Director, Health Plan Program

Title: Director of Health Plan Program

Location: Fountain Valley, CA

Department: Foundation

Status: Full-time

Shift: Day

Pay Range*: $152,152-$209,206/annually

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Director, Health Plan Program, Self-Funded Products is a senior leader accountable for the strategic direction, operational execution, and performance of MemorialCare’s self-funded health plan portfolio. This role provides end-to-end ownership of plan performance, including establishing long-term strategies, leading cross-functional initiatives, coordinating clinical review teams when needed, and driving data-informed improvements to quality, service, and cost. The Director partners closely with clinical, operational, financial, and technology stakeholders to ensure compliance, optimize processes, and deliver measurable outcomes over time.

Essential Functions

• Strategic Planning & Portfolio Direction
• Set clear program goals and annual/long-range plans that align with MemorialCare’s mission, values, and enterprise strategy.
• Define the strategy for the self-funded portfolio, including positioning, operating model, service standards, and performance targets (quality, access, service, affordability).
• Translate strategy into a prioritized roadmap of initiatives with business cases, success metrics, and expected outcomes.
• Overall Operational Management & Performance Ownership
• Provide strategic and operational ownership of the MemorialCare self-funded portfolio, ensuring day-to-day reliability and long-term performance improvement.
• Establish and maintain standard operating procedures, service levels, and escalation paths; monitor process adherence and close gaps quickly.
• Drive continuous process improvements using Lean/Six Sigma or similar methodologies; track benefits realization and sustain gains over time.
• Clinical Review Team Coordination
• Identify situations requiring clinical review teams (e.g., utilization, complex case patterns, quality variance) and assemble, facilitate, and guide multidisciplinary teams for timely decisions and corrective actions.
• Ensure reviews are evidence-based, documented, and linked to follow-up actions and measurable outcomes.
• Data Analytics, Insights & Reporting
• Lead the measurement framework for the portfolio: define KPIs, dashboards, and review cadences (e.g., access, quality, utilization, total cost of care, member experience, operational efficiency).
• Use advanced analytics to interpret trends, segment populations, and identify actionable opportunities; recommend priorities and areas of focus grounded in data.
• Prepare executive-level reports and presentations with clear insights, decisions required, and progress against plan.
• Closely monitors care and expenses outside of MemorialCare and supports repatriation efforts.
• Compliance, Quality & Risk Management
• Ensure operations adhere to federal, state, and local requirements and accreditation standards, including HIPAA, ERISA, HEDIS, STARS and applicable contractual obligations.
• Lead quality assurance and improvement activities; embed controls, audit readiness, and remediation plans.
• Proactively identify operational risks, performance barriers, and failure points; develop mitigation strategies and contingency plans.
• Budget, Financial Stewardship & Resource Allocation
• Develop and manage the program budget, forecasts, and investment plans; ensure resources are allocated to the highest-value priorities.
• Implement cost containment and value improvement strategies without compromising quality or service.
• Partner with Finance to validate savings, ROI, and affordability outcomes; maintain transparent financial reporting.
• Project Planning & Delivery
• Convert strategy into programs and projects with scoped outcomes, timelines, and owners; manage interdependencies and projects.
• Lead multifunctional project teams to deliver on time and within scope; ensure change management and adoption plans are in place.
• Stakeholder Communication & Partnerships
• Serve as the primary liaison among clinical leaders, operations, HR/benefits, finance, IT, and external partners (e.g., plan administrators, provider networks).
• Communicate program updates, decisions, and outcomes to senior leadership and impacted teams; maintain alignment and momentum.
• Represent the portfolio in governance forums; advocate for initiatives that improve quality, equity, access, and affordability.
• Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.
  
  

Minimum Requirements

Qualifications/Work Experience:

• 7 years of progressive experience in health services management, health plan operations, or program leadership.
• Demonstrated experience leading self-funded health plan programs or similar payer/health system products with measurable performance results.
• Proven ability to analyze complex data, set priorities, and convert insights into sustained improvements.
• Deep knowledge of managed care operations, claims processes, provider networks, utilization management, and regulatory standards (HIPAA, ERISA, HEDIS, STARS).
• Handson proficiency with program management tools and analytics software (e.g., advanced Excel, SQL; familiarity with EHR ecosystems).
  
  

Education/Licensure/Certification

• Bachelor’s degree in Healthcare Administration, Business, Public Health, or related field.
• Preferred- Advanced degree (MBA, MHA, MPH) preferred; clinical background (MD/DO/RN) a plus.
• Formal training/certification in Lean, Six Sigma, or Project Management (PMP/PGMP).