication skills.
• Very strong presentation skills.
• Strong customer service skills.
• Intermediate mathematics skills, including basic algebra.
• Intermediate skills in Word, Excel and Outlook.
• Ability to articulate and embrace organizational values.
• Very strong coaching/counseling skills.
• Ability to speak and be understood in English.
• Ability to handle confidential information with appropriate discretion.

Requirements

• 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 in UM, CM or behavioral health for government sponsored programs.
• At least 5 years of experience in developing & implementing Quality, Population Health Programs in a managed care setting in a senior leadership role.
• At least three years of experience developing and/or implementing health care diversity initiatives.
• Certificated in Health Equity and Diversity, Health Disparities and Health Inequality or other certification that meets California and/or federal requirements or within one year of hire.

Benefits

• Robust and affordable medical coverage including HMO and PPO plan options.
• Employee Wellness Program promoting physical, mental, and financial well-being.
• Dental and vision plan with multiple provider choices.
• Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays).
• CalPERS retirement pension program, automatic employer-paid retirements contributions, plus a voluntary defined contribution plan.
• Two flexible spending accounts (FSAs) for healthcare and dependent care expenses.
• Employer-Paid Term Life and AD&D Insurance.
• Employer-Paid Disability Insurance.
• Employer-Paid Assistance Program (EAP).
• Health Advocacy to help you navigate medical care and benefits.
• Voluntary supplemental benefits including medical, legal, identity theft protection.
• Online discount mall.
• Tuition reimbursement.
• Remote work contingent on business needs and company guidelines.
• A chance to work for an organization that is mission-driven.