Associate Director of Clinical Integration

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Job description

Overview:
Under direction from the Director of Care Coordination, manages and provides direction to the
Care Coordination (CC) Department's Clinical Integration Team's Managers, Supervisors, and
Individual contributors. A key component of this position is the enhancement and refinement of
existing programs, and enthusiastic innovation in the development, management, integration, and
refinement of new and existing programs. The Associate Director of Clinical Integration
identifies and communicates opportunities aligned with strategic initiatives, market, stakeholder,
and regulatory needs. This position is a critical intersection of identification and intake of
clinical, regulatory, and business needs from internal and external stakeholders across Care
Coordination programs, aligns expected outcomes, plans roadmap, and oversees alignment and
execution of deliverables in collaboration with Care Coordination leaders and internal
departments. This position works closely with Care Coordination's operational leaders,
Associate Directors of Care Coordination and their regional case management teams, as the
design and deliverable branch to support operations and department growth and performance.
This Associate Director leads a multi-functional team responsible for the department's reporting,
policy development and compliance, program development and associated deliverables, as well
as the Care Coordination training team.

Responsibilities:
Provides day-to-day direction to Care Coordination's Clinical Integration Team's
Managers, Supervisors, and Individual Contributors to meet department goals and
objectives.

Oversees team performance management, including onboarding activities and annual
performance evaluation process. Keeps Director apprised of staff concerns and
accomplishments, and provides feedback on performance evaluations.

Coordinates activities with Health Equity, Quality, Member Services, and Population
Health, along with Regional Leaders and Communications, and other PHC departments to
identify, track, and monitor alignment for Care Coordination activities across the
organization.

Coordinates activities with Member Services, Claims, Grievance and Appeals, and
Provider Relations departments to identify, track, and monitor quality of care issues and
trends.

Works with other departments within PHC to develop and implement improvements that
will lead to improved performance or enhanced workflow of staff.

Responsible for establishing and maintaining reports that will support the efficacy of each
CC activity/program and to produce dashboards that includes a summary of CC program
activities, member outcomes, return on investment, and quality improvement activities

Prepares reports on departmental activities according to established schedules and format;
including formal regulatory submissions.

Reports any issues with regulatory compliance to Director of Care Coordination and
assists in design and implementation of a corrective action plan when necessary.

Responsible for audit and survey readiness activities to ensure the department is compliant
with all applicable regulation and DHCS standards, licensure requirements, accreditation
standards (i.e. NCQA), new legislation, and Partnership policies and procedures.
Participates in onsite audits by various regulatory agencies as necessary.

Provides oversight to department auditing to ensure compliance with DHCS standards.
Uses summary of findings to lead team in process improvement activities.

Ensures that all policies and procedures are updated at least annually or as needed and
presented to appropriate committees for review.

Assists PHC staff and providers with the interpretation of PHC policies, procedures, and
regulatory requirements for all product lines.

Develops structures, relationships, and processes to promote active partnerships with
providers, community stakeholders, and/or other healthcare professionals to meet and
support key organizational initiatives (ex: MOU requirements, CalAIM, etc)

Acts as a designated Business Owner to the Director of Care Coordination in the
Regulatory Change Management process by reviewing and participating in
operationalizing newly released All Plan Letters (APL).

Performs Human Resources functions such as time card management, directing work
activities, implementing workplace changes, conducting annual reviews, and conducting
staff trainings.

Works with operational Managers and Supervisors, and Trainers to develop standardized
training content and material for new staff and for the ongoing education of existing staff.

Provides oversight of training program to ensure adequate training accomplishes
objectives and results in staff competency.

Actively participates in organizational meetings and goals; providing input where
appropriate and informing assigned team of what is learned or changed as a result of those
meetings.

Participates in strategic goal setting for department activities and initiatives. Develops
annual goals for individual performance and updates at least every six (6) months for
progress.

Promotes the continuous improvement process and implements recommended changes.

Participates in all cost containment efforts on behalf of department and PHC

Facilitates meaningful data presentations; uses data to identify needed process
improvements; Acts as designated business owner for needed system modifications and
oversees or delivers the specifications and requirements on behalf of Care Coordination or
associated programs

Participates in the planning of new enhanced Health Services products.

Serves as a role model and resource to colleagues, staff, members, and others across
assigned regional offices.

Manages vendor relationships as assigned.

Leads strategic projects using best practices; acts as designated business owner to the
Director of Care Coordination for department representation.

Attends Internal Quality Improvement Committee (IQI), Physician Advisory Committee
(PAC) and Quality Utilization Activity Committee (QUAC) meetings.

Works with providers, vendors, and community or county partners to facilitate issue
resolution and ensure a consistent CC process.

Other duties as assigned.

Qualifications:
Education and Experience

Bachelor's degree. Masters degree preferred. Clinical or healthcare
related degree or licensure strongly preferred. Minimum five (5) years
of clinical experience; five (5) years of managed care experience (case
management preferred; minimum five (5) years of management
experience in a medical management setting, with effective problem
solving in an area where few precedents have been set; or equivalent
combination of education and experience. Program or product
development experience preferred.

Special Skills, Licenses and Certifications

Current California Registered Nurse license for registered nurses, if
applicable. Effective telephone and computer skills required. General
knowledge of utilization management, ICDCM, and CPT coding
schemes. Thorough knowledge of case management programs and
application of related clinical criteria and protocols. Knowledge of and
experience with Federal Medicaid and/or California Medi-Cal
programs and Medicare experience in managed care settings preferred.
Ability to work effectively across departments and functions within the
organization. Proficiency with PCs and medical management software,
word processing, spreadsheets, etc. Valid California driver's license
and proof of current automobile insurance compliant with PHC policy
are required to operate a vehicle and travel for company business.

Performance Based Competencies

Demonstrated effective leadership and analytical skills. Effective oral
and written communication skills. Excellent interpersonal skills.

Work Environment And Physical Demands

Ability to use a computer keyboard. Ability to prioritize workload and
initiate action to acquire needed information from professionals by
phone. Ability to function effectively with frequent interruptions and
direction from multiple team members. More than 50% of work time is
spent in front of a computer monitor. Must be able to lift, move, or
carry objects of varying size, weighing up to 10 lbs.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;

Promote teamwork and cooperative effort among employees;

Maintain safe practices; and

Abide by the HealthPlan's policies and procedures as they may from time to time be updated.

HIRING RANGE:

$(phone number removed) - $(phone number removed)

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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