Director, Health Home Programs

Job Category:  Management/Executive
Department:  Safety Net Initiatives
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  3461

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary


The Director of Health Home Programs is responsible for the development of the Health Homes Program (HHP) design, planning and development of the implementation work plan and building the HHP staffing model for approval by L.A. Care Health Plan's Leadership Group and HHP Advisory Council. Obtains HHP stakeholder input on HHP design and implementation plan. Integrates California Department of Health Care Services (DHCS) guidance for HHP and collaborates with respective participating Medi-Cal managed care plans on model development. Acts as a point-of-contact within L.A. Care Health Plan for HHP.  Responsible for the launch and implementation of the HHP. Collaborates with community programs/services that assist members with the provision of social services and supports needed to achieve good health outcomes. Manages and works with assigned staff to develop protocols for relationship-building and collaboration/coordination of services with HHP Community Based-Case Management Entities (CB-CME). Guides the Provider Network Management (PNM) Department's contracting, oversight of, and collaboration with CB-CMEs that are delegated responsibility for the provision of HHP.  Responsible for the training and education programs on HHP. Reviews and approves department budgeting and cost monitoring and ensures HHP services provided are in compliance with State and federal regulations. Supervises and oversees key managers and staff during program implementation. Assures all HHP functions are operating in accordance with L.A. Care Health Plan's mission, values, and strategic goals and that all services are provided in a manner that is responsive and sensitive to the needs of LA Care's culturally diverse membership.

Duties

Identify program design options, including all project considerations and program components, and create HHP implementation work plan for consideration and approval by L.A. Care Leadership Group and HHP Advisory Council, integrating California Department of Health Care Services (DHCS) HHP guidance. Plan core HHP service components, organizational structure within L.A. Care Health Plan, and roles to be integrated across Community Based-Case Management Entities (CB-CME).

Identify CB-CME provider network model and requirements and, in collaboration with Provider Network Management (PNM), select potential CB-CME providers and execute necessary contracts. Develop CB-CME, physician network, and Plan Partner referral, collaboration and monitoring interfaces. Secure dedicated case managers, clinical consultants, community health workers, homeless housing navigators (through CB-CME providers or by contract).

Establish and implement administrative operations (i.e., human resources, information technology, space, telephones, and budget, contracts and expense tracking), training and education programs on HHP for stakeholders (L.A. Care staff, County agencies, members, contracted service providers, Plan Partners, and CB-CME organizations), and health assessment, care planning and health record systems. Collaborate with key L.A. Care administrative, information technology and finance departments for implementation.

Create and maintain effective structures, policies, workflows, and internal operational oversight for up-to-date HHP contracts and agreements, compliance with State and federal contracts (i.e., California DHCS, CMS and Department of Managed Health Care) and regulations, grievance and appeals procedures, other requirements, and integration of HHP services as health plan benefits.

Establish and maintain collaborative relationships with public and private agencies providing services to members. Create structure for Plan Partners cooperation and compliance. Create forums for collaboration and information sharing with CB-CME's. Officiate at events including: Participating in events for HHP

communities; Serving as a presenter in local, State and national forums; Participating in State and local workgroups; Acting as key HHP liaison in interactions with DHCS, CMS and DMHC; Acting as key HHP liaison in community stakeholder and outreach events.

Oversee human relations functions in coordination with the Human Resources Department including creating job descriptions, hiring a HHP Manager and other key staff, and supervising and completing performance appraisals for direct reports in accordance with established policies and procedures. Assure staff have access to and complete appropriate training and educational opportunities. Promote a culturally sensitive work environment.

Develop HHP application and conduct California DHCS and/or Centers for Medicare and Medicaid (CMS) on-site review.

Perform other duties as assigned.

 

 

Education

In lieu of Degree, relevant experience may be considered.

Master's Degree in Social Work, Sociology, or Human Services related field or Public Health/Public Health Administration

Experience

Required:
With Master's Degree: At least 4 years management experience working with seniors and persons with disabilities in diverse settings such as health plans, non-profit organizations, social service agencies, clinics or other civic organizations. 

At least 4 years of management/supervisory experience.

At least 4-5 years in a Director-level in the fields of Social services, Aging or Health Care.

Demonstrated experience in building strong relations with health care providers, vendors, community-based organizations and State and federal agencies.

Demonstrated experience with program and policy development.

Equivalent Experience:
With High School Diploma/GED: At least 12 years of experience working with seniors and persons with disabilities in diverse settings such as health plans, non-profit organizations, social service agencies, clinics or other civic organizations. 

With Associate's Degree: At least 9 years management experience working with seniors and persons with disabilities in diverse settings such as health plans, non-profit organizations, social service agencies, clinics or other civic organizations. 

With Bachelor's Degree:  At least 4 years management experience working with seniors and persons with disabilities in diverse settings such as health plans, non-profit organizations, social service agencies, clinics or other civic organizations.

Professional Licenses

Professional Certifications


 

Required Training

Additional Information

Required:
Knowledge of managed care and Medicare and Medi-Cal benefit programs.

Demonstrated sensitivity to the diverse needs of the most vulnerable populations in Los Angeles.

Excellent public speaking skills with a track record of presenting to health consumer groups, advocacy organizations and community-based organizations.

Ability to effectively organize meetings, trainings and events.

Demonstrated experience with program and policy development.

Knowledge of the California Department of Health Care Services (DHCS) structure and function.

Excellent interpersonal, communication and analytic skills.

Effective time management, organizational and project management skills.

Proficiency with Microsoft Word, Excel, Outlook and PowerPoint.

Strongly Preferred Professional Licenses: LCSW or RN

 

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

Job Segment: Medical, Social Services, Public Health, Medicare, Medicaid, Healthcare, Service