Health Plan Clinical Program Officer, Martinez, CA
Contra Costa Health Plan
HEALTH PLAN CLINICAL PROGRAM OFFICER
Class specifications are intended to present a descriptive list of the range of duties performed by employees in the class. Class specifications are not intended to reflect all duties performed within this job.
Under direction of the Medial Director and Quality Director, the Clinical Program officer (CPO) provides leadership for ensuring that CCHP complies with all necessary clinically related regulations and standards.
The CPO provides clinical/regulatory guidance and leadership for the Quality Management Department and provides consultation to other departments. The position also provides regulatory and accreditation expertise in the design of new programs. This position serves as a regulatory expert to prepare and guide the Quality Management Department through medical audits and to assist all areas in maintaining and demonstrating compliance with NCQA Accreditation standards. The position also provides clinical expertise to Performance Improvement Project teams and performs Delegation Audits of CCRMC and Kaiser.
This class is distinguished from the class of Quality Management Director in that the CPO is responsible for Compliance and for clinical consultation for quality and performance improvement, whereas the Quality Director has responsibility for the entire functioning of the Quality Program.
- Participates with organizational strategic directions and projects
- Participates in the design of new programs and products
- Member of the Quality Council
- Participates with other committees as designated
- Coordinates regulatory audits and corrective action plans
- Maintains ongoing regulatory readiness for clinical programs
- Guides staff training regarding regulatory requirements
- Provides clinical and technical consultation for the Quality Management Program.
- Coordinates the development of Clinical Practice Guidelines
- Assists with New Technology reviews
- Collaborates with Health Plan physician consultants regarding clinical projects
- Provides regulatory guidance in conjunction with the Quality Management Director, and clinical consultation to the Health Education Program
- Collaborates with County agency leaders to design or improve clinical services for the County
- Prepares documents and presentations as needed, and upon the request of the Medical Director or Executive Council
- Collaborates with Quality Management staff to develop and maintain quality improvement projects
- Identifies barriers and guides the development of processes to improve and monitor access to care
License: Possession of a valid license as a Registered Nurse in the State of California.
Education: Possession of a Master’s Degree in nursing, business, public, administration, or closely related field.
Experience: 2 years of full-time or its equivalent experience working for a managed care health plan in a leadership role with responsibility for regulatory compliance (NCQA, DHS, CMS, HEDIS), and quality improvement or utilization management.
Substitution: Two additional years of full-time or its equivalent experience of the type noted above or a Certified Professional in Health Quality certification may be substituted for the Master’s Degree.
KNOWLEDGE, SKILLS AND ABILITIES:
- Regulatory requirements of Department of Health Services (DHCS), Health Plan Employer Data and Information Set (HEDIS), Department of Managed Health Care (DMHC), Children’s Medical Services (CMS), National Commission on Quality Assurance (NCQA), including standards, benchmarks, and guidelines
- Continuous Quality Improvement methodology
- Provide clinical strategic alternatives with minimal direction
- Communicate effectively verbally, in writing, and through presentations
- Influence outcomes with tact and skill
- Identify creative methods to improve efficiency
- Identify, participate, and/or lead clinically related activities that guide the Health Plan to improve efficiency while improving care and services
- Identify and participate in organizational planning to improve the use of technology to improve clinical care and services
- Chair or participate on committees representing CCHP and task forces as needed as well as being an active member of Health Plan committees
- Effectively analyze and manage complex projects
- Demonstrate motivation and guidance to managers
- Oversee development of policies and procedures to meet regulatory requirements and/or accreditation standards of various agencies
To apply, please go to https://www.governmentjobs.com/careers/contracosta.
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