Vice President of Health Services

Hours: M-F 8a-5p
Pay: $122.60-156.25

Job Description:

• Provides leadership, direction, and oversight to all of the Health Services areas (Case Management, Utilization Management, Quality Improvement, Behavioral Health,
• Pharmacy, Long Term Services and Supports, Process Improvement) and vendor(s) to ensure achievement of organizational, departmental and individual goals and maximize health outcomes for health plan members.
• Designs, implements and administers best practices to ensure health care quality and value is maximized at the plan through appropriate utilization of health care services and contracts and relationships with delegates and vendors.
• Assures effectiveness of departments by designing and monitoring key metric to continuously improve outcomes, and take targeted actions when metrics indicate improvement is warranted.
• In conjunction with the Chief Medical Officer, develops and implements appropriate clinical policies and procedures and programs.
• Plans and prepares designated Committee meetings (Pharmacy and Therapeutics, Utilization Management, Quality Improvement). As well as assist with meeting.

Required Skills & Education:

• Active unrestricted CA RN, NP, PA, or LCSW
• 10 years of experience in managed care Medi--Cal/Medicaid and Medicare with health plans operations
• 10 years of experience in mid to senior-level management positions demonstrating increased levels of accountability
• Leadership in program implementation and management and change management
• Ability to plan, organize, administer, and coordinate a variety of large and complex services, projects, and programs.
• Proven ability to exercise sound business judgment in determining priorities and resolving problems.
• Proven track record of success in plan management.
• Experience in strategic planning and development.
• Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff
• Demonstrated Knowledge of CMS, DHCS, and DMHC regulations
• Demonstrated knowledge of NCQA requirements and implementation

Preferred qualifications:

• Masters degree in business, health care, or related field
• Certification in process improvement (Siz Sigma, Lean, TQM)

#INDAR

Pay: $122.60 - $156.25 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Medi-Cal, Medicare, Medicaid: 10 years (Required)

License/Certification:

• RN License (Required)

Work Location: In person

Salary : $123 - $156