Executive Director, Health Services - RN

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

The Health Planof San Joaquin  is now hiring an experienced and dedicated Executive Director, Health Services!

RN license required.

Location: We are looking for someone who lives in our service area. (Must reside in California.)

Remote: This is a remote position; however, must be able to attend monthly onsite meetings, and as needed for business and community purposes.

Under limited supervision, the Executive Director of Health Services is responsible for overseeing the strategic direction across HPSJ Health Services 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, Health Equity, Health Education, HEDIS & NCQA, Credentialing, and Grievance and Appeals. Work is varied, complex and requires a high degree of discretion and independent judgment.

Directors of Health Services
Managers of Health Services

Continuously improve the health of our community.

We provide healthcare value and advance wellness through community partnerships.

• Oversee 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 programs for health services, based on regulatory requirements, opportunities, issues, and trends.
• Oversee the development of relevant, timely and accurate internal and external reports.
• Supports implementation of targeted interventions designed to eliminate health inequities
• Assists the Chief Health Services Officer in identifying medical service issues that have an impact on plan benefits and their administration; assists subordinate managers in resolving grievances, appeals, quality and other health equity related issues.
• Oversee the review of quality concerns identified through the QI process and the implementation and monitoring of corrective action plans.
• Oversee the preparation of and participate in regulatory audits and external review activities; oversee the development, implementation and monitoring of corrective action plans.
• Oversee routine and ad hoc internal audits and corrective action plans to ensure practices adhere to applicable guidelines and HPSJ criteria.
• Ensures collaboration among the health services team with a focus on the member care.
• Promotes strong collaboration across Health Services, Medical Management and other departments to ensure that the Quality program meets or exceeds NCQA and CMS, DHCS and DMHC regulatory standards.
• Collaborate 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.
• Serves as a representative and spokesperson for HPSJ in support of Quality and Health Equity with key county partners.
• Participate in State and industry work groups such as DHCS, DMHC, CHCF, NCQA, ACAP and CAHP to expand HPSJ's influence on benefit design, regulations, and policy direction.
• Leads or participates in internal and external committees.
• Promotes and maintains and ensures that direct reports promote and maintain an environment that supports HPSJ's strategy, vision, mission, and values.
• Hires, develops, retains, and ensures that subordinate managers hire, develop and retain competent staff, coach and support staff development.
• Promotes, and ensures that direct reports promote an environment that supports and encourages the adoption of HPSJ's stated values.
• Oversee the development and management of select Health Services department budgets.

Required

• 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, and implement effective interventions based on results.
• In‑depth knowledge of standard contract components and contract language specific to healthcare.
• In‑depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
• In‑depth knowledge of medical management information systems and their interrelationships.
• Strategic mindset: ability to translate strategic concepts into actionable business plans.
• Very strong project management skills, with the ability to function as a sponsor and owner on complex projects; a track record of successful large project implementations.
• Very strong facilitation, negotiation and conflict…