Description

Salary Range: $288,664 - $382,480

Job Summary

This position is a member of the Executive Leadership Team reporting to the Chief Executive Officer (CEO). Under the direction of the CEO, and in collaboration with the Chief Medical Officer, the Chief Operating Officer (COO) will provide:

• Executive leadership to coordinate, integrate and monitor operations across the organization to ensure high quality results
• Integration and organization of operational systems, programs and plans to support achievement of strategic objectives, including implementing and operationalizing new business plans, policies and programs
• Administrative and programmatic management and direction for all operational functions overseen, including responsibility for regulatory and operational performance
• Strategic operational oversight for departments focused on the management of member care, including Medical Management, Utilization Management, Enhanced Care Management and Community Supports, Complex Case Management, Whole Child Model, Behavioral Health and Pharmacy
• Collaboration with the Chief Medical Officer and Medical Directors to promote the highest quality clinical, operational and medically necessary care and ensure evidence-based practices are available to our members
• Communication to the Senior Leadership Team to support rapid change in a highly regulated environment and enable implementation of state policy to support CenCal Health success and expansion of services and benefits
• Participating in strategic planning and goal setting in collaboration with CenCal Healths Executive Leadership Team in alignment with CenCal Healths vision, mission, and values

Duties & Responsibilities

Executive leadership to coordinate, integrate and monitor operations across the organization to ensure high quality results:

• Develop, organize and optimize departmental business operations, systems and programs.
• Integrate departmental policies and procedures and ensure compliance with policy and regulatory requirements.
• Establish and promote effective communication protocols for cross-functional and departmental deliverables internally and externally.
• Design and implement standard and ad hoc reports to measure operational performance and analyze business issues and report regularly to CEO and Executive Leadership Team.
• Develop and maintain analytic reports and performance metrics related to goals and projects

Integration and organization of operational systems, programs and plans to support achievement of strategic objectives:

• Design and implement and operationalize new business plans, policies and programs.
• Support development of new programs based on strategic objectives.
• Organize feasibility analyses, work plan implementation and overall evaluation.
• Develop, recommend, implement and evaluate operational policies.
• Provide leadership, including consultation, coaching and mentorship to leaders, during work plan development, resource budgeting and allocation, monitoring of progress and evaluation of outcomes.
• Develop contingency plans, corrective actions or risk mitigation strategies and communicate agreements, progress and results.
• Advise and collaborate with the CEO and the Chief Medical Officer on strategic issues involving current and new programs.
• Ensuring adherence to operational and regulatory requirements, in addition to ensuring accreditation standards, as applicable.

Administrative and programmatic management and direction for all operational functions overseen, including responsibility for regulatory and operational performance:

• Advance CenCal Healths mission and operational effectiveness through executive supervision of planning, implementation and monitoring of Health Services operations, work plans and processes.
• Identify and articulate the vision and strategic direction of the Health Services department, and collaborate on the implementation of strategies and objectives.
• Collaboration with the Chief Medical Officer and Medical Directors to promote the highest quality clinical, operational and medically necessary care and ensure evidence-based practices are available to our members.
• Strategic operational oversight for departments focused on the management of member care, including Medical Management, Utilization Management, Enhanced Care Management and Community Supports, Complex Case Management, Whole Child Model, Behavioral Health and Pharmacy.
• Lead efforts to ensure a strong and healthy internal culture by being an adaptive, strategic, creative and innovative leader.
• Conduct analysis and make strategic recommendations to meet the business needs of the health plan and the needs of plan members.
• Develop and improve program performance and outcomes, and ensure policies and procedures are in alignment with contractual obligations, health plan initiatives, and strategic goals.
• Identify opportunities for efficient and effective operations within and between Health Services departments, and organizes cross-departmental solutions to departmental and company business challenges; and
• Supervise Health Services Officer and Directors in setting goals, objectives and standards, implementing work plans, monitoring and evaluating performance, and making corrective actions.

Participating in strategic planning and goal setting in collaboration with CenCal Healths Executive Leadership Team in alignment with CenCal Healths vision, mission, and values:

• Communicate to the Senior Leadership Team to support rapid change in a highly regulated environment and enable implementation of state policy and expansion of services and benefits to support CenCal Health success.
• Anticipate and forecast industry trends affecting Health Services and CenCal Health operations.
• Set proactive goals and develop opportunities to improve efficiency and effectiveness of operations to benefit customer service, administrative quality, and operating efficiency.
• Communicate operational performance and capabilities, with duties including but not limited to: developing and presenting reports and information to customers, regulators, agencies, staff and the governing board as needed.

Mobilize others to create extraordinary results, and unite people to turn challenges into successes by embracing The Five Practices of Exemplary Leadership of The Leadership Challenge:

1. Model the Way:

• Clarify values by finding your voice and affirming shared values
• Set the example by aligning actions with shared values

2. Inspire a Shared Vision

• Envision the future by imagining exciting and ennobling possibilities
• Enlist others in a common vision by appealing to shared aspirations

3. Challenge the Process

• Search for opportunities by seizing the initiative and my looking outward for innovative ways to improve
• Experiment and take risks by consistently generating small wins and learning from experience

4. Enable Others to Act

• Foster collaboration by building trust and facilitating relationships
• Strengthen others by increasing self-determination and developing competence

5. Encourage the Heart

• Recognize contributions by showing appreciation for individual excellence
• Celebrate the values and victories by creating a spirit of community

• Other duties as assigned.

Qualifications

Knowledge/Skills/Abilities

• Extensive knowledge of California Medi-Cal program and requirements, including knowledge of the Medicare programs preferred
• Strong knowledge of health plan operations, business planning and assessing performance capabilities and results
• Working knowledge of Utilization Management, Care Management, Whole Child Care, Behavioral Health and Pharmacy Improvement programs and procedures
• Thorough knowledge of health care fiscal principles and operations
• Working knowledge of managed care provider payment methods and contracting
• Working knowledge of public policy and regulatory issues in health care
• Working knowledge of customer service and quality improvement methods
• Ability to organize, integrate, plan, assign, direct, supervise and evaluate the work of others and cross-functional divisions and departments
• Ability to communicate effectively both verbally and in writing to develop and maintain critical internal and external relationships and motivate staff to achieve goals and objectives
• Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position
• Ability to effectively prioritize multiple tasks and deadlines and accurately complete tasks within established times
• Ability to be a team player as demonstrated through supporting staff, mentoring staff, demonstrating mutual respect and acknowledging staff value
• Ability to demonstrate excellent leadership skills to provide strategic direction to CenCal Health to establish short- and long-range goals, and create a strong, values driven internal culture of excellence and continuous improvement
• Ability to handle varying situations with tact and diplomacy
• Knowledge of Santa Barbara and San Luis Obispo Counties preferred

Education & Experience

• Bachelors Degree in related field required and Masters Degree in Business, Public Health, Health Administration or a related field preferred or equivalent combination of education and experience;
• At least ten (10) years senior leadership experience, a majority of which should be in an operational leadership position including responsibilities for development and implementation of strategic programs, policies and practices in support of overall operational mission, objectives and goals; and
• Management experience within a Local Health Plan in California with five (5) years experience as an operational leader and five (5) years program development experience, which includes experience with the Medi-Cal program, general and fiscal operations, customer service and provider relations, health care information systems, and regulatory compliance.