Search for More Jobs
Forward this job to a friend
Apply by email without Registering
Apply by creating/using account
Please enter your registered email address, and we'll email you a link to reset your password right away.
Position Purpose: The Director Public Programs and Long Term Services and Supports (LTSS) drives Health Net's Public Programs overall strategy and oversees integrated medical, behavioral and social services for a large, complex program. The Director is responsible for the planning, implementation and oversight of Health Net's current State Health Program services and Long Term Services and Supports (LTSS) program. The Director ensures all regulatory requirements are operationalized and complex compliance standards are met.
· Operations related responsibilities:
o Designs, implements and oversees the LTSS internal operations and processes that refer and link members with supports and services provided by public and community agencies.
o Responsible for ensuring an effective and comprehensive health care delivery system is structured between Health Net's Public Health Programs department, internal medical management, external Participating Physician Groups (PPG), care management and community based organizations/agencies. Agencies/programs include but are not limited to local County health departments, Regional Centers, Local Education Agencies, California Children's Services (CCS), Comprehensive Perinatal Services Program (CPSP), various community agencies, local schools, and Child Health and Disability Prevention (CHDP) services. For LTSS, they will also include Multipurpose Senior Services Program (MSSP), Community Based Adult Services (CBAS), Long Term Care and Skilled Nursing Facility (LTC/SNF), In-Home Supportive Services (IHSS) and other Home and Community Based Services (HCBS). Identifies gaps in overall services and integrates resources required to support overall care needs.
o Ensures all compliance and reporting is completed accurately and according to established timeframes.
o Responsible for oversight of internal and external facing support functions required to support operational, contractual and relationships related to Public Programs including the forecasting, reporting, performance metrics, performance improvement, budgeting, staffing and space requirements.
o Oversees the development of mechanisms to improve or increase appropriate utilization of local public health or community services and positively affect overall member satisfaction and total cost of care.
o Ensures that department provides reporting, analysis and trending of utilization data to Health Net's Utilization Management Committee, Health Net Quality Improvement Committee and other internal bodies as needed.
· Stakeholder relations responsibilities:
o Responsible for management of the team (approximately 45 associates) who have oversight of provider, vendor, community based organizations and public agency relations related to all Health Net public programs, including the LTSS program.
o Works with Health Net's Compliance, Legal and Provider Network Development Departments to develop and negotiate subcontracts for local county public health services, LTSS providers and other agencies while ensuring appropriate and compliant policy development is maintained.
o Responsible for ensuring that total cost of care is effectively managed. Works in conjunction with supporting internal departments to oversee, evaluate and provide recommendations for the management and coordination of services, the effectiveness and availability of LTSS providers, health education programs, materials, and other outreach efforts.
o Works in concert with Health Net internal departments to coordinate, develop, and evaluate programs and policy initiatives affecting members covered by State Health Programs, seniors and persons with disabilities, members requiring long term care in a facility (SNF/SubAcute/ICF) and any other services related to LTSS. Facilitates problem resolution for complex problems between LTSS and other community based providers and contracting, marketing, claims, member relations and other internal departments.
o Ensures community based organizations and member advocacy representatives are familiar with Health Net services and are satisfied with their interactions with the public programs department. Develops programs to address when gaps are identified.
o Responsible for needs analysis of education and training for internal and external resources related to the availability, referral processes, and coordination of services with public health programs and services for their members.
o Responsible for metric development, timely data analysis of applicable data and ensures that information is presented internally and externally in an accurate, timely and professional manner, including presentations and education as needed.
o Responsible for the development of effective departmental goals and ensuring a positive working environment for staff.
· Additional duties as assigned.
Education/Experience: Bachelor's degree in relevant field required, Master's Degree in Public Health, Healthcare Administration, Business Administration or clinical background preferred. Minimum ten years progressively responsible operations management experience. Minimum five years customer service experience, Medi-Cal, Medicare and experience in interacting with government agencies and senior populations preferred. Minimum ten years managing budgets and overseeing managerial and supervisory staff. Geriatric and/or developmental disability experience preferred.
License/Certification: Current and Valid Driver's license to travel between worksites.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
More Information About the Job
Is Relocation Available?
Is there a bonus structure?
Are you open to sponsorship?
This position is:
Is there a possibility to work remote?
Is there equity?
Are there flexible work hours?
Does this position have direct reports?
Who does this position report to?
Provider Engagement & Innovation Officer
What are the 3-4 non-negotiable requirements on this position?
Bachelor's degree in relevant field required, Master's Degree in Public Health, Healthcare Administration, Business Administration or clinical background preferred. Minimum ten years progressively responsible operations management experience, including managing budgets and overseeing managerial and supervisory staff. Minimum five years customer service experience, Medi-Cal, Medicare. Current and Valid Driver's license and ability to travel between worksites.
What are the nice-to-have skills?
Experience in interacting with government agencies and senior populations preferred Geriatric and/or developmental disability experience preferred.
What is exciting about this opportunity? Please use this section to describe team and company culture.
This is a high-visibility position that will have significant impact and influence on how we improve the lives in our communities, one person at a time.
Mandatory Recruiter Notes
All agencies must provide the details below within their recruiter notes in order to submit a candidate:
Availability date to start a new role:
Apply by creating/using account