Health Services Officer

Central Coast Salary Range: $288,416 - $461,465

Candidates for this position must reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey, and Santa Cruz Counties) or be willing to relocate to the area upon hire. As a community-facing role, a local presence is essential to effectively engage with and serve our community. Please note that relocation assistance may be available.

Job Summary

This position is part of the Senior Leadership Team, reporting directly to the Chief Medical Officer (CMO). Under the CMO's guidance, the Health Services Officer (HSO) is accountable for the following responsibilities:

• Leading the Health Services Division, which encompasses Utilization Management, Case Management, DSNP Clinical Operations, Whole Child Model, Behavioral Health, and Pharmacy.
• Overseeing the implementation and optimization of new clinical programs, policies, and projects to achieve high-quality outcomes.
• Providing leadership and direction for operational functions within Health Services, while receiving clinical guidance from the CMO and aligning with operational strategy with the Chief Operating Officer (COO).
• Organizing and integrating Health Services operations, systems, programs, and resources with the annual operating plan and organizational performance objectives.
• Leading the execution and monitoring of daily operational services, standards, and best practice protocols within Health Services, ensuring alignment with CenCal Health's strategic vision, strategic plan and organizational goals.

Duties and Responsibilities

1. Provide leadership to the Health Services Division, encompassing Utilization Management (UM), Case Management (CM), Dual Special Needs Program (DSNP) Clinical Programs, Whole Child Model (WCM), Behavioral Health (BH), and Pharmacy, with duties including but not limited to:

• Drive operational optimization, integration and effectiveness by overseeing the planning, implementation, and monitoring of Health Services operations, work plans, and processes.
• Foster a strong, positive internal culture within Health Services.
• Enhance the performance and outcomes of UM, CM, DSNP-Clinical Operations, WCM, BH, and Pharmacy programs and operations.
• Accountability for departmental and divisional performance metrics and goals.
• Ensure compliance with Federal, State, and accreditation requirements.
• Identify opportunities to streamline operations within and across Health Services departments, encouraging cross-departmental collaboration through process improvement, technology efficiencies and operational enhancements.
• Supervise department Directors in setting goals, objectives, and standards, overseeing work plans, evaluating performance, and taking corrective actions as necessary.

2. Organize and integrate existing Health Services operating systems, programs, policies, procedures, and communications to ensure high-quality results and through initiatives with providers and partners, with duties including but not limited to:

• Optimize and streamline departmental operations, systems, and programs.
• Integrate services with providers, county agencies and community partners.
• Ensure departmental policies and procedures are organized and compliant with regulatory requirements.
• Establish effective communication protocols for departmental work.
• Collaborate internally to develop and implement standardized and ad hoc reports to assess operational performance.

3. Lead the implementation and optimization of new Health Services programs, operations, projects, policies, and procedures to ensure high-quality outcomes, with duties including but not limited to:

• Partner with the COO and CMO to design and develop new Health Services programs.
• Organize and implement new initiatives and programs.
• Partner with Chief Performance Officer (CPO) on staffing strategies to align Health Services staffing with organizational approach (i.e., budgets, benchmarks) to resourcing
• Monitor and report progress, making corrective action plans as needed.

4. Communicate the operational performance and capabilities of Health Services, with duties including but not limited to:

• Develop and present reports to customers, regulators, agencies, staff, and the governing board as needed.
• Collaborate in managing regulatory audits and inquiries related to Health Services.
• Coordinate relationships with clinical and social service agencies, ensuring clear protocols for communications and referrals including overseeing management of data sharing and service integration aligned with various memorandums of understanding.

5. Other duties as assigned.

Knowledge / Skills / Abilities

• In-depth knowledge of the California Medi-Cal program and entitlement programs, with a preference for familiarity with the medical community in Santa Barbara and San Luis Obispo counties.
• Strong understanding of Utilization Management, Care Management, Whole Child Care, Behavioral Health, and Pharmacy Improvement programs and procedures.
• Strong understanding of DSNP Programs and Medicare member needs and services
• Comprehensive knowledge of healthcare fiscal principles and operations, in addition to data sharing requirements and capabilities
• Thorough understanding of federal, state, and administrative regulations and requirements.
• Thorough understanding of process improvement principles and effective staffing strategies
• Familiarity with managed care provider payment methods and contracting.
• Working knowledge of public policy and regulatory issues in healthcare.
• Practical understanding of customer service and quality improvement methods.
• Knowledge of how to leverage data to explore improvement opportunities without jumping to conclusions (e.g., NCQA accreditation, CalAIM).
• General understanding of MIS applications in healthcare systems.
• Ability to plan, assign, direct, supervise, and evaluate the work of others.
• Strong communication skills, both oral and written, to build and maintain critical internal and external relationships and motivate staff to meet goals and objectives.
• Ability to take responsibility and exercise sound judgment in decision-making within the scope of the position's authority, aligning with team behaviors and commitments
• Strong organizational skills with the ability to prioritize multiple tasks and deadlines effectively.
• Demonstrated ability to complete tasks accurately within established timelines.
• Commitment to maintaining confidentiality and organizational alignment.
• Ability to collaborate as a team player, support and mentor staff, demonstrate mutual respect, and recognize the value of team members.
• Strong leadership skills to provide strategic direction for CenCal Health, establish short- and long-term goals, and foster a values-driven internal culture of excellence and continuous improvement.
• Ability to navigate complex situations with tact and diplomacy.
• Commitment to:
  • Being present in the moment to inspire enthusiasm and allow individuals to channel their passion into their work.
  • Helping individuals connect their daily responsibilities to CenCal Health's larger mission.
  • Ensuring all voices within CenCal Health are heard and advocating for inclusivity.
  • Acting ethically and contributing to economic development while enhancing the quality of life for our workforce, their families, and the broader community.
  • Recognizing the value of diverse perspectives and cultures and leveraging these differences to create experiences that align with both our internal and external communities.
  • Fostering innovation by challenging the status quo and exploring opportunities that offer a competitive advantage.
  • Contributing to and being part of a work environment where individuals feel joy, comfort, and a sense of connection to the organization's broader initiatives, with a focus on cultural acceptance and belonging.
  • Implementing cross-functional best practices and principles from across the healthcare industry to improve the execution of strategies and deliver high-quality experiences.

Education and Experience

Required:

• Master's Degree in Nursing, Health Care, Public Health, Health Administration, or a related field, or an equivalent combination of education and experience.
• A minimum of ten (10) years of relevant management experience, with the majority in a senior leadership role, including responsibility for the development and implementation of strategic programs, policies, and practices supporting the overall operational mission, objectives, and goals.
• Experience in Health Services operations (e.g., Utilization Management, Case Management, DSNP Clinical Programs, Pharmacy, etc.).
• Management experience within a healthcare organization (preferably in managed care or a prepaid health system), including expertise with the Medi-Cal program, general and fiscal operations, customer service, provider relations, healthcare information systems, and regulatory compliance.

Preferred:

• Active, unrestricted California clinical license or other acceptable healthcare professional license.