PACE Director of Health Plan Operations (Central Valley PACE - Modesto)
PACE Director of Health Plan Operations (Central Valley PACE - Modesto)
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$ 114982 - 120731
1 Vacancy
Job Description
The Director of Health Plan Operations is responsible for the development planning and implementation of the PACE Health Plan Operations Department.
Schedule: Monday Friday working from 8:00am 5:00pm.
Location: Modesto Center
Compensation: $114982.40 - $120731.52 Salary
Essential Duties and Responsibilities
- Responsible for providing oversight and leadership to the Central Valley PACE Health Plan Department.
- Ensures health plan activities efficiently serve multiple PACE sites including oversight of the contracted health network Participant benefits utilization management claims authorizations medical records marketing/enrollment and third party administrator contracts.
- Provides effective leadership by coordinating and integrating services with other departments as well as outside providers/entities.
- Monitors and evaluates the results of department operations against established objectives quality assurance/service standards and budget/other financial criteria and reports and submits performance plans as indicated to the Vice President of Senior Services.
- Evaluates performance of employees for compliance with established policies and objectives of the department and contributions in attaining objectives.
- Helps set the tone of the department to ensure morale teamwork and that the positive employment culture of the organization is maintained.
- Responsible for the administrative functioning of health plan activities.
- Establishes and ensures delivery of department objectives quality of service and budgetary expectations.
- Ensures department activities satisfy regulatory requirements and compliance standards.
- Collaborates with PACE Center Operations and Quality and Safety departments on continuous quality improvement and monitoring.
- Collaborates with internal stakeholders in strategic planning activities and ongoing effectiveness of the organization.
- Executes and monitors department business plans and collaborates with leadership on the development and monitoring of department budget.
- Promotes and maintains an environment that supports GVHCs strategy vision mission and values.
- Hires supervises and retains staff.
- Collaborates with leadership on developing department objectives and business plans.
- Other duties as required.
Physical Demands
- Ability to lift up to 30 pounds. Moving lifting or pushing greater than 30 pounds should be done with assistance as appropriate.
- Must be able to hear staff on the phone and those who are served in-person and speak clearly in order to communicate information to clients and staff.
- Must have vision with or without lenses that is adequate to read memos a computer screen personnel forms and clinical and administrative documents.
- Must have high manual dexterity.
- Must be able to reach above the shoulder level to work must be able to bend squat and sit stand stoop crouching reaching kneeling twisting/turning fingering and feeling.
Work Environment
- Exposure to biohazards including infectious material and waste and any other conditions common in a health care environment.
- Subject to unpleasant odors.
- The noise level is usually quiet to moderate but may at times be noisy and crowded.
Education/Experience Requirements
Minimum Qualifications
- Work is varied and moderately complex and requires a moderate degree of discretion and independent judgment.
- Ability to direct and manage staff in multiple disciplines.
- Must have strong communication and presentation skills both oral and written.
- Bilingual: Spanish/English preferred.
- Proficient in Microsoft Office applications; advanced Microsoft Excel experience required.
- Strong interpersonal skills analytical and team leading skills.
- Identify and solve problems; collect correlate and analyze data.
- Detail oriented precise and well organized.
- Able to meet short deadline projects with quality work.
- Familiarity with DHCS/CMS/HPMS or similar state or federal data information technology.
- Meet a standardized set of orientation and/or individual competencies for the specific position description established by Central Valley PACE and approved by CMS before working independently.
- Valid California Drivers License acceptable driving record and vehicle insurance.
Education/Experience
- High school diploma or equivalent.
- Bachelors Degree in healthcare administration or related field preferred.
- Associates Degree in Business or related field required; or two (2) years of work related experience in lieu of degree.
- Minimum five (5) years progressively responsible experience with Health Plan processes compliance and reporting.
- Minimum four (4) years supervisory experience.
Required Experience:
Director
Employment Type
Full-Time
