Senior Director, Enterprise Performance

Job Summary

The Senior Director of Enterprise Performance is responsible for creating an integrated, efficient Enterprise Performance compliance organization. The Senior Director will develop a centralized, integrated, proactive Enterprise and Network-wide oversight and monitoring, performance data management and delegate communications program (Program) to ensure Plan and Network excellence. The Senior Director will ensure that these programs are responsive to regulatory, market, structural, and policy changes. The Senior Director will develop the governance structure, task forces, committees, and other programmatic and tactical components essential to build the infrastructure needed to successfully implement and promote the Program.  

This position is responsible for directing all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Build and maintain a department that will keep abreast of impactful regulatory and policy changes, as well as industry best practices, trends, and innovation specific to L.A. Care’s ecosystem.  Conduct strategic planning to utilize resources in order to meet current and future departmental goals.

Leads three core functions - oversight and monitoring of delegate and internal business processes, collection and validation of data from delegates and internal business units regarding performance and communication with delegates regarding performance (including notices of noncompliance, corrective action plans and management of sanctions). Manages a delegation oversight committee through the communications unit.

Support management of core functions to prevent, detect and correct compliance issues through collaboration with other senior management and peers within L.A. Care Health Plan.

Drives change management efforts to address operational, strategic, or requirements-based revisions to existing processes to ensure that these internal and public, member, and provider-facing documents are up-to-date and consistent with current requirements and policy decisions.

Performs cross-functional analysis of how L.A. Care’s Network and Plan Partners are currently informed of all applicable requirements and L.A. Care make policy decisions; identifies and closes process gaps; designs and implements a protocol and workflows regarding the same. 

Leads efforts to aggregate, analyze, validate, communicate, and systematically track foundational federal, state, accreditation, contractual, and Plan-imposed requirements to identify gaps and opportunities for improved performance. 

Duties Continued

Leads a cross-functional work group to manage a progressive provider discipline process.

Leads a cross-functional effort to assess the current state of the delegation oversight audit program. Define and document future delegate auditing framework requirements and protocols based on best practices. Conduct a gap analysis between future frameworks an existing protocols.

Develops metrics to proactively inform the L.A. Care organization, senior Leadership, and relevant committees of internal and external noncompliance issues and possible risks to enable a diverse set of stakeholders in making informed decisions; ensures appropriate performance improvement, remediation, and corrective action plans are developed and implemented to proactively resolve issues and mitigate risk.

Provide reports and presentations to senior management, internal compliance committees and the L.A. Care Board of Governors.

Supports all aspects of preparing for and responding to internal and regulatory audits; examining audit findings and responding to cited deficiencies; and, making recommendations for corrective actions and monitoring internal and external corrective action plans.

Develop goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:
At least 8 years of experience with legal or regulatory topics; or experience in a complex, high-demand business setting, including oversight of health care provider groups and vendors.
  
At least 8 years of supervisor/management experience or equivalent experience.

Skills

Required:
Effective prioritization and task execution skills in a high-demand environment.

Ability to function independently, anticipate issues and lend solutions, and respond to change and ambiguity, as well as generate and champion ideas and initiatives.

Ability to integrate efforts across units and functions to build a cohesive whole out of operational units and delegated entities.  

Effectively communicate and summarize complex content.

Demonstrated project management skills.

Ability to think strategically think with business risk awareness and analytical and problem-solving capabilities.

Ability to analyze complex problems and formulate effective solutions.

Knowledge of regulatory governance (e.g. California Department of Health Care Services (DHCS), California Department of Managed Health Care (DMHC), and Centers for Medicare and Medicaid Services (CMS) regulatory requirements).
 

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information