Director, Health Services
Company: Executive Search Resource Group, Inc.
Posted on: November 19, 2021
Would you thrive in a highly regarded, mission driven
organization that is dedicated to ensuring quality, cost effective
care for the underserved? Does your background include experience
in Utilization and Care Management or Quality in Managed Medi-Cal,
Medicaid and/or Managed Care settings? Do you possess exceptional
leadership, organization and communication skills? Does the
opportunity to work collaboratively with a team that strives for
excellence appeal to you? If so, CenCal Health has an exciting
opportunity that you may want to consider! COMPANY OVERVIEW CenCal
Health (formerly The Santa Barbara Regional Health Authority) is
the Medi-Cal Managed Care Program for low income residents of Santa
Barbara and San Luis Obispo counties. Since its inception in 1983,
CenCal Health has, among other things, created access to high
quality health care for its members through contracts with local
providers and through a primary care provider case management
network in addition to Health Education and Disease Management
programs and activities. The program that began at CenCal is now
acknowledged to be the oldest Medicaid managed care program of its
kind in the country and has since become a demonstration program
for other counties and states which is a model for Medicaid reform.
CenCal Health is dedicated to the community and local residents.
Medi-Cal is CenCal Health's largest program that is currently
serving approximately 178,000 residents in their service areas of
Santa Barbara and San Luis Obispo counties. Once members are in the
CenCal Health system, they are able to choose (or have assigned) a
Primary Care Physician (PCP), which will serve as their "medical
home". Cen Cal Health's mission is to improve the health and
well-being of the communities they serve by providing access to
high quality health services, along with member education and
outreach. There is a dedicated bilingual, bi-cultural Member
Services Department that is able to assist with member questions,
appointment scheduling, arranging non-emergency transportation if
required, interpreter services at provider offices when needed at
no cost and numerous other services. LOCATION Santa Barbara is a
2-hour drive north from Los Angeles or a short hop from any corner
of the world via the Santa Barbara airport. The city lies between
the sleepy Santa Ynez Valley and the Pacific Ocean with a
population of 88,410, making it the second largest city in the
county after Santa Maria, while the contiguous urban area, which
includes the cities of Goleta and Carpinteria, along with the
unincorporated regions, has a population of 220,000. The city
economy includes a large service sector, education, technology,
health care, finance, agriculture, manufacturing and local
government. Education in particular is well represented with five
institutions of high learning on the south coast. Behind the city
is the Los Padres National Forest, which contains several remote
wilderness areas. Santa Barbara's harbor is home to the
world-famous Stern's Wharf and visiting the Wharf and the
zoological gardens makes a scenic and educational day trip. From
the city, you are just minutes away from the world-famous Santa
Barbara wine country. The gorgeous Santa Ynez Valley, with its
breathtaking vistas is home to such notable attractions as Solvang
and the Chumash Reservation. Santa Barbara's climate is often
described as Mediterranean and it is sometimes referred to as the
American Riviera. Its beautiful beaches, majestic mountains, and
colorful culture make Santa Barbara a premier place to live and
work. Please visit the Santa Barbara Conference & Visitor Council's
website at http://www.santabarbaraca.com for more information. Job
Summary (General Overview, reporting to, work environment) As a
direct report to the Chief Medical Officer (CMO), the Director of
Health Services is the equivalent to a Vice President within
CenCal's organizational structure and is an 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 budget, forecasting the development or improvement of
clinical programs and building a high performing team. Utilization
Management, Care Management, and Social Work programs are under the
direction and responsibility of the Director of Health Services.
This position is also responsible for overseeing the development of
quality, effective programs that enhance the members' experience,
access to care, improve their wellbeing, and provide continuity of
care, while decreasing care fragmentation and adhering to
regulatory requirements DUTIES AND RESPONSIBILITIES
- Provide leadership and strategic direction to Health Services
leadership team and larger operations organization.
- Develop and ensure delivery of performance goals for all areas
- Develop key performance indicators to monitor performance and
adjust as needed to address needs and trends.
- Develop and execute a strategic roadmap to optimize talent,
processes and technology.
- Ensure operations are efficient, 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 Health Services.
- Develop and drive programs and initiatives within Health
Services, and actively engage in organization-wide projects as a
- Provide leadership and strategic direction for vendor
- Collaborate with the CMO and larger CMO organization to develop
and support Quality Improvement Programs.
- In collaboration with direct report team and with input from
larger Health Services operations organization, develop and execute
an engagement strategy that promotes communication, active
participation, accountability, growth and development.
- Build strong cross-functional relationships throughout the
organization that are collaborative and productive.
- Responsible for ensuring CenCal Health meets all regulatory and
- Develop and maintain understanding of applicable regulatory
initiatives, requirements and industry trends related to
utilization management, case management, and quality improvement to
evaluate impact on organization; and develop plans for program
changes as indicated; support regulatory compliance; participating
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
- Oversight of the members' health services programs on an
- Represent and support CenCal Health's 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, and other departments, as well
as the Health Services team to educate, train and implement
effective health services operations.
- Other duties and projects as assigned by the Chief Executive
Officer and/or Chief Medical Officer. SKILLS, KNOWLEDGE & ABILITIES
- Experienced leader and operator with experience leading
clinical operations; utilization management, case management,
disease or population management.
- Experience building high performing teams.
- Experience leading operations through change and increasing
- Strategic mindset with ability to execute and deliver
- Current working knowledge of the California Medi-Cal
- Knowledge of the California Children Services.
- Deep knowledge of managed care in a health plan setting.
- Demonstrated leadership skills with the ability to establish
and motivate team members to achieve person and professional goals
- Ability to develop and design medical management programs that
- Strong communication and presentation skills.
- Leading and participating in internal and external committees
- Complying with the organization's Code of Conduct, all
regulatory and contractual requirements, organizational policies,
procedures, and internal controls.
- Strong problem-solving skills, facilitation skills, and
analytical skills. Preferred, not required:
- Knowledge of Medicare and Commercial lines of business.
- Certification in Case Management COMPETENCIES
- Management Administration Skills: Manages and/or facilitates
employees, budgets and equipment assigned to them, while helping
employees maintain a clear picture of their roles and
responsibilities to achieve organizational objectives. Helps to
develop employee performance by delegating responsibilities and
providing accurate feedback and assessments on a timely basis.
- Leadership Skills: Able to assume a role of formal or informal
authority as necessary; advocate new ideas, even when risk is
involved; delegate responsibility and empower associates to make
decisions; capable of providing constructive feedback to others;
able to receive constructive feedback from others; makes personal
commitment to mentor and grow others.
- Strategic Thinking: Formulates objectives and priorities and
implements plans consistent with the long-term interest of the
organization in a global environment, capitalizes on opportunities
and manages risks.
- Communication Skills-Oral, Listening & Written: Communicates
both verbally & in writing in such a manner that it is easy to
understand and interpret what and why information is being
communicated. Listens attentively without interrupting and/or being
distracted by other things.
- Collaboration & Teamwork: Utilizes communication techniques &
methods that generate trust, collaboration, open two-way
communication and a supportive work environment. Develops and
generates team momentum, enthusiasm, and camaraderie to obtain
maximum team performance. Values diverse talents of team members
and works to include various points of view in
- Human Capital Management: Builds and manages workforce based on
organizational goals, budget considerations, and staffing needs.
Ensures employees are appropriately recruited, selected, appraised,
and rewarded; takes action to address performance problems. Manages
a multi-sector workforce and a variety of work situations.
- Conflict Management: Encourages creative tension and
differences of opinions. Anticipates and takes steps to prevent
counter-productive confrontations. Manages and resolves conflicts
and disagreements in a constructive manner.
- Decisiveness: The ability to make difficult decisions in a
- Walk the Talk: Do what you say you are going to do. Be
accountable for your actions.
- World Class Mindset: Behaves in an honest, fair, and ethical
manner. Shows consistency in words and actions. Models high
standards of ethics. Punctual, exhibits professional email
etiquette. Adhere to company and department standards. Commitment
to excellence. EDUCATION AND EXPERIENCE
- Bachelor's Degrees in a related field
- Master's degree in related field, Nursing, Business, Health
Care, Health Administration, etc., preferred
- An active and unrestricted California clinical license or other
acceptable licensed healthcare professional preferred
- Seven - ten (7-10) years of relevant experience in either
managed care and/or insurance industry
- Seven - ten (7-10) years of people leadership experience
working with utilization management, case management, and/or
disease management ESSENTIAL FUNCTIONS--(Consider sitting,
standing, travel, working at computer for long periods of time,
- Physical requirements needed to perform the essential functions
of this job, with or without accommodation:
- Mobility Requirements: ability to operate a keyboard and sit
for long periods; stand, sit, reach, bend, crawl, stoop, lift up to
- Visual Requirements: ability to read close-up and do close-up
- Dexterity Requirements: ability to perform repetitive motion
(keyboard); writing (note-taking)
- Hearing/Talking Requirements: ability to hear normal speech,
hear and talk on the telephone
- Emotional/Psychological Requirements: ability to deal with
public contact, in person and Normal office environment. Must be
able to sit and work at a computer for long periods of time
- Must be able to travel outside the office and attend meetings
during and after regular work hours
- Regular attendance is essential to perform this job
- Must be able to work full time
- Possess a current, valid driver's license with a clean driving
record The Director, Health Services will have an opportunity to
make a significant contribution to the lives of CenCal's member
population. Share your vision, expertise and skills with a company
that is committed to improving the quality and cost of healthcare
for the underserved! For further information, please contact: The
above information on this description has been designed to indicate
the general nature and level of work performed by CenCal Health
employees within this classification. It is not designed to contain
or be interpreted as a comprehensive inventory of all duties,
responsibilities, and qualifications required of employees assigned
to this job.
Keywords: Executive Search Resource Group, Inc., Santa Barbara , Director, Health Services, Executive , Goleta, California
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