Assistant Director, Managed Care Programs - Operations

Salary : $181,964.87 - $233,468.77 Annually

Location : Throughout the County of Santa Clara, CA

Job Type: Executive Management

Job Number: 24-B89-A

Department: Valley Health Plan

Opening Date: 03/18/2024

Closing Date: Continuous

Bargaining Unit: 91

Description

Under direction, to direct the design, development and implementation of managed care systems of the Santa Clara Valley Health and Hospital System's Local Initiative Plan; to maintain internal relations with medical staff and administration, managers and other clinicians, and to develop and maintain relations with external potential health care providers, work groups and customer departments and agencies.

Learn More About This Position
Assistant Director, Managed Care Programs for Operations Brochure

Filing Period and Application Procedure
This recruitment is open until filled. The first review of resumes will be on Monday, April 8, 2024. You are encouraged to apply as soon as possible and to monitor this site for updated closing information.

This recruitment requires the submission of an online application. No paper applications will be accepted. Applicants must apply online at

It is important that the following information be included in your application packet as it will be evaluated during the competitive review process:

1. Rsum;
2. References contact information (minimum of 3);
3. Cover letter explaining why you are the ideal candidate including specific examples from your experience (maximum of 3 pages);
4. Complete responses to the supplemental questions.

Questions regarding this Executive recruitment may be directed to
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Typical Tasks

• Provides leadership and directs the design and development and implementation of the managed care program;
• Directs activity of consultants, attorneys, and internal management information systems and managed care administrative and analyst staff;
• Develops and maintains cooperative relationships with internal administrative and medical staff members;
• Recommends to administration which services to provide or buy from external providers;
• Develops networks and maintains cooperative relations with potential providers and customer departments, businesses and agencies;
• Represents the Health and Hospital System's interests before Federal, State, and local government agencies and community interest groups;
• Works with the management of public and mental health and alcohol program departments and hospital and clinics to develop and modify roles and missions so that they are congruent with managed care programs;
• Performs other related duties as required.

Employment Standards

Possession of a bachelor's or higher degree in business administration, health care administration or a related field and substantial experience with health care delivery programs to acquire the knowledge and abilities listed below.

Experience Note: This position requires substantial managed care program or related experience where a high level of responsibility and accountability was held, preferably in programs dealing with medicaid, a large geographic area, and variety of providers, a teaching hospital, and a public/political environment.

Knowledge of:

• Laws and regulations governing the development and operation of managed care programs;
• Business practices and operating customs peculiar to health care providers and networks;
• The nature and extent of political interests and considerations surrounding health care delivery;
• The potential affects of federal, state and local budgetary actions on managed care programs.

Ability to:

• Apply creativity, imagination and leadership to the development of programs;
• Assume a leadership role in gaining the cooperation of internal staff and external providers, customers, and community interests;
• Recognize and respond effectively to the political realities of the health care delivery environment;
• Recognize and meet customer needs and market considerations;
• Work cooperatively and effectively with all elements of the health care delivery system;
• Work effectively and react intelligently in a high charged, dynamic environment;
• Maintain focus on customer service, market share, and financial factors affecting programs.

Overview of County of Santa Clara's Executive Leadership Benefits package.

01

Please answer the following questions and submit your responses with a completed application and resume. This information is REQUIRED, as it will be used to initially determine minimum qualifications. For those applicants meeting the employment standards, this information will be critical in the subsequent competitive assessment to identify those candidates to be invited to the oral examination. Resumes will not be accepted in lieu of required supplemental responses. You may attach a separate sheet and type "see attached" in the required field for each question. If you are attaching a separate document to answer the supplemental questionnaire, the responses should be limited to 2-3 pages. Do you understand this requirement?

• Yes
• No

02

For each relevant position held, briefly provide specific information that clearly describes: a. Your functional areas of responsibility; b. The size and type of each organization; c. Your position within each organization and the title of the position to which you report(ed); and d. The number of staff managed;

03

Identify the managed care operations you have managed in a Knox Keene licensed health plan and the associated regulatory requirements, as applicable (i.e., Contracting, (Ancillary, Facility, Fee-for-service, Professional, Risk Based), Contract and Benefits Configuration, Compliance, Disputes and Grievances, Credentialing, Claims, Provider Data Management, Provider Relations, Service Operations, or Provider Services). Include years of experience and level of proficiency (Novice, Intermediate, Advanced).

04

Describe your experience in data analytics and data interpretation and your ability to work with various platforms, i.e; EPIC Tapestry, EPIC EHR, Dynamics or other applicable Health Plan systems.

05

Describe your experience identifying and implementing process improvement opportunities. Provide an example of a process improvement project that you have led and the outcome of that project.

06

Describe how you have addressed provider network data integrity in order to improve timeliness and accuracy of claims processing and reporting.

07

Provide any other relevant information that would demonstrate your qualifications for this position.

Required Question