Vice President, Health Services

About Us:

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.

General Description of Position:

The Vice President, Health Services is responsible for optimizing the quality and value of health care received by health plan members by providing consistent, innovative leadership and direction to design, implementation, analysis, monitoring and reporting of effective and efficient health management services across all lines of business. This includes management and oversight of all strategic and operational functions of the Case Management, Utilization Management, Quality Improvement, Behavioral Health, Pharmacy and Long Term Supports Services departments. The position is also responsible for ensuring compliance with the state and federal requirements for these departments as well as related vendors. This position is also responsible for working in close collaboration with various Departments of Santa Clara County and Santa Clara Valley Health.

Responsibilities:

1. Provides leadership, direction, and oversight to all of the Health Services areas (Case Management, Utilization Management, Quality Improvement, Behavioral Health, Pharmacy, Long Term Services and Supports, Process Improvement) and vendor(s) to ensure achievement of organizational, departmental and individual goals and maximize health outcomes for health plan members.
2. Designs, implements and administers best practices to ensure health care quality and value is maximized at the plan through appropriate utilization of health care services and contracts and relationships with delegates and vendors.
3. Assures effectiveness of departments by designing and monitoring key metric to continuously improve outcomes, and take targeted actions when metrics indicate improvement is warranted.
4. In conjunction with the Chief Medical Officer, develops and implements appropriate clinical policies and procedures and programs. Plans and prepares designated Committee meetings (Pharmacy and Therapeutics, Utilization Management, Quality Improvement). As well as assist with meeting.
5. Operationalizes new benefits, pilots and existing programs such as Palliative Care, Dual Eligible Special Needs Plan (DSNP), CalAIM, Student Behavioral Health Incentive Program (SBHIP) and Housing and Homeless Incentive Program (HHIP) among others.
6. Creates and reviews budgets of assigned departments as part of the annual planning and budgeting cycle and ongoing.
7. Contributes to the development of strategic planning for short and long term health plan goal development in conjunction with integration of Health equity measures to decrease disparities.
8. Develops innovative solutions to management and sharing of data needed for Health Services for operational and programmatic initiatives.
9. Drives new health services initiatives and collaborations across departments to support continuous improvement and health plan goals.
10. Instills a culture of Continuous Process Improvement, identify, design and implement Process Improvement opportunities, implement new systems required to support health services operations.
11. Supports and builds cross-functional relationships with key partners across the organization. Motivates teams and individuals to achieve goals, while enforcing accountability.
12. Ensures ongoing audit readiness and compliance with regulatory requirements from Centers for Medicare and Medicaid Services (CMS), CA Department of Health Care Services (DHCS), CA Department of Managed Health Care (DMHC) and National Committee for Quality Assurance (NCQA).

Requirements:

1. Clinician with active unrestricted license to practice in the State of California (RN, NP, PA, LCSW, or equivalent clinical licensure).
2. Master’s degree in business, health care, public health, or related field.
3. Minimum of ten years of experience in senior-level management or director-level positions demonstrating increased levels of accountability.
4. Minimum of ten years of experience in mid to senior-level management positions demonstrating increased levels of accountability.
5. Demonstrated knowledge of CMS, DHCS and DMHC regulations.
6. Demonstrated knowledge of NCQA requirements and implementation.
7. Demonstrated successful leadership in program implementation and management and change management. Ability to plan, organize, administer and coordinate a variety of large and complex services, projects and programs.
8. Successful leadership and management experience building effective teams, managing cross-functional teams and continuous improvement programs. (R)
9. Ability to establish and maintain effective relationships with widely diverse groups, including individuals at all levels both within and outside the organization and gain their cooperation.

Santa Clara Family Health Plan (SCFHP) is a nonprofit organization with a long history of caring for the health of our community. And we take the health and well-being of our employees just as seriously. We're proud to be one of the top providers of healthcare jobs in Santa Clara County, with ample benefits and opportunities for advancement. These include:

• Competitive wages. We keep track of the current market and local economy to offer our employees competitive pay ranges, regular increases, and longevity bonuses.
• Comprehensive health insurance, including vision and dental coverage. Employees have their choice of medical plans through the California Public Employees' Retirement System (CalPERS).
• Other insurance. We offer life insurance, accidental death and dismemberment insurance, and long-term disability insurance.
• Generous paid time off—with cash-out and carry-over options. We want our employees to have time to rest, relax, and grow outside of work. Paid time off increases with longevity and starts at 18 days per year for regular employees.
• Flexible spending accounts. This includes optional pretax accounts for healthcare, dependent care, and transit and parking.
• Retirement benefits. Benefits are made up of four different programs: CalPERS Pension Plan, 401A Discretionary Plan, 401A Supplemental PEPRA Plan, and an optional 457 deferred compensation plan.
• Union representation. Certain positions are represented by the Service Employees International Union.
• Wellness perks. Health isn't just for outside the workplace. We strive to maintain a thriving work environment with standing work stations, an on-site gym, and a low-cost farmers market. We also offer free, confidential counseling 24 hours a day, 7 days a week through our employee assistance program.
• Financial services. Employees of SCFHP get help investing wisely and planning for the future through financial planning, investment counseling, and retirement planning workshops. Employees also have the opportunity to join the County Federal Credit Union.
• Travel and education. To help our employees expand their horizons, we offer tuition reimbursement for continued education and development. We also offer discounts on certain hotels and cell phone plans, as well as emergency travel assistance via the TravelConnect program.