Senior Director, Model of Care

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.

Work Culture

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

• Integrity

• Accountability

• Collaboration

• Trust

• Respect

Disclaimers:

• Flexible work schedule is based on job duties, department, organization, or business need.

• Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

Working independently under the direction of the Chief Innovation Officer, this position develops, oversees, and executes complex, mission-critical, and enterprise-wide strategic initiatives and implementing innovative solutions that advance the Model of Care, including health programs, benefits and services, operational improvements, and provider and community partnerships that improve outcomes and quality of care and address the social and environmental needs of the members we serve. This role serves as a leader in process improvement, identifying problems, recommending solutions, initiating change, generating results, and successfully implementing transformational solutions. It carries responsibility for independently organizing efforts internally and externally to engage with stakeholders of all levels including members, staff, providers, the Commission and its committees, and community partners to ensure alignment with the needs and preferences of members, community, leadership, and regulators.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

Amount of Travel Required: 20%

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

• Creates, manages and spearheads the organization’s roadmap to achieve and continuously improve the Model of Care

• Evaluates, plans and executes improvements in business process and practice to align with the Model of Care

• Launches innovative programs and ensures ongoing success of programs by building frameworks, capabilities and tools including providing technical assistance, quality assurance and ensuring fidelity to models and champions the use of program frameworks organization wide.

• Launches new benefits and services to support the Model of Care and ensures efficiency and continuous improvement of related operational and provider processes.

• Collaborates with stakeholders to build and support data-driven decision making and evaluation of outcomes

• Acts as change agent and resource to teams across the organization, building acceptance strategies, sustainability plans, improving efficiency, and improving measurement for programs, initiatives, projects and services to improve performance and outcomes.

• Research leading-edge trends, market disruptions, emerging technologies and opportunities that might impact the organization and the members we serve.

• Provides strategic analysis and reporting to Executive Team, Commission, Committees, Regulators and other Key stakeholders.

MINIMUM QUALIFICATIONS

Required Education and Experience:

• Master’s degree in business, health care, social work, or related field of study.

• 10 to 15 years of operations experience in Medicaid and Medicare managed care; demonstrable experience across core health plan operations, health services, member experience, provider partnerships.

• 10+ years in a leadership role in a health plan or similar business, with specific experience in CA Medicaid and Medicare (D-SNP).

• Experience with building and maintaining effective working relationships with providers, community representatives and regulators.

• Proven experience organizing and directing multiple cross-departmental teams, simultaneously, on large, complex, and high-stakes work plan execution.

• Proven success leading large, complex, cross-functional, and high-stakes projects.

• Excellent communicator in written and verbal form with significant experience in highly effective corporate communications with internal and external stakeholders.

• Extremely versatile, dedicated to efficient productivity.

Preferred Education and Experience:

• Proficiency in project management tools and software applications preferred

• Proven experience in project management, preferably in a healthcare or provider network setting.

• Proven experience in process improvement using Six Sigma or other relevant process improvement methods

Equivalent In lieu of degree: Will accept 2 additional years of experience in lieu of a Master’s degree which demonstrates the ability to perform the duties of the position.

KNOWLEDGE, SKILLS & ABILITIES

Preferred Qualifications:

• Demonstrated relationship management skills with internal and external partners; strong client and consultant facing skills.

• Experience in managed care, public health, or other clinical/medical background in healthcare that is relevant to the Medicaid/Medicare population.

• Experience leading performance improvement initiatives and teams: track record in making data driven decisions and implementing successful operational improvements.

• Demonstrated solution design experience: developing innovative clinical approaches to address the needs of a population.

• Supervisory experience: strong orientation to teamwork

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s)

Competency Statements

• Management Skills - Ability to organize and direct oneself and effectively supervise others.

• Business Acumen - Ability to grasp and understand business concepts and issues.

• Decision Making - Ability to make critical decisions while following company procedures.

• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

• Interpersonal - Ability to get along well with a variety of personalities and individuals.

• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

• Consensus Building - Ability to bring about group solidarity to achieve a goal.

• Relationship Building - Ability to effectively build relationships with customers and co-workers.

• Presentation Skills - Ability to effectively present information publicly.

• Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.

• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.

• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.

• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

• Judgment - The ability to formulate a sound decision using the available information.

• Communication, Oral - Ability to communicate effectively with others using the spoken word.

• Communication, Written - Ability to communicate in writing clearly and concisely.

• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.

Apply Here: https://www.click2apply.net/NL5WWRc7L2MElFaJzfl6g1

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