Health Services Executive Director (RN or MD) at Central California Alliance for Health

We have an opportunity to join the Alliance as the Health Services Executive Director overseeing the Alliance Health Services Departments of Quality Improvement and Population Health (QI/PH), Utilization Management (UM), Care Management (CM), Health Services Operations, and Pharmacy.*This position can be based in any of our service areas and may include occasional in-office or local travel - generally no more than twice per week. Our service areas include Mariposa, Merced, Monterey, San Benito and Santa Cruz counties.WHAT YOU'LL BE RESPONSIBLE FORReporting to the Chief Medical Officer, this position:Provides strategic management, leadership, and accountability for the Alliance Health Services Departments of Quality Improvement and Population Health (QI/PH), Utilization Management (UM), Care Management (CM), Health Services Operations, and Pharmacy to achieve Alliance strategic plan objectives and outcomesProvides senior leadership in new business plans, policies, programs and projects to ensure high quality resultsOrganizes and integrates Health Services departmental operations, systems, and programs to ensure policies, procedures, and execution are in alignment with contractual obligations, Health Plan initiatives, and strategic goalsParticipates in strategic planning and goal setting for the AllianceABOUT THE TEAMAll of our departments within the Health Services Division maintain a proactive stance when it comes to promoting access to effective, quality care in our service areas. Our commitment is reflected in our mission statement, which affirms that Health Services embodies the Alliance vision through:Equitable, optimized healthcare with meaningful impact through responsive, community-focused innovation; andEstablishing trust through transparent clinical leadership, sustainable solutions, and shared accountability.We recognize that each Alliance member is an individual with their own health care needs. Those needs can range from preventative check-ups to prescriptions to case management and more - and often a combination of these factors. At the same time, we track the overall health of our communities from a bird's-eye view and, when necessary, take action in concert with local providers and agencies.THE IDEAL CANDIDATEA visionary leader and effective delegator, able to set direction and empower others to deliver results.Brings deep operational experience across the areas of quality improvement and population healthcare management, utilization management, health services operations, and pharmacy.Acts with independence and sound judgment, executing confidently while knowing when to escalate to executive leadership.Trusted and respected, cultivating credibility and strong relationships across all levels of the organization and within the broader community - including providers, partner agencies and members.Rolls up their sleeves when needed, working shoulder to shoulder with teams to problem-solve and move initiatives forward.Community-minded and empathetic, fostering a sense of belonging and shared purpose; offering steady support when teams face challenges.Serves as a connector and coach, linking strategy with execution and mentoring managers to perform at their best.Uses data to drive decisionsWHAT YOU'LL NEED TO BE SUCCESSFULTo read the full position description and list of requirements, click here.Knowledge of:Thorough knowledge of the principles and practices of managed careThe principles and practices of utilization management and care managementThe clinical practices related to license as an MD or RNTitle 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulationsThe principles and practices of supervision and trainingPromoting and applying change management principlesThe principles and practices of program development and project managementNational Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Centers for Medicare and Medicaid Services (CMS) requirements and standardsAbility to:Direct, manage, supervise, mentor, train and evaluate the work of staff and assist department directors in doing soPromote an atmosphere of teamwork and cooperation, convey the mission and values of the organization, and motivate staff to achieve goals and objectivesDevelop, plan, organize and direct programs and activities that are complex in nature and regional in scopeReview and assess overall division function, including the core work, goals and structure of each department, and oversee the directors' development and implementation of short- and long-term planning to achieve strategic plans and completion of an annual department assessmentProvide leadership, facilitate meetings, and partner with and guide directors, managers and employees in the resolution of issuesDemonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate riskEducation and Experience (RN):Current and unrestricted license as a Registered Nurse issued by the state of CaliforniaBachelor's Degree in Nursing, Public Health, Health Administration, Behavioral Health, Social Science, or a related field and a minimum of ten years of experience in healthcare which included a minimum of five years of experience in a leadership position responsible for running core health plan operations across utilization management and care management functional areas in a managed care setting, as well as the development and implementation of strategic programs, policies and practices in support of the overall operational mission, goals and objectives (a Master's degree may substitute for two years of the general healthcare experience); or an equivalent combination of education and experience may be qualifying.Education and Experience (MD):Doctor of Medicine, current license to practice medicine issued by the state of California, and a minimum of five years of experience in a leadership position responsible for running core health plan operations across utilization management and care management functional areas in a managed care setting, as well as the development and implementation of strategic programs, policies and practices in support of the overall operational mission, goals and objectives; or an equivalent combination of education and experience may be qualifying. OTHER INFORMATIONWe are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.The full compensation range for this position is listed by location below.The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego areaTypical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka areaZone 1 (Monterey, San Benito and Santa Cruz)$236,931—$379,101 USDZone 2 (Mariposa and Merced)$215,600—$344,968 USDOUR BENEFITSAvailable for all regular Alliance employees working more than 30 hours per week.Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.Medical, Dental and Vision PlansAmple Paid Time Off12 Paid Holidays per year401(a) Retirement Plan457 Deferred Compensation PlanRobust Health and Wellness ProgramOnsite EV Charging StationsABOUT USWe are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at ourFact Sheet.The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employerAt this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.