Senior Director, Health Services

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The Company:

AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all. This is accomplished with emphasis on prevention and primary care through community health centers that founded us and continue to guide us as well as with others that share our commitment. As Hawaii’s third-largest health plan, AlohaCare offers comprehensive prevention, primary and specialty care coverage in order to successfully build a healthy Hawaii.

The Culture:
AlohaCare employees share a passion for helping Hawaii’s most underserved communities. This passion for helping and caring for others is internalized and applied to our employees through a supportive and positive work environment, healthy work/life balance, continuous communication and a generous benefits package.

AlohaCare’s leadership empowers and engages its employees through frequent diversity, recognition, community, and educational events and programs. AlohaCare’s strong commitment to support local Hawaiian families is practiced with our employees by reinforcing a healthy work/home balance. Because AlohaCare values honesty, respect and trust with both our internal and external customers, we encourage open-door, two-way communication through daily interactions, employee events and quarterly all-staff meetings. AlohaCare’s comprehensive benefits package includes low cost medical, dental, drug and vision insurance, PTO program, 401k employer contribution, referral bonus and pretax transportation and parking program.

These employee-focused efforts contribute to a friendly, team-oriented culture which is positively reflected into the communities we serve.

The Opportunity:
The Senior Director of Health Services (SDHS) provides strategic leadership for health services operations in alignment with the AlohaCare mission and strategic priorities. SDHS’ primary responsibility is a management infrastructure that ensures contractual compliance and quality service to AlohaCare’s members and providers. SDHS is accountable for creating a culture that is integrated, collaborative, inter-disciplinary, data-driven, transparent, innovative, and sound in managed care fundamentals.

Primary Duties and Responsibilities:
• Directs multiple health services operational areas, demonstrating an understanding of utilization management and care coordination across the continuum of services for members with different levels of risk. Key operational areas may include:
o Field-Based Service Coordination (high risk, SHCN, LTSS , and self-direction)
o Telephonic Care Coordination
o Behavioral Health Care Coordination
o Transition of Care
o Medical Management (Utilization Management/Prior Authorization)
o Travel and Clinical Support Services
o Care Coordination Administrative Assistants
• Works collaboratively with other leaders within the Health Services Division, as well as throughout the rest of the company, in order to achieve contractual expectations, quality initiatives, and excellent customer service
• Collaborates with community health centers (FQHCs, Rural Clinics) and major private providers over common interests
• Leverages clinical expertise and experience of medical directors in building a strong medical-behavioral-social model, promoting interdisciplinary teamwork, conducting relevant analytics
• Submits annual plans for departments or programs that include goals, metrics, ownership, timelines, and budgets, ensuring an alignment with organizational priorities and making adjustments in the plan as necessary
• Maintains competency in defining and addressing expense and revenue issues, capital expenditures, and budgeting, regarding their impact on MLR (Medical Loss Ratio)
• Applies Dashboards consisting of Key Performance Indicators and non-KPI metrics, interpreting trends and significant variances as opportunities to improve outcomes
• Incorporates actionable analytics, utilizing business intelligence tools, care coordination tools, and claims systems (QNXT) in order to identify issues, mitigate risks, and develop solutions
• Ensures compliance with Medicare (Special Needs Plans) and MedQUEST program requirements, as well as NCQA accreditation standards and HIPAA, demonstrating proactive leadership
• Is knowledgeable about all lines of business, products, and cohorts of members from a clinical perspective, as well as the special challenges in rural Hawaii and neighbor islands
• Fosters and promotes 2-way communication and information sharing that are necessary for successful clinical program implementation
• Contributes actively to health plan strategic planning
• Recruits, develops, and retains talented, high-potential staff, based on individualized planning, coaching and mentoring
• Identifies gaps in services, followed by PDSA (Plan-Do-Study-Act) Methodology
• In conjunction with a medical director, ensures regularly scheduled interdisciplinary team meetings and processes to address member and provider issues or needs
• Sits on the Executive Council and serves on standing or ad hoc committees as appointed
• Develops and maintains external relationships with MedQUEST, CMS Medicare, and other major stakeholders, local and national, as well as with ACAP (Association of Community Affiliated Plans)
• Demonstrates leadership attributes such as active listening, defining issues, resolving conflict, being facilitative, inspiring staff, empowering staff, and training the ‘trainers
Required Qualifications:
• Bachelor’s degree in public health or health administration, nursing, social work, or a related field.
• Minimum of 10 years of work experience in health services
• Minimum of 5 years in Medicaid and/or Medicare programs
• Minimum of 3 years in managed care and/or care management
• Minimum of 5 years of management and supervision
• Minimum of 3 years of experience in multiple health services operational areas (see list in responsibilities section)
• Clinical program development and implementation experience
• Valid Hawaii driver’s license and access to vehicle for off-site tasks
• Maintenance of health care license (RN, LCSW, LMFT, etc.)

Required Skills:
• Managing and overseeing health services operations including Directors, Managers, Supervisors, and staff
• Cost of care and budget accountability (MLR, P+L, SG&A)
• Demonstrated track record of participation in audits and compliance programs
• Working knowledge of State and Federal policy initiatives that relate to health services
• Experience in quality improvement programs
• Experience in applying PDSA methodology or other systematic critical thinking approaches
• Ability to lead meetings and deliver professional presentations
• Strong written and verbal communication and presentation skills
• Able to travel up to 50% of the time on-island and occasionally to neighbor islands
• Demonstrable use of tools such as Microsoft Office Suite
Preferred Qualifications:
• Advanced degree
• Field based or in-home care management and/or care coordination experience in terms of planning, implementation, and monitoring
Mental, Physical and Environmental Demands:
• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time.
• Inside working conditions
• No environmental hazards
• Requires operation of general office equipment to include PC

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veterans status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.

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