Provides oversight of Care Coordination programs and initiatives implemented by the Care Coordination Team designed to improve the health of PHC members and to provide excellent customer service to Members and Providers.

• Provides direction to the Associate Director concerning the programs and staff.
• Fulfills leadership role for specific projects including appropriate delegation of tasks.
• Participates in community groups and external workgroups on issues related to PHC Health Services or other community health issues.
• Works with the Chief Medical Officer and Associate/Regional Directors to meet department goals and objectives.
• Collaborates with other County Organized Health Systems and Local Initiative health plans to ensure the sharing and support of best practices.
• Responsible for developing and tracking measureable outcomes of individual Care Coordination programs.
• Summarizes reports of progress and challenges at mid-year and fiscal year-end or upon request and submits to the Senior Director of Health Services.
• Prepares and presents a summary of Care Coordination programs and their outcomes at least annually or upon request.
• Prepares reports on Care Coordination activities for plan management according to established schedules and format. Identifies patterns and trends and develops and implements corrective action plans when necessary.
• Participates in the development and implementation of policies and procedures to ensure compliance with all regulatory requirements (i.e. DHCS, DMHC, NCQA).
• Facilitates oversight of grant programs and other external PHC initiatives as appropriate.
• Ensures appropriate and timely completion of all employee evaluations.
• Maintains a collaborative, positive environment that encourages staff participation in finding creative solutions for members and processes.
• Participates in internal committee meetings as assigned.
• Works with Team to develop, implement, and complete annual fiscal year goals in a timely manner.
• Identifies and reports to the Senior Director of Health Services any issues regarding regulatory requirements and recommends Corrective Action Plan.
• Works with other departments in a collaborative, positive manner to promote and maintain inter-department communication.
• Collaborates with the Director of Utilization Management (UM) to ensure appropriate integration of HS procedures.
• Creates an environment encouraging continuous quality improvement in all areas of the department.
• Works with the Health Education Department staff to ensure compliance with educational material, and cultural and linguistic requirements.
• Prepares a draft of projected annual expenses including personnel and submits to the Senior Director of Health Services in May of each year.
• Manages processes and staffing to meet budgetary expectations.

SECONDARY DUTIES AND RESPONSIBILITIES

• 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:

$180,252.50 - $243,340.87

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.