Health Services Director

This position is responsible for clinical operations performance and delivery, cross-functional collaboration, developing and monitoring department budget, forecasting the development or improvement of clinical programs, and building a high performing team. Utilization Management, Care Management, and Social Work programs are under the direction and responsibility of the Director of Health Services. This position is responsible for overseeing the development of quality, effective programs that enhance the members’ experience, access to care, improve their well-being, and provide continuity of care, while decreasing care fragmentation and adhering to regulatory requirements.

• Provide leadership and strategic direction to Health Services leadership team and larger operations organization
• Develop and ensure delivery of performance goals for all areas of responsibility
• Develop key performance indicators to monitor performance and adjust as needed to address needs and trends
• Develop and execute a strategic roadmap to optimize talent, processes, and technology
• Ensure operations are efficient, effective, and provide value to members and provider community
• Develop standard operational processes and procedures that promote quality, compliance, and consistency
• Develop and execute talent strategy to support growth and development of leaders and team within Health Services
• Develop and drive programs and initiatives within Health Services, and actively engage in organization-wide projects as a collaborative partner
• Provide leadership and strategic direction on vendor partnerships
• Collaborate with the CMO and larger CMO organization to develop and support Quality Improvement Programs
• In collaboration with direct report team and with input from larger Health Services operations organization, develop and execute an engagement strategy
that promotes communication, active participation, accountability, growth and development
• Build strong cross-functional relationships throughout the organization that are collaborative and productive
• Responsible for ensuring CenCal Health meets all regulatory and licensing requirements
• Develop and maintain understanding of applicable regulatory initiatives, requirements and industry trends related to utilization management, case
management, and quality improvement to evaluate impact on organization; and develop plans for program changes as indicated; support regulatory
compliance; participating on committees as appropriate
• Fiduciary responsibility for department costs, as well as supporting reserves. Prepare annual department budget plans, monitor expenses and document
variances from approved budgets
• Oversight of the members’ health services programs on an organization-wide basis
• Ensure departmental readiness for all DHCS, DMHC, etc. audits
• Represent and support CenCal Health’s benefit decisions at administrative hearings as needed
• Prepare reports and make presentations at various internal quality committees and occasionally to the governing board
• This position works collaboratively with Claims, Member Services, Provider Services, Legal, and other departments, as well as the Health Services team to
educate, train and implement effective health services operations
• Other duties and projects as assigned

Position Description »