Director-Health Related Social Needs Initiatives - Public Health Foundation Enterprises, In

For over 50 years, Heluna Health has worked with government leaders, policymakers, community-based organizations academic researchers and healthcare systems to optimize the health of communities. We do this by strengthening health interventions and creating equitable access to services across broad populations. Our team develops, launches and supports a wide range of programs and organizations across the population health spectrum, in focus areas from outbreak preparedness to the health impacts of climate change and the social determinants of health, such as factors affecting maternal and infant care. Heluna Health is also an innovator of direct services, including programs in early literacy, breastfeeding and nutrition, and research. Visit https://www.helunahealth.org to learn more about how you can make an impact by joining our team.

Salary Range: $122,241 to $141,256.00 annually commensurate with experience. 

POSITION DESCRIPTION 

This position will lead the development & implementation of Heluna Health’s cross-functional Medicaid/Medi-Cal program delivery team, including ensuring programmatic compliance and full cycle billing for Community Health Workers (CHWs), Doulas, Registered Dietitian Nutritionists (RDNs), Lactation Consultants, Enhanced Care Management (ECM), and Community Supports (CS). The Director will bring experience standing up billable Medicaid/CalAIM initiatives for managed care plans, providers, and other stakeholders, preferably related to community organizations’ new ability to bill for activities related to the social determinants of health. The Director is responsible for program leadership and day-to-day operations, including (but not limited to) internal team coordination, external, client/partner/provider engagement and support, securing new community partnerships, contracts administration, billing, claims submission & financial management, IT implementation and reporting. The Director is also responsible for state and federal regulation compliance, including meeting all Medicaid/Medi-Cal and managed care plan documentation, reporting, and security requirements.

ESSENTIAL FUNCTIONS

• Oversee the development, implementation, and continuous improvement of Medicaid/Medi-Cal program delivery in collaboration with external clients/partner service providers. This work includes setting objectives, performance metrics, and quality improvement initiatives to enhance patient care and program sustainability.
• Direct Medicaid/CalAIM implementation, including with working with internal and external client/partner providers, such as Community Health Workers (CHWs), Doulas, Registered Dietitian Nutritionists (RDNs), Lactation Consultants, Enhanced Care Management (ECM), and Community Supports (CS) personnel. 
• Experience with populations of focus, including birth equity, people experiencing or at risk of homelessness, chronic health conditions, mental health and substance use, justice-involved individuals.
• Establish and maintain relationships with managed care plans, healthcare providers, community organizations, and other stakeholders to enhance service delivery and ensure compliance with managed care plan requirements, as well as state and federal regulations.
• Oversee managed care plan contracting, documentation and practice management, billing/claims submission, reporting and security requirements.  
• Direct the development, growth and integration of allowable, non-grant (fee-for-service) billable services related to addressing the social determinants of health, including fiscal maximization strategies. Provide oversight to billing/claiming processes, ensuring alignment with contractual requirements and Medicaid/Medi-Cal standards.
• Oversee IT implementation related to this work and lead continuous improvement for Medicaid/Medi-Cal practice management and billing/claiming processes.
• Evaluate program operations and activities in terms of overall effectiveness and compliance; use data to inform program decisions, track performance against goals, and identify areas for improvement. Implement improvements and modifications as necessary.

JOB QUALIFICATIONS

Education & Experience

• Four (4) year degree in Health Sciences or Social Sciences or related fields AND four (4) years of full-time administrative supervisory experience working in healthcare program delivery; OR
• Master’s degree in healthcare administration, public health, social work or related fields (including MBA) AND at least two (3) years of administrative supervisory experience working in healthcare program delivery, OR
• Additional experience may be substituted for education on a year-for-year basis or possess at least six (6) cumulative years of full-time administrative supervisory experience in healthcare program delivery
• Experience in and working knowledge of Medicaid/Medi-Cal and CalAIM initiatives.
• Experience in and working knowledge of managed care plans and MCP documentation, data, reporting, and compliance requirements, particularly related to health-related social needs and/or experience with community-based organizations program implementation and billing for health-related social needs.
• Experience in and working knowledge of Medicaid/Medi-Cal billing infrastructure and implementation, including work with external client/partner providers. 
• Experience in and working knowledge of Medicaid/Medi-Cal practice management and billing IT implementation.
• Experience with community-based service providers in a managed care environment. 
• Experience with HIPAA compliance. 

Other Skills, Knowledge, and Abilities

• Leadership, Collaboration and Teamwork: Lead cross-functional teams and projects. Set clear goals and work effectively with others, seeking out and building positive working relationships with colleagues, participants, and stakeholders, recognizing the strengths and contributions of others.
• Communication: Convey information clearly and effectively (both verbally and in writing) to individuals and groups in a manner that informs, engages and maintains their attention. Ability to relate to diverse populations in culturally sensitive ways.
• Creativity and Initiative: Take action and make decisions without being prompted, demonstrating a proactive approach to work. Think outside the box, generating innovative solutions to problems or challenges.
• Critical Thinking and Problem Solving: Analyze and evaluate information and situations, identify key issues, consider alternatives, and make logical decisions based on sound reasoning that will achieve the desired outcome.
• Analytical Skills and Attention to Detail: Gather and interpret data, identifying trends, patterns, and insights to inform decision-making. Ability to consistently produce high-quality work, ensuring accuracy and precision in all tasks.
• Ethics and Boundaries: Maintain ethical and professional standards, demonstrating honesty, integrity, and a commitment to doing the right thing in all situations while maintaining professional boundaries.

PHYSICAL DEMANDS

• Stand: Frequently
• Walk: Frequently
• Sit: Frequently
• Handling / Fingering: Occasionally
• Reach Outward: Occasionally
• Reach Above Shoulder: Occasionally
• Climb, Crawl, Kneel, Bend: Occasionally
• Lift / Carry: Occasionally - Up to 10 lbs.
• Push/Pull: Occasionally - Up to 10 lbs.
• See: Constantly
• Taste / Smell: Not Applicable

Key

• Not Applicable = Not required for essential functions
• Occasionally = (0 - 2 hrs./day)
• Frequently = (2 - 5 hrs./day)
• Constantly = (5+ hrs./day)

WORK ENVIRONMENT

• General Office Setting, Indoors Temperature Controlled

EEOC STATEMENT

It is the policy of Heluna Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)