Director Government Programs, Clinical Services
Cambia Health Solutions

Job Info

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Director Government Programs, Clinical Services

Open to remote work from Oregon, Washington, Idaho and Utah

Primary Job Purpose

Provides leadership and oversight for the clinical teams supporting one or more health plan lines of business (e.g. Government Programs or Group/Commercial). Oversees functions such as care and disease management, and supports utilization review. Ensures programs offered are market competitive, compliant with regulatory and accrediting standards, and designed to manage health care costs while achieving quality outcomes. Serves a key member of broader Clinical Services Leadership Team to establish business objectives, allocate resources and drive results.

Minimum Requirements

• Demonstrated ability to lead high performing teams.
  
• Strong communication and facilitation skills with all levels of the organization, including the ability to resolve issues and build consensus among groups of diverse stakeholders.
  
• General business acumen including understanding of market dynamics, financial/budget management, data analysis and decision making.
  
• Knowledge of health insurance industry trends and technology.
  
• Demonstrated ability to develop, build, implement and oversee performance of care management programs to drive results across internal teams and/or external vendors.
  
• Extensive knowledge of CMS and state regulatory requirements and demonstrated ability to manage compliant operations. NCQA, URAC and/or HEDIS accreditation experience strongly preferred.
  
• Ability to decipher and interpret clinical data and deliver presentations to various internal/external audiences related to clinical outcomes.
  

Normally to be proficient in the competencies listed above:

Director would have a Bachelor's Degree in Nursing, 7 years of progressively responsible clinical care experience, 5 years of management experience, 10 years of experience in health plan case management, utilization management or quality management or equivalent combination of education and experience. Masters preferred.

Required Licenses, Certifications, Registration, Etc.

Current unrestricted Registered Nurse (RN) license

General Functions and Outcomes

• Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for clinical teams.
  
• Aligns team goals with the organization's vision and strategy.
  
• Develops strategies and tactics to effectively manage healthcare costs, improve clinical quality and enhance the member experience for assigned lines of business.
  
• Collaborates with Medical Directors, Healthcare Informatics, Network Management and other departments as needed to collect, analyze, and report on effectiveness of programs and address quality of care issues. Uses data to guide the development and implementation of health care interventions that improve value to the member.
  
• Manages the organization by ensuring clear performance expectations along with appropriate skills sets. Fosters an effective work environment and ensures employees receive recognition, feedback and development. Participates in organizational talent management and succession planning.
  
• Determines appropriate staffing levels and resource needs, creates and manages department and/or project budget, allocates resources, and approves expenditures.
  
• Oversees the development of effective and efficient clinical and operational policies, procedures and standards. Monitors results and implements process or system changes as needed.
  
• Ensures clinical programs meet federal and state regulations, accreditation standards, quality metrics, client requirements, and evolving models of care (e.g. accountable care organizations, patient centered homes).
  
• Makes recommendations as to the use and selection of external vendors. Provides clinical leadership and operational oversight to vendors.
  

Expectations of All Cambia Staff

Conducts business with high regard for Cambia's corporate values and in compliance with its Code of Business Conduct.

Maintains high regard for member and Medicare beneficiary privacy and complies with Cambia's Corporate Privacy and information security policies.

Contributes to the achievement of our Corporate Affirmative Action goals and objectives.

Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company's quality initiatives.

FTE's Supervised

25-50

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

This job has expired.