Health Services Executive Director (RN or MD)

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 FOR

Reporting 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 outcomes
• Provides senior leadership in new business plans, policies, programs and projects to ensure high quality results
• Organizes 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 goals
• Participates in strategic planning and goal setting for the Alliance

ABOUT THE TEAM

All 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; and
• Establishing 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 CANDIDATE 

• A 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 decisions

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements, click here. 

• Knowledge of:
  • Thorough knowledge of the principles and practices of managed care 
  • The principles and practices of utilization management and care management
  • The clinical practices related to license as an MD or RN
  • Title 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulations
  • The principles and practices of supervision and training
  • Promoting and applying change management principles
  • The principles and practices of program development and project management
  • National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Centers for Medicare and Medicaid Services (CMS) requirements and standards
• Ability to:
  • Direct, manage, supervise, mentor, train and evaluate the work of staff and assist department directors in doing so
  • Promote an atmosphere of teamwork and cooperation, convey the mission and values of the organization, and motivate staff to achieve goals and objectives
  • Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope
  • Review 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 assessment
  • Provide leadership, facilitate meetings, and partner with and guide directors, managers and employees in the resolution of issues
  • Demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
• Education and Experience:
  • Current and unrestricted license as a Registered Nurse issued by the state of California 
  • Bachelor’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.

Or

• • 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 INFORMATION

• We 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 area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area