Y AS-NEEDED Retired Annuitant - Director, Network Management, Health Network Relations (Director III)

Position Information:

• Department: Provider Relations
• Salary Grade: 322 - $192,386 - $307,817 ($92.49 - $147.9891)
• Work Arrangement: Full Telework 
• Work Schedule: Varies
• Expected Assignment Duration: June 30, 2027 but may be adjusted as needed 
  

Duties & Responsibilities:

• 95% - Administrative Duties
  • Hires, supervises, develops, counsels, and reviews performance of department staff.
  • Develops and maintains operating budgets for the department.
  • Coordinates the development of policies, procedures, and standards for all department activities.
  • Ensures that the department is the primary point of contact for all communications with delegated providers.
  • Coordinates department activities and collaborates with other CalOptima departments, senior management, and the delegates to assure proper operations of the overall program.
  • Prepares and presents special provider materials and presentations in collaboration with the executive management team.
  • Maintains positive relations with CalOptima’s delegated providers. Monitors delegated provider performance on an on-going basis to identify levels of compliance with delegated functions and resolve operational issues.
  • Ensures that delegated entities receive the training and education to ensure compliance with all California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), and Centers for Medicare & Medicaid Services (CMS) regulatory requirements and collaborate with all appropriate CalOptima functional areas to ensure optimal delegation oversight and regulatory compliance by delegates.
  • Analyzes the impact of new DHCS, DMHC, and CMS regulatory requirements on delegated providers and develop policies and procedures for executing and facilitating compliance with such requirements by delegated providers.
  • Directs training of delegated providers to promote cost-effective managed care, compliance, and enhancement of service standards.
  • Plans, organizes, and delivers standing and ad hoc meetings, including Joint Operations Meeting (JOM), Health Network Forum meeting, and Health Network CEO meeting.
    
    
• 5% Other
  • Other projects and duties as assigned.

Minimum Qualifications:

• Bachelor’s degree in health care management or a related field; or the equivalent combination of education and/or experience in directing provider network activities or a related field required.
  
• 7 years of experience in provider network operations, relations, contracting, or related functional areas required.
  
• 5 years of progressive leadership experience, including direct supervision of staff, in managed care, providers or health plans required.
  
• Medicaid managed care, Medicare risk-contract, or commercial Health Maintenance Organization (HMO) insurance experience required.
  
• Have access to means of transportation for work away from the primary office approximately 10% of the time or more.

Preferred Qualifications:

• Leadership experience in provider organization working with payers preferred.
  
• Master’s degree in health care management or related field preferred.
  
• Medi-Cal managed care plan experience or related government client or public sector experience preferred.
  
  

Required Licensure / Certifications:

• n/a

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.  
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. 
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. 

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.