Population Health Manager

Company Description

Looking for a career that makes a difference in people’s lives?  CenCal Health is a locally-run, not-for-profit health plan that serves nearly 180,000 people, with offices in both Santa Barbara and San Luis Obispo Counties.  For 35 years we’ve been improving the health and well-being of our neighbors through partnership and collaboration, and we’re looking for exceptional, mission-driven professionals to help us grow. We are an employer of choice in Santa Barbara, offering competitive salaries, generous vacation & holidays, comprehensive health/dental/vision benefits including a CalPERS pension plan and 457 deferred income plan, a wellness program, a gym in our headquarters and even parking lot BBQs. Come join our group of nice people doing good work at a great company. 

For more information on who we are and what we do, please visit our website at www.cencalhealth.org

Job Description

Job Location: Santa Barbara Office 4050 Calle Real, Santa Barbara, CA 93110

Position Type: Full-Time

• Monday to Friday
• Hybrid 1-2 days per month

Benefits:

• Pension Plan
• Professional Development and Wellness Benefits
• Alternative Transportation Incentives
• Comprehensive medical, dental, vision & life insurance
• Paid Time Off
• Ten (10) paid holidays per year

Job Summary

At the direction of the Director of Quality, the Population Health Manager is responsible for the daily operations and functions of population health, clinical quality, and health promotion, including personnel oversight and mentorship. In coordination and collaboration with the Director of Quality, support the execution and implementation of a Population Health and Quality Strategy to achieve health equity. The position has direct oversight of the Clinical Quality, Population Health, and Health Promotion teams and is responsible for organizing, motivating, leading, and coordinating team members.

Duties and Responsibilities

• Provide day-to-day management and oversight of the Population Health Management and Quality Program to improve population health, mitigate the negative impacts of social determinants of health, and achieve health equity
• In collaboration with the Director of Quality, coordinates and implements CenCal Health's Population Health and Health Equity Strategy across departments as needed to ensure compliance with NCQA Accreditation standards.
• Implements, maintains, and coordinates the plan-wide review, update, and continual improvement of CenCal Health's Quality Improvement System, to maximize CenCal Health managed care effectiveness and compliance readiness with respect to applicable DHCS, DMHC, CMS, and NCQA requirements.
• Initiates and advances partnerships with contracted providers to increase their adoption and engagement in CenCal Health's strategic initiatives, including but not limited to Pay for Performance programs, to improve the quality of care and achieve health equity
• Engages providers in topic-specific Performance Improvement Projects and PDSAs to improve select aspects of care for populations in need of improvement
• Develops and updates written department policies and procedures to ensure compliance with regulatory requirements (e.g., DHCS Contract, NCQA accreditation)
• Supports the annual development of a Population Needs Assessment
• Collaborates with contracted providers and community-based organizations to develop long-term relationships to inspire a shared vision to achieve strategic objectives
• Collaborate with multiple stakeholders to implement evidenced-based guidelines, efficient workflows, and strategic initiatives to advance high-quality healthcare delivery.
• Leads, mentors, and strategically develops staff expertise; monitors the production and quality standards for assigned teams, including all aspects of performance necessary to assure operational success
• Prepares weekly, monthly, and quarterly reports for internal and external reporting
• Acts on behalf of the Director of Quality as necessary and other duties as assigned

Qualifications

Education and Experience

Required:

• Current active, unrestricted California Registered Nurse (RN) and/or Nurse Practitioner (NP) License with a minimum of 2 years experience as an RN or NP
• Bachelor's degree in Health Care Administration or Business or a related field
• Thorough knowledge of Medi-Cal/Medicaid and NCQA standards
• A minimum of seven (7) years of experience in a managed care environment or equivalent combination of education/experience
• A minimum of three (3) years of supervisory experience in a managed care organization, or a combination of demonstrated supervisory and project management excellence
• A minimum of three (3) years of leadership in the management of regulatory audits as a principal liaison to lead auditors
• Thorough knowledge of medical provider systems and managed care quality management operations
• Excellent judgment in planning and efficiently and effectively executing goals

Desired:

• Graduate degree in a job-relevant or health-related discipline (e.g., MPH, MSN, MBA)
• Certified Professional in Healthcare Quality (CPHQ)

Additional Information

All your information will be kept confidential according to EEO guidelines.