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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

      • Monday to Friday
      • Hybrid


        • 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

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