Associate Chief Operating Officer


Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year. 

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

Associate Chief Operating Officer

POSITION SUMMARY

Incorporates appropriate monitoring of all utilization patterns in all aspects of the company’s health care delivery system by providing oversight of all health care services activities and of utilization patterns for plan members with the ultimate goal of improving the health of Community Health Group’s members in measurable ways.  Ensures efficient, accurate and timely processing of all claims and encounter data.  Ensures outstanding Customer Service using the 33 Points of MAGIC.  Establishes and maintains staffing structure necessary to ensure that the functional responsibilities of all assigned departments are conducted in a timely and efficient manner, coordinated in collaboration with the other functional departments, and performed in accordance with established policies and procedures.  Ensure 100% compliance with all regulatory and operational requirements.  Effectively lead the Claims, Utilization Management, and Customer Service departments.

 

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with all applicable state and federal regulations including those promulgated by CMS, DHCS and DMHC.  Earns passing grades for all regulatory audits related to the areas of responsibility.

 

RESPONSIBILITIES

  • Provides administrative oversight and monitors utilization of all assigned departments by developing and implementing systems to manage programs; develops systems to track turn-around times and ensure compliance with contract requirements.

  • Maintains staff job results by coaching, counseling, and disciplining employees; planning, monitoring, appraising and following up on job results.

  • Maintains efficient daily operations of by initiating, coordinating, and enforcing personnel policies and procedures; developing, revising, and implementing work-flow and productivity parameters; trouble-shooting with practitioners, providers, facilities, and CHG staff when needed; providing hands-on case management and utilization review when needed.

  • Maintains processes that are fully compliant with all regulatory requirements.

  • Maintains processes that allow Community Health Group to retain NCQA accreditation no lower than ‘Commendable’ but preferably ‘Excellent.’

  • Maintains systems that identify cases/patterns of over and underutilization by analyzing historical trends, reviewing established guidelines and protocols, and pursing corrective actions based on findings; monitors/reports appropriate utilization of resources consistent with community practices.

  • Ensures adherence to Medi-Cal and/or Medicare and/or Milliman clinical practice guidelines as applicable.

  • Develops and implements training sessions for network providers on topics based on membership need; collaborating with plan staff to incorporate training opportunities related to community and preventive health services at initial provider orientation and other forums as needed.

  • Provides overall administration and coordination of the Utilization Management Committee, Pharmacy & Therapeutics Committee and all other standing Health Care Services committees by coordinating standing meetings; expanding membership and ensuring compliance with regulatory requirements.

  • Supports the team effort by assisting all CHG departments with program implementation and overall operations; attending meetings as required and participating on committees as directed; and performing other related duties as assigned or requested.

  • Enhances professional growth and development by participating in educational workshops, seminars, and related training; reviewing current literature.

  • Maintains product and organization reputation and contributes to the team effort by conveying professional image and accomplishing related tasks; participating on committees and in meetings; performing other duties as assigned or requested.

  • Implements and/or maintains systems and/or processes to ensure all regulatory audits are passed with either no or minimal findings and with no repeat findings.

     

    Education:          

  • Five years of administrative/supervisory experience in managed care field required.

  • Master’s degree in Business Administration or Master’s degree in Public Health Administration or equivalent required.

     

    Experience/Skills:

  • 5 years’ experience in a Medicaid health plan at a management level.

  • 3 years of direct supervision experience.

  • Ability to operate a personal computer, telephone, fax, copier.

  • Conceptual strength is essential as are analytical, verbal and written communication skills; good public relations.

  • California Driver’s License and proof of auto insurance.

  • Physical Requirements:

  • Prolonged sitting.

  • Driving within County.

  • Will be required to work evenings and/or weekends.