Assistant Director Clinical Services

Cambia Health Solutions • Medford, OR

2d • Hybrid

About The Position

Assistant Director Clinical Services Hybrid within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of clinical leaders are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Assistant Director Clinical Services provides leadership and clinical direction for clinical care management, clinical programs, and provider engagement strategies across all health plan lines of business. This role oversees core medical and/or behavioral health teams, condition specific programs, and engages in the development of new programs and services. In addition, this role supports implementation of enterprise-wide health strategy initiatives and may represent clinical service programs to external parties and customers as needed. This role works collaboratively with the utilization management team, medical directors and the broader health service leadership team to effectively manage health care costs while achieving quality outcomes. Consultation with Product, Network Management, Quality, Finance and Sales ensures the clinical offerings are market competitive and designed to support the care needs of our members – 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. What if your next leadership role combined clinical excellence with strategic innovation? Ready to lead clinical innovation that truly makes health care easier and lives better? Then this role may be the perfect fit.

Requirements

• Bachelor's degree in nursing or comparable clinical degree including master's degree in psychology, sociology, social work or related field
• 7 years clinical experience
• 5 years of management experience in health insurance or managed care related field.
• Active unrestricted professional license in nursing, psychology, psychiatry, social work or related clinical field
• Experience in areas such as integrated care management models, partnerships with providers, third-party suppliers of clinical services, community groups and other member-facing stakeholders
• Ability to lead the design, development and implementation of clinical programs, processes, structure, and measurement indicators that drive operational results.
• Experience executing and driving complex projects that require collaboration in a matrixed environment.
• Demonstrated competency in using data to drive decisions, organizing work, providing leadership, establishing measures for success, and managing to deliverables.
• Proven ability to build relationships, collaborating with diverse business partners and stakeholders who may or may not have direct accountability or engagement.
• 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
• Demonstrated ability to deliver results in compliance with all local, state, and federal regulatory requirements, including HEDIS.

Nice To Haves

• Experience in health plan case management, utilization management or quality management or equivalent combination of education and experience preferred
• NCQA or URAC Accreditation experience strongly preferred.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Responsibilities

• Accountable for the performance and results of teams focused on delivering care management programs and services that support members mental and physical wellbeing and health.
• Supports implementation of an industry leading health strategies that are integrated with utilization management, pharmacy, and provider network teams.
• Works closely with cross-functional leaders to clarify goals and priorities and create operational plans to ensure successful execution of initiatives.
• Prepares and presents program summaries, and outcomes to various committees, levels of stakeholders and executive leadership.
• Represents program goals and initiatives with various audiences, internal and external.
• Supports evaluation and recommendations regarding use of vendors to support health strategies.
• Provides clinical expertise and leadership to improve the quality and cost of care delivered to members through provider partnerships.
• Collaborates with Medical Directors, Health Informatics, Provider Services and other departments as needed to collect, analyze, and report on health utilization trends and effectiveness of programs, quality and outcomes.
• Aligns health program strategy and goals with organization's vision and strategy.
• Champions and creates a sense of urgency within the organization related to evolving health programs.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Director