Under direction from the Director of Care Coordination, manages and provides direction to the
Care Coordination (CC) Department’s Clinical Integration Team’s Managers, Supervisors, and
Individual contributors. A key component of this position is the enhancement and refinement of
existing programs, and enthusiastic innovation in the development, management, integration, and
refinement of new and existing programs. The Associate Director of Clinical Integration
identifies and communicates opportunities aligned with strategic initiatives, market, stakeholder,
and regulatory needs. This position is a critical intersection of identification and intake of
clinical, regulatory, and business needs from internal and external stakeholders across Care
Coordination programs, aligns expected outcomes, plans roadmap, and oversees alignment and
execution of deliverables in collaboration with Care Coordination leaders and internal
departments. This position works closely with Care Coordination’s operational leaders,
Associate Directors of Care Coordination and their regional case management teams, as the
design and deliverable branch to support operations and department growth and performance.
This Associate Director leads a multi-functional team responsible for the department’s reporting,
policy development and compliance, program development and associated deliverables, as well
as the Care Coordination training team.

• Provides day-to-day direction to Care Coordination’s Clinical Integration Team’s
  Managers, Supervisors, and Individual Contributors to meet department goals and
  objectives.
• Oversees team performance management, including onboarding activities and annual
  performance evaluation process. Keeps Director apprised of staff concerns and
  accomplishments, and provides feedback on performance evaluations.
• Coordinates activities with Health Equity, Quality, Member Services, and Population
  Health, along with Regional Leaders and Communications, and other PHC departments to
  identify, track, and monitor alignment for Care Coordination activities across the
  organization.
• Coordinates activities with Member Services, Claims, Grievance and Appeals, and
  Provider Relations departments to identify, track, and monitor quality of care issues and
  trends.
• Works with other departments within PHC to develop and implement improvements that
  will lead to improved performance or enhanced workflow of staff.
• Responsible for establishing and maintaining reports that will support the efficacy of each
  CC activity/program and to produce dashboards that includes a summary of CC program
  activities, member outcomes, return on investment, and quality improvement activities
• Prepares reports on departmental activities according to established schedules and format;
  including formal regulatory submissions.
• Reports any issues with regulatory compliance to Director of Care Coordination and
  assists in design and implementation of a corrective action plan when necessary.
• Responsible for audit and survey readiness activities to ensure the department is compliant
  with all applicable regulation and DHCS standards, licensure requirements, accreditation
  standards (i.e. NCQA), new legislation, and Partnership policies and procedures.
  Participates in onsite audits by various regulatory agencies as necessary.
• Provides oversight to department auditing to ensure compliance with DHCS standards.
  Uses summary of findings to lead team in process improvement activities.
• Ensures that all policies and procedures are updated at least annually or as needed and
  presented to appropriate committees for review.
• Assists PHC staff and providers with the interpretation of PHC policies, procedures, and
  regulatory requirements for all product lines.
• Develops structures, relationships, and processes to promote active partnerships with
  providers, community stakeholders, and/or other healthcare professionals to meet and
  support key organizational initiatives (ex: MOU requirements, CalAIM, etc)
• Acts as a designated Business Owner to the Director of Care Coordination in the
  Regulatory Change Management process by reviewing and participating in
  operationalizing newly released All Plan Letters (APL).
• Performs Human Resources functions such as time card management, directing work
  activities, implementing workplace changes, conducting annual reviews, and conducting
  staff trainings.
• Works with operational Managers and Supervisors, and Trainers to develop standardized
  training content and material for new staff and for the ongoing education of existing staff.
• Provides oversight of training program to ensure adequate training accomplishes
  objectives and results in staff competency.
• Actively participates in organizational meetings and goals; providing input where
  appropriate and informing assigned team of what is learned or changed as a result of those
  meetings.
• Participates in strategic goal setting for department activities and initiatives. Develops
  annual goals for individual performance and updates at least every six (6) months for
  progress.
• Promotes the continuous improvement process and implements recommended changes.
• Participates in all cost containment efforts on behalf of department and PHC
• Facilitates meaningful data presentations; uses data to identify needed process
  improvements; Acts as designated business owner for needed system modifications and
  oversees or delivers the specifications and requirements on behalf of Care Coordination or
  associated programs
• Participates in the planning of new enhanced Health Services products.
• Serves as a role model and resource to colleagues, staff, members, and others across
  assigned regional offices.
• Manages vendor relationships as assigned.
• Leads strategic projects using best practices; acts as designated business owner to the
  Director of Care Coordination for department representation.
• Attends Internal Quality Improvement Committee (IQI), Physician Advisory Committee
  (PAC) and Quality Utilization Activity Committee (QUAC) meetings.
• Works with providers, vendors, and community or county partners to facilitate issue
  resolution and ensure a consistent CC process.
• Other duties as assigned.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures as they may from time to time be updated.

HIRING RANGE:

$156,741.30 - $203,763.69

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.