This position will be accountable for the performance of a portfolio of Medical Management initiatives and the implementation of the Health Equity Cultural Competency Program. The candidate must reside in the state of California. This role is responsible for the overall planning, management, and effective implementation and support of initiatives to create value across clinical operations areas such as care management, utilization management, outreach programs, and other services related to both physical and behavioral health. The position evaluates specialty companies/vendors, defines business terms during contracting, and partners with these entities, Corporate departments, and other health plan departments to lead the implementation of new medical management programs. It oversees or directly manages a team responsible for project management, performance improvement, and clinical analytics. The role collaborates with internal and external stakeholders to identify, develop, and implement innovative programs to improve outcomes. It promotes an environment of cultural competence by identifying and implementing culturally-inclusive best practices and innovations, such as developing provider trainings to improve cultural awareness and competency. The role partners with community, regional, and statewide organizations to identify collaboration opportunities for culturally competent programs and services. It assesses the cultural diversity of the provider network to identify resources and gaps, including needs analysis for non-traditional providers, and develops recommendations for credentialing and network development. The position monitors and evaluates provider practices through KPIs within health equity dashboards to assess and improve cultural competence, addressing care gaps and aligning interventions. It is responsible for implementing population-specific activities, including training and awareness through media, and partnering with external equity stakeholders. The role identifies trends in specific populations, recommends interventions, identifies population health disparities, and creates outreach, community activities, and innovative programming to engage in services. Finally, it creates and implements a comprehensive, outcomes-based Cultural Competency Plan aligned with CLAS standards and national/regional priorities, incorporating data-driven assessments and defining a strategy for continuous improvement.
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Job Type
Full-time
Career Level
Senior