Director Clinical Services at Cambia Health Solutions, Inc

Work from home within Oregon, Washington, Idaho or Utah

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Who We Are Looking For:

Every day, Cambia's dedicated team of Clinical Service leaders are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Director of Clinical Services 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 management, disease management, and 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. - all in service of creating a person-focused health care experience.

As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.

Are you a seasoned clinical leader passionate about creating a person-focused healthcare experience? Do you thrive in a dynamic environment where no two days are the same? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelor's Degree in Nursing (Masters preferred)

• 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

• Equivalent combination of education and experience

• Current unrestricted Registered Nurse (RN) license

Skills and Attributes:

• Demonstrated ability to lead high performing teams, manage managers, and direct vendors.

• 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 create and execute care management and utilization management programs and 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.

What You Will Do at Cambia:

• 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.

75 - 100

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