Chief Health Services Officer

This is a fully remote position, open to applicants in California.

📋 Description

• Provide strategic guidance across HPSJ Health Services functions, aligning with contractual, regulatory, and organizational strategies.

• Oversee Utilization Management, Case Management, Behavioral Health and Social Work, Quality Management, Quality Improvement and Health Equity, Health Education, HEDIS and NCQA, and Grievance and Appeals functions.

• Supervise executive directors, directors, managers, and an executive assistant within Health Services.

• Manage operational objectives, business plans, strategies, and the implementation of care programs.

• Analyze opportunities, issues, and trends in care; recommend and execute necessary changes.

• Collaborate with the Chief Medical Officer on Quality Improvement and Quality Management initiatives.

• Provide guidance on medical claims review, grievances, appeals, and other Health Services matters.

• Ensure consistent application of medical criteria in utilization management decisions.

• Develop programs and educational resources for providers and members regarding Quality Improvement and Health Equity Transformation objectives.

• Coordinate Health Services and organizational teams with a focus on enhancing member care.

• Lead health equity initiatives to meet or exceed CMS, DHCS, DMHC, and NCQA standards.

• Develop policies, procedures, targeted interventions, and metrics aimed at improving health equity and minimizing health disparities.

• Ensure that diversity, equity, and inclusion training is provided for staff, subcontractors, and network providers.

• Co-chair the Quality Improvement and Health Equity Transformation Committee and supervise the Health Equity Annual Report.

• Represent HPSJ with county partners and engage in state and industry workgroups, including DHCS, DMHC, CHCF, NCQA, ACAP, and CAHP.

• Prepare and oversee internal and external audits, regulatory reviews, corrective action plans, and quality reports.

• Monitor trends in quality concerns and issues related to the medical delivery system.

• Develop and manage departmental budgets.

• Oversee the collection, storage, and retrieval of pertinent data and information.

• Maintain necessary records, documents, policies, and procedures.

• Promote organizational values and foster a supportive workplace culture.

• Recruit, develop, retain, coach, and mentor leaders and staff within Health Services.

⛳️ Requirements

• Legal and valid work authorization, Green Card, or U.S. citizenship; the Health Plan does not sponsor visas.

• Must be a resident of California.

• Bachelor’s degree in nursing from an accredited nursing school.

• Minimum of six years in clinical operations within a healthcare environment.

• At least six years in progressively responsible leadership roles in a healthcare setting.

• Experience in an HMO or managed care environment.

• Background in utilization management, case management, or behavioral health for government-sponsored programs.

• Minimum of five years of experience in developing and implementing Quality and Population Health Programs in a senior leadership role within a managed care setting.

• At least three years of experience in developing and/or implementing healthcare diversity initiatives focused on health equity and health disparities.

• Certificate in Health Equity and Diversity, Health Disparities and Health Inequality, or a similar certification that meets California and/or federal requirements, or must obtain within one year of hire.

• Valid driver’s license.

• Current unrestricted California RN license (if applicable).

• Expert knowledge and proficient skills in administering clinical operations protocols.

• In-depth knowledge of Medi-Cal and Medicare regulatory requirements pertaining to utilization management, case management, and behavioral health.

• Ability to identify, implement, monitor, and analyze relevant metrics models.

• Comprehensive understanding of healthcare contract components and terminology.

• In-depth knowledge of audit, control, and monitoring processes.

• Extensive knowledge of medical management information systems and their interrelationships.

• Strong understanding of health equity and diversity principles, concepts, and best practices.

• Solid knowledge of medical policy benefits and exclusions.

• Skills in strategic planning and business plan development.

• Excellent project management, facilitation, negotiation, conflict resolution, collaboration, interpersonal, communication, presentation, coaching, and counseling abilities.

• Strong capabilities in budget development and management.

• Customer service skills.

• Intermediate mathematical skills, including basic algebra.

• Proficiency in Word, Excel, and Outlook, including spreadsheets, formulas, tables, and graphs.

• Ability to communicate effectively in English.

• Ability to handle confidential information with discretion.

• Preferred: strong clinical skills; awareness of California or San Joaquin County healthcare issues; knowledge of Medi-Cal and/or Medicare; familiarity with managed care; and research knowledge in diversity, equity, and inclusion best practices.

• Preferred master's degree in nursing, business, public health, or a related field.

🏝️ Benefits

• Comprehensive and affordable medical coverage including HMO and PPO plan choices.

• Employee Wellness Program that supports physical, mental, and financial health.

• Dental and vision plans offering various provider options.

• Generous paid time off: earn up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays.

• Participation in the CalPERS retirement pension program.

• Automatic employer-paid retirement contributions.

• Voluntary defined contribution plan.

• Two flexible spending accounts (FSAs) for healthcare and dependent care expenses.

• Employer-paid Term Life and AD&D Insurance.

• Employer-paid Disability Insurance.

• Employer-paid Assistance Program (EAP).

• Health Advocacy services to assist you in navigating medical care and benefits.

• Optional supplemental benefits including medical, legal, and identity theft protection.

• Access to an online discount mall.

• Tuition reimbursement opportunities.

• Remote work options based on business needs and company policies.

• A mission-driven organization committed to serving members and the community.