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Associate Director, Health Services, Santa Barbara, CA

CenCal Health

Associate Director

Santa Barbara, CA

July 27, 2017

Apply Here

Associate Director, Health Services
Santa Barbara, CA, US

Worker Category :Regular Full-Time

Job Summary (General Overview, reporting to, work environment)

Working with the Director of Health Services, oversees implementation of Health Services Department strategies and initiatives, particularly related to care management, transitions of care and behavioral health integration. The Associate Director of Health Services is responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. Provides leadership and supervision to case managers, social workers and case management coordinators. Assesses needs and plans, communicates and designs services that are appropriate to the plans mission and member needs. Integrates and coordinates services using continuous quality improvement tools and contacts.

Duties and Responsibilities

  • In collaboration with the Director of Health Services, lead the development, communication and implementation of methodologies to enhance the case management program and effectiveness
  • Develop bridges between the physical health providers and behavioral health provides.
  • Create an interdisciplinary process to manage the “whole” person
  • Manage and improve the performance of the department through effective oversight and coaching of teams, managing team performance, monitoring daily workflow, and improving processes and outcomes
  • Identify additional strategies for strengthening professional role of Case Managers in the organization
  • Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports
  • Oversee and assist in providing exceptional service and information to members, providers, employers, agents, and other external and internal contacts
  • Serve as liaison between Health Services and community providers including mental health, behavioral health, and physical health providers
  • Oversee embedded programs and program development within hospital(s) and patient centered medical homes
  • Standardize systems, processes, and policies across the organization, where feasible
  • Continually seeks to improve quality of service, care, and processes for internal and external contacts
  • Provide oversight and expertise to disease management, case promotion, and behavioral health
  • Investigate and settle issues as needed. Handle dispute resolution or relay information to appropriate departments and personnel for further resolution
  • Serve as liaison with all CenCal Health departments to coordinate optimal provision of service and information. Participate in management planning, Request for Proposals, complete the yearly UM report to the Department of Health Care Services (DHCS) as required by the state as well as other cross-departmental functions
  • Analyze and develop processes required for certification by NCQA as appropriate
  • Serve on various interoffice and organizational committees as required or designated.
  • Document and report any pertinent communications back to the teams or department
  • Provide for operational excellence through management reports, up-to-date systems, and strategic initiatives
  • Monitor caseloads and workflow of nurses, department representatives, functional specialists, and team managers or coordinators to assure appropriate distribution and processing of tasks
  • Develop and support improvement of skills, performance, professional acumen, and educational needs of clinical and operational teams
  • Remain current in specialty field and keep apprised of current and anticipated trends in medical management
  • Develop policies, procedures, guidelines, and other operational protocols for the Health Services Department. Evaluate and recommend systems additions and upgrades as appropriate Actively pursue partnerships and build relationships with key healthcare stakeholders in the communities served by CenCal Health
  • Keep the Health Services team informed of community healthcare efforts
  • Coordinate business activities by maintaining collaborative partnerships with key departments
  • Responsible for process improvement and working with other departments to improve interdepartmental processes. Utilize lean methodologies for continuous improvement. Utilize visual boards and daily huddles to monitor key performance indicators and identify improvement opportunities
  • Actively participate as a key team member in Manager/Supervisor meetings
  • Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy
  • Act as backup for other team members and departmental functions
  • Actively participates as a key team member in company Managers/Supervisors meeting
  • Actively participates in various strategic and internal committees in order to disseminate information within the organization, represents company philosophy, and preserves visibility within the community
  • Assist with other duties or functions that may be required for the efficient and effective functioning of the department or CenCal Health
  • Meet department and company performance and attendance expectations
  • Follow the CenCal Health privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information
  • Perform other duties as assigned

Skills/Knowledge/Abilities (Indicate Required or Desired)

  • Candidate must have prior management experience; must have a minimum of five years recent management experience with a health plan strongly preferred
  • Ideal candidate will have experience in Medicare and Medicaid programs, particularly Medi-Cal programs
  • Clinical background as a Registered Nurse or Licensed Clinical Social Worker (LCSW)
  • Experience in case management, disease management, utilization management and program development using evidence based medicine required. Prior success in healthcare integration, process development and program implementation is preferred
  • Thorough knowledge and understanding of medical procedures, diagnoses, care modalities, procedures codes, including ICD-10, and CPT Codes, health insurance and mandated benefits
  • Ability to deal with members, patients and families at all levels of care and/or crisis.
  • Knowledge of community services, providers, vendors and facilities available to assist members
  • Ability to use computerized systems for data recording and retrieval
  • Ability to supervise and manage a regular staff and a professional nursing staff
  • Ability to implement goals and objectives of the department within the context of CenCal Health’s strategic and management planning
  • Continually seeks to improve quality of service, care, and processes for internal and external customers. Assures patient confidentiality, privacy, and health records security.
  • Accurately interprets contractual benefits
  • Provides compassionate and confidential service to members/patients
  • Supports policy and change process, both internal and with providers

Education and Experience

  • Registered nurse or Licensed Clinical Social Worker (LCWS) with current unrestricted License
  • Candidate must have prior management experience
  • Must have experience in a Managed Care; experience in Medi-Cal preferred
  • Good understanding of Department of Health Care Services (DHCS) regulatory requirements Knowledge of Center of Medicare and Medicaid Services (CMS) and Department of Managed Health Care
  • Maintains current clinical knowledge base and specialty nurse functions. Certified Case Manager (CCM) as accredited by CCMC (The Commission for Case Management Certification), or equivalent preferred

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