Chief Health Services Officer

🔥 13 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $295k - $430k / year

⏰ Full Time

🔴 Lead

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Health Plan of San Joaquin/Mountain Valley Health Plan

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1996

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Health Plan of San Joaquin/Mountain Valley Health Plan is a regional managed care organization that provides Medi-Cal (Medicaid) and Medicare Advantage coverage—including a Dual Special Needs Plan (D-SNP)—to residents in San Joaquin County and surrounding areas. The plan offers member services, pharmacy benefits, provider networks and tools, care coordination (enhanced care management), community health programs, and compliance/quality oversight (NCQA accreditation). It focuses on serving Medicaid and dually eligible populations through partnerships with local health agencies and community initiatives.

📋 Description

• Provide strategic direction across HPSJ Health Services functions, consistent with contractual and regulatory requirements 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 across Health Services • Oversee operational objectives, business plans, tactics, and care program implementation • Analyze care opportunities, issues, and trends; recommend and implement changes • Collaborate with the Chief Medical Officer on Quality Improvement and Quality Management Programs • Provide direction on medical claims review, grievances, appeals, and other Health Services issues • Ensure consistent application of medical criteria in utilization management decisions • Develop programs and educational opportunities for providers and members regarding Quality Improvement and Health Equity Transformation goals • Coordinate Health Services and organizational teams with a focus on member care • Lead health equity efforts to meet or exceed CMS, DHCS, DMHC, and NCQA requirements • Develop policies, procedures, targeted interventions, and metrics to improve health equity and reduce health disparities • Ensure required diversity, equity, and inclusion training for staff, subcontractors, and network providers • Co-chair the Quality Improvement and Health Equity Transformation Committee and oversee the Health Equity Annual Report • Represent HPSJ with county partners and participate in state and industry work groups including DHCS, DMHC, CHCF, NCQA, ACAP, and CAHP • Prepare and oversee internal and external audits, regulatory reviews, corrective action plans, and quality reports • Oversee quality concern trends and medical delivery system quality issues • Develop and manage department budgets • Oversee collection, storage, and retrieval of relevant data and information • Maintain required records, documents, policies, and procedures • Promote organizational values and a supportive workplace environment • Hire, develop, retain, coach, and mentor Health Services leaders and staff

🎯 Requirements

• Legal and valid work authorization, Green Card, or U.S. citizenship; the Health Plan does not sponsor visas • Must reside in California • Bachelor’s degree in nursing from an accredited nursing school • At least six years in clinical operations in a healthcare setting • At least six years in progressively responsible leadership positions in a healthcare setting • Experience in an HMO or managed care setting • Experience in utilization management, case management, or behavioral health for government-sponsored programs • At least five years of experience developing and implementing Quality and Population Health Programs in a managed care setting in a senior leadership role • At least three years of experience developing and/or implementing healthcare diversity initiatives addressing health equity and health disparities • Certificate in Health Equity and Diversity, Health Disparities and Health Inequality, or another certification meeting California and/or federal requirements, or obtain within one year of hire • Valid driver’s license • Current unrestricted California RN license (if RN) • Expert knowledge and proficient skills in administering clinical operations protocols • Expert knowledge of Medi-Cal and Medicare regulatory requirements for utilization management, case management, and behavioral health • Knowledge and ability to identify, implement, monitor, and analyze relevant metrics models • In-depth knowledge of healthcare contract components and language • In-depth knowledge of audit, control, and monitoring processes • In-depth knowledge of medical management information systems and their interrelationships • In-depth knowledge of health equity and diversity principles, concepts, and best practices • Strong knowledge of medical policy benefits and exclusions • Strategic planning and business plan development skills • Very strong project management, facilitation, negotiation, conflict resolution, collaboration, interpersonal, communication, presentation, coaching, and counseling skills • Strong budget development and management skills • Customer service skills • Intermediate mathematics skills, including basic algebra • Intermediate skills in Word, Excel, and Outlook, including spreadsheets, formulas, tables, and graphs • Ability to speak and be understood in English • Ability to handle confidential information with discretion • Preferred: strong clinical skills; knowledge of California or San Joaquin County healthcare issues; Medi-Cal and/or Medicare knowledge; managed care knowledge; and diversity, equity, and inclusion research and best-practice knowledge • Preferred master’s degree in nursing, business, public health, or similar

🏖️ Benefits

• Robust and affordable medical coverage including HMO and PPO plan options • Employee Wellness Program promoting physical, mental, and financial well-being • Dental and vision plan with multiple provider choices • Generous paid time off: accrue up to 3 weeks of PTO, 4 paid floating holidays, and 9 paid holidays • 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 to help you navigate medical care and benefits • Voluntary supplemental benefits including medical, legal, and identity theft protection • Online discount mall • Tuition reimbursement • Remote work contingent on business needs and company guidelines • Mission-driven organization focused on members and community