Medical Management Director Full Time - Main Office - Santa Barbara, CA, 93110 chevron_right
Company: CenCal Health
Location: Santa Barbara
Posted on: March 10, 2023
Job Description:
Job Details
Job Location: Main Office - Santa Barbara, CA
Position Type: Full Time
Salary Range: $204,316.00 - $326,906.00 Salary/year
Job Category: Medical Management
Job Summary
As a direct report to the Health Services Officer (HSO), the
Director of Medical Management is a strategic, operational leader
with deep experience leading clinical operations. This position is
responsible for clinical operations performance and delivery,
cross-functional collaboration, developing and monitoring
department budgets, forecasting the development or improvement of
clinical programs, and building a high-performing team. Utilization
Management, Care Management (including Enhanced Care Management),
Disease Management, Community Supports program, and Social Work
programs are under the direction and responsibility of the Director
of Medical Management. This position is responsible for overseeing
the development of quality, effective programs that enhance the
members experience and access to care, improve their well-being,
and provide continuity of care while decreasing care fragmentation
and adhering to regulatory requirements. The Director of Medical
Management holds responsibility for CenCal Healths Utilization and
Care Management programs (inclusive of Enhanced Care Management)
and ensures the integration of Behavioral Health to support
whole-person care.
Duties and Responsibilities
- Provide leadership and strategic direction to the Medical
Management leadership team and larger clinical
organization
- Develop the trilogy documents (program descriptions, annual
work plan, annual work plan evaluations) for Utilization
Management, Care Management, and Disease Management programs, and
ensure appropriate integration of Behavioral Health.
- 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 across Utilization
Management, Care Management, Disease Management, and Community
Support.
- Active leadership and accountability to develop and deliver
CalAIM initiatives and programs within Medical Management
- Develop and execute a strategic roadmap to optimize talent,
processes, and technology
- Ensure operations are efficient, and 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 Medical Management
- Develop and drive programs and initiatives within Medical
Management and actively engage in organization-wide projects as a
collaborative partner
- Provide leadership and strategic direction on vendor
partnerships
- Collaborate with the Quality Officer to develop and support
Quality Improvement Programs
- In collaboration with the direct report team and with input
from the CHOO, develop and execute an engagement strategy that
promotes communication, active participation, accountability,
growth, and development
- Build cross-functional solid relationships throughout the
organization that are collaborative and productive
- Responsible for ensuring CenCal Health meets all regulatory and
licensing requirements
- Develop and maintain an understanding of applicable regulatory
initiatives, requirements, and industry trends related to
Utilization Management, Care Management, Disease Management, and
quality improvement to evaluate the impact on the organization;
develop plans for program changes as indicated; support regulatory
compliance; participate 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.
- Ensure departmental readiness for all DHCS, DMHC, etc.
audits
- Represent and support CenCal Healths 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, Quality, Pharmacy, and other
departments, as well as the CHOO and Chief Medical Officer (CMO)
teams to educate, train and implement effective medical management
operations
- Other duties and projects as assigned
Education and Experience
- Bachelor's Degree in a related field
- Master's degree in a related field, Nursing, Business, Health
Care, Health Administration, etc., preferred
- An active and unrestricted California clinical license or other
acceptable licensed healthcare professional
- Minimum seven (7) years of relevant experience in either
managed care and/or the insurance industry
- Minimum seven (7) years of people leadership experience working
with utilization management, case management, and/or disease
management
Additional Information
Schedule:
- Monday to Friday
- Hybrid
Benefits:
- Pension Plan
- Professional Development and Wellness Benefits
- Alternative Transportation Incentives
- Comprehensive medical, dental, vision & life insurance
- Paid Time Off
- Ten (10) paid holidays per year
Keywords: CenCal Health, Santa Barbara , Medical Management Director Full Time - Main Office - Santa Barbara, CA, 93110 chevron_right, Administration, Clerical , Santa Barbara, California
Didn't find what you're looking for? Search again!
Loading more jobs...