Enhanced Health Services Director

Location: Merced, California; Monterey, California; Santa Cruz, California; Mariposa, California or San Benito, California

We have an opportunity to join the Alliance as our first Enhanced Health Services Director leading a new Department in the Health Services Division.

Reporting to the Health Services Officer, this position provides strategic management oversight in implementing, directing, and monitoring the Alliance’s CalAIM strategies, including Enhanced Case Management (ECM), Community Supports (CS), and Transitional Care Services, in alignment with Medi-Cal, Knox-Keene, and other regulatory and accreditation standards by designing, developing, implementing, and maintaining programs, policies, and procedures to meet regulatory, contractual, accreditation, and performance standards. This position directs the Enhanced Services Department, acts as a subject matter expert, and provides executive level advice and guidance on Enhanced Services issues and overall business operations and directs, manages and supervises staff.

This Department will include an existing team of ECM and CS staff and will build out a new Transitional Care Services team. This role will design, develop, and maintain ECM, CS, and Transitional Care Services processes and ensuring full operational compliance and govern end-to-end ECM, CS, and Transitional Care Services provider performance, in partnership and collaboration with Provider Services.

To read the full position description, and list of requirements please visit our Careers page
Knowledge of:
o Complex practices, issues and theoretical principles related to community care coordination, including behavioral health and the concepts and guidelines related to prepaid and managed healthcare
o The principles and practices of case management, utilization management, care management and coordination
o The principles and practices of program development and project management
o The principles and practices of supervision and training
o Joint Commission, NCQA, URAC and/or other accrediting bodies, Medi-Cal and related policy and benefits-related Title 22 regulations
Ability to:
o Direct, manage, supervise, mentor, train and evaluate the work of staff
o Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
o Provide leadership, facilitate meetings, and partner with and guide managers and employees in the resolution of issues that are complex and may have considerable impact
o Review and assess overall department function, core work, goals, and structure, develop and implement short- and long-term planning to achieve strategic plans, and complete an annual department assessment
Education and Experience:
o Bachelor’s degree in Nursing, Social Work, Behavioral Health, Social Science or a related field
o Ten years of relevant experience in the clinical aspects of effectively managing a Case Management, Health Education, Utilization Management, or Quality Improvement program with demonstrated experience in process improvement and project management.
o Including a minimum of three years of management-level experience
o A Master’s degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying

• While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
• Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
• Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate’s qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Merced County & Mariposa County Pay Range
$127,904.97—$204,651.20 USD

Monterey County, San Benito County & Santa Cruz County Pay Range
$140,240.61—$224,390.40 USD

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

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