Chief Health Services Officer

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. At this time, the Health Plan does not sponsor visa. Candidates must have legal and valid work authorization, Green Card, or U.S. citizenship. This is a remote position. Must reside in California. What You Will Be Doing:Under limited supervision, the Chief Health Services Officer is responsible for providing strategic direction across HPSJ Health Services functions, consistent with contractual and regulatory requirements, and HPSJ strategies and objectives.

Health Services functions include Utilization Management, Case Management, Behavioral Health & Social Work, Quality Management, Quality Improvement and Health Equity, Health Education, HEDIS & NCQA, and Grievance and Appeals. Work is varied, complex and requires a high degree of discretion and independent judgment. Supervises Executive Director of Health Services Directors of Health Services (select) Director of Special Projects Quality Director, Strategic Initiatives and Programs Managers of Health Services (select) Executive Assistant Essential Functions:Oversees operational objectives and plans; ensures the development and implementation of associated business plans and tactics.

Anticipates the need for, develops and implements relevant and effective care for utilization management, care management, social work and behavioral health programs. Anticipates, identifies, analyzes and reports on care opportunities, issues and trends; makes appropriate recommendations; develops and implements agreed upon changes. Collaborates with the Chief Medical Officer in the strategic planning, implementation and oversight of the Quality Improvement and Quality Management Programs.

Collaborates with the Chief Medical Officer and Medical Director(s) in identifying medical service issues that have an impact on plan benefits and their administration; provides direction in resolving medical claims review, grievances, appeals, and other Health Services issues. In collaboration with the Chief Medical Officer, will ensure consistent application of medical criteria to utilization management decision making.

Collaborates with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding HPSJ’s Quality Improvement and Health Equity Transformation Program goals and activities. Ensures collaboration among Health Services teams and other teams with a focus on Member care. Works collaboratively with all departments across the organization to achieve health equity goals established by NCQA, CMS, DHCS and DMHC, and partners with the Quality team to ensure that the QIHETP program is implemented and monitored to meet or exceed CMS, DHCS, DMHC and NCQA requirements.

Ensures organizational policies, procedures, and programs consider health inequities and are designed to promote health equity where possible, including but not limited to: Marketing strategies, medical and other health services policies, member and provider outreach, Community Advisory Committee, quality improvement activities, including delivery system reforms, grievances and appeals, and utilization management.

Oversees the development and implementation of policies and procedures aimed at improving health equity and reducing health disparities. Oversees the development of targeted interventions designed to eliminate health inequities. Develops quantifiable metrics that can track and evaluate the results of the targeted interventions designed to eliminate health inequities. In collaboration with Compliance and other responsible business areas, ensures staff, subcontractor, downstream subcontractor and network provider staff receive mandatory diversity, equity and inclusion training, as specified in the CMS and DHCS contract; including review of training materials to ensure materials are up to date with current standard