Senior Director, Health Services

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

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