Talent.com
No se aceptan más aplicaciones
Vice President of Clinical Operations, Parkland Community Health Plan

Vice President of Clinical Operations, Parkland Community Health Plan

Parkland Health and Hospital SystemIrving, TX, US
Hace 23 días
Tipo de contrato
  • A tiempo completo
Descripción del trabajo

Job Description

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we’ve been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children’s Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job—it’s a passion to serve and improve lives every day.

Disclaimer

The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job.

Primary Purpose

  • Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements.

Minimum Specifications

Education

  • Graduate of an accredited school of nursing required; BSN preferred.
  • Master’s degree in healthcare, business administration or related discipline preferred.

    • Experience

  • Five (5) years of leadership experience in clinical operations required.
  • Three (3) years of experience with Texas Medicaid, Medicaid and / or a Medicaid managed care organization required.
  • STAR / STAR Kids, CHIP and Medicare / Medicare Advantage experience required.
  • Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required.
  • ACA / Marketplace experience preferred.

    • Equivalent Education and / or Experience

  • Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor’s degree.

    • Certification / Registration / Licensure

  • Current and unrestricted licensure as a RN in the State of Texas required.
  • Project management or Six Sigma certification preferred.

    • Required Tests for Placement

    Skills or Special Abilities

  • Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms.
  • Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders.
  • Demonstrated ability to coach and influence for results.
  • Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization.
  • Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals.
  • Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups.
  • Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities.
  • Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services.
  • Knowledge of Texas Medicaid (STAR / CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
  • Ability to analyze data for purposeful improvements in health outcomes.
  • Proficient Microsoft Office and computer skills.

    • Responsibilities

  • Strategy

    • Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals.

  • Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets.
  • Develop integrated population health strategies in coordination with behavioral health.
  • Identify and implement strategies and operational plans for optimal performance.
  • Establish department goals, objectives, and standards of performance for assigned areas of responsibility.
  • Clinical Operations

    • Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members.

  • Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized.
  • Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build / maintain prior authorization tools to reduce employee and provider burden.
  • Facilitates integration of care coordination, long-term care, acute and pharmacy services.
  • Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum.
  • Ensures effective inter-departmental collaboration and interaction between staff and other departments.
  • Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting.
  • Regulatory

    • Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations.

  • Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards.
  • Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary.
  • Works collaboratively with leadership and / or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary.
  • Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies.
  • Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements.
  • Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR / TDI / OIG reports; monitoring submissions of data; monitoring pends / data rejections and correct submissions.
  • Fiscal Management and Operating Budget

    • Operationally responsible for the financial performance of assigned area(s).

  • Promote activities to achieve operational efficiency.
  • Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements.
  • Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets.
  • Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs.
  • Manage staffing levels within established targets.
  • Talent Management

    • Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve.

  • Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work.
  • Accountable for orientation, ongoing education and training, and competency verification for all employees.
  • Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends.
  • Timely completion of employee performance appraisals.
  • Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan.
  • Mentor, coach, and support direct reports with building teamwork, professional development, and education to achieve optimal performance and develop talent.
  • Ensure employee engagement survey participation rates and results meet established targets.
  • Mandatory requirements are completed timely by employees.
  • Required licensure, certification, and / or registry are current and in good standing for all employees.
  • Employee performance is monitored and managed. Consult with the Office of Talent Management as appropriate regarding employee performance concerns and disciplinary action.
  • Professional Accountability

    • Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.

  • Adheres to organizational policies, procedures, and guidelines.
  • Completes assigned training, self-appraisal, and annual health requirements timely.
  • Adheres to hybrid work schedule requirements.
  • Attends required meetings and town halls.
  • Recognizes and communicate ethical and legal concerns through the established channels of communication.
  • Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
  • Maintains confidentiality at all times.
  • Performs other work as requested that is reasonably related to the employee’s position, qualifications, and competencies.

    • Job Accountabilities

  • Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
  • Stays abreast of the latest developments, advancements, and trends in the field by attending seminars / workshops, reading professional journals, actively participating in professional organizations, and / or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  • Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
  • Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
  • Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
  • Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

    • #L1-NB1

    Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

    Crear una alerta de empleo para esta búsqueda

    Of Clinical Parkland • Irving, TX, US

    Ofertas relacionadas
    • Oferta promocionada
    Director of Clinical Services RN (Nonprofit)

    Director of Clinical Services RN (Nonprofit)

    Thrive Women's ClinicDallas, TX, US
    A tiempo completo
    The Director of Clinic Services demonstrates a passion for the mission of the Thrive Women’s Clinic to offer Christ-like love in a compassionate and responsive manner that values the family a...Mostrar másÚltima actualización: hace 14 días
    • Oferta promocionada
    Senior Director of Clinical Services

    Senior Director of Clinical Services

    Behavioral InnovationsCedar Hill, TX, US
    A tiempo completo
    The Senior Director of Clinical Services manages clients and supervises BCBAs to ensure the highest quality of care of all clients in the center. This position is responsible for managing their own ...Mostrar másÚltima actualización: hace 1 día
    • Oferta promocionada
    Director of Clinic Operations Cardiovascular

    Director of Clinic Operations Cardiovascular

    Dallas StaffingDallas, TX, US
    A tiempo completo
    Dir Operations - Clinics is responsible for planning, overseeing, and leading the day-to-day operations of one or more clinics or ambulatory care facilities for Baylor Scott and White Health (BSWH)...Mostrar másÚltima actualización: hace 2 días
    • Oferta promocionada
    Clinical Director / BCBA

    Clinical Director / BCBA

    ICBDPlano, TX, US
    A tiempo completo
    Clinical Director (BCBA) – Texas ABA Centers.Are you a BCBA interested in taking your career in a new direction? Our Clinical Director is responsible for monitoring the daily clinical operati...Mostrar másÚltima actualización: hace 1 día
    • Oferta promocionada
    Center Base Clinical Director - ABA Therapy

    Center Base Clinical Director - ABA Therapy

    Bright achievementsAddison, TX, US
    A tiempo completo
    A leading provider of Applied Behavior Analysis (ABA) therapy dedicated to improving the lives of individuals with autism and related disorders. Our center near Dallas, Texas, offers a support...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Director, Global Clinical Operations - APAC

    Director, Global Clinical Operations - APAC

    Carrot FertilityArlington, TX, US
    A tiempo completo
    Director, Global Clinical Operations - APAC.Carrot is a global, comprehensive fertility and family care platform, supporting members and their families through many of life's most memorable moments...Mostrar másÚltima actualización: hace 1 día
    • Oferta promocionada
    • Nueva oferta
    AVP, Clinical Operations

    AVP, Clinical Operations

    Texas StaffingDallas, TX, US
    A tiempo completo
    Provides strategy and leadership to a team responsible for enterprise clinical operations and program design initiatives. Supports and enables clinicians across Molina to drive desired member outcom...Mostrar másÚltima actualización: hace 22 horas
    • Oferta promocionada
    Director of Transplant Services

    Director of Transplant Services

    LeaderStatDallas, TX, US
    A tiempo completo
    Director of Transplant Services.Parkland Health goals as it pertains to the assigned program priority.Assist in identifying the required framework and build the infrastructure to support an effecti...Mostrar másÚltima actualización: hace 1 día
    • Oferta promocionada
    • Nueva oferta
    Clinic Director

    Clinic Director

    BrightPath BehaviorFlower Mound, TX, United States
    A tiempo completo
    New Clinic Opening! Build your clinical team.Our team is passionate about being part of the positive changes that ABA therapy can bring to our clients, their families, and the community they live i...Mostrar másÚltima actualización: hace 21 horas
    • Oferta promocionada
    Assistant Director of Clinical Services

    Assistant Director of Clinical Services

    Universal Health Services, Inc.DeSoto, TX, United States
    A tiempo completo
    Dallas, has been providing quality health care to the residents of DFW since 1988.Hickory Trail Hospital provides inpatient and day treatment for children, adolescents, adults, and senior adults.Ou...Mostrar másÚltima actualización: hace 18 días
    • Oferta promocionada
    Director of Clinical Operations - Nurse Practitioner

    Director of Clinical Operations - Nurse Practitioner

    Favorite Healthcare StaffingFort Worth, TX, US
    A tiempo completo +1
    Director of Clinical Operations – Nurse Practitioner.Multi-Site Clinical Operations – Cardiology Practice.Fort Worth, TX (Hybrid schedule) – must be able to travel to other clinic...Mostrar másÚltima actualización: hace 2 días
    Clinical Director

    Clinical Director

    Quadrant Health GroupWeatherford, Texas, United States, 76087
    A tiempo completo
    This role involves clinical supervision, program development, quality assurance, and adherence to all regulatory and ethical standards. The Clinical Director will lead a team of dedicated clinicians...Mostrar másÚltima actualización: hace 1 día
    • Oferta promocionada
    VP, Clinical Operations

    VP, Clinical Operations

    Dallas StaffingDallas, TX, US
    A tiempo completo
    Molina Healthcare Services (HCS) works with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, i...Mostrar másÚltima actualización: hace 2 días
    • Oferta promocionada
    Vice President Operations

    Vice President Operations

    Pediatric Home ServiceDallas, TX, US
    A tiempo completo
    Pediatric Home Service is a friendly and professional leader in home health care with a singular passion for and commitment to . As a leader in home health care, we help kids achieve their best...Mostrar másÚltima actualización: hace 4 días
    • Oferta promocionada
    Clinical Director - ABA Therapy

    Clinical Director - ABA Therapy

    Bright achievementsAddison, TX, US
    A tiempo completo
    A leading provider of Applied Behavior Analysis (ABA) therapy dedicated to improving the lives of individuals with autism and related disorders. Our center near Dallas, Texas, offers a support...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    VP Chief Advncmnt Foundation

    VP Chief Advncmnt Foundation

    Parkland Health and Hospital SystemDallas, TX, US
    A tiempo completo
    Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland ...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Director Practice Operations / Surgical Specialty Clinics

    Director Practice Operations / Surgical Specialty Clinics

    Parkland Health and Hospital SystemDallas, TX, US
    A tiempo completo
    Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland ...Mostrar másÚltima actualización: hace más de 30 días
    • Oferta promocionada
    Vice President, Development

    Vice President, Development

    Fort Worth StaffingFort Worth, TX, US
    A tiempo completo
    Since our founding in 1924, we've cut cardiovascular disease deaths in half, but there is still so much more to do.To overcome today's biggest health challenges and accelerate this progress, we nee...Mostrar másÚltima actualización: hace 1 día