CareOregon, Inc.
Director, Regional Operations---------------------------------------------------------------This position is responsible for directing the integration and execution of network, clinical and operational strategy for a Coordinated Care Organization (CCO). Work is focused on enterprise-wide engagement, as well as regional operations. Primary duties include operational planning and oversight, as well as resource, relationship, and people management. This position operates as a core member of the leadership team, working closely with the Medical Director, Behavioral Health Director, and Community Health Partnerships Director to assure financial sustainability and integration of CCO-funded programs, including Quality Pool payments, risk share funds, VBPs and/or other CCO-derived investments for clinical performance. The position is a part of the leadership matrix within the CCO and CareOregon to meet CCO strategic initiatives and mission. This position also provides input into strategic plans for the broader organization.
NOTE: This position is for the CPCCO region which includes Columbia, Clatsop, and Tillamook counties.**Estimated Hiring Range:**$152,415.00 - $186,285.00**Bonus Target:**Bonus - SIP Target, 10% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.---------------------------------------------------------------## **Essential Responsibilities**Technical Leadership* Lead the execution of strategic initiatives, plans, and goals in alignment with organizational vision and goals.* Direct work of various departmental staff and regional partners to design and implement clinical initiatives that further quality, access, equity and/or cost and utilization goals for Medicaid and Medicare LOB.* Develop internal systems and measures to ensure effective, efficient, and compliant CCO operations.* Develop, regularly monitor, and report on metrics performance and other CCO measures including regulatory reporting required by the CCO.* Implement and oversee effective systems to ensure access, program integrity, quality of clinical care, utilization management, compliance with OARs and other regulatory standards, systems, and technology security.* Partner with CareOregon departments and CCO leadership teams to develop, implement, direct, and oversee programs and policies that provide clinical and operational integration to accomplish CCO strategic goals.* Report to CCO Board of Directors on collaborative initiatives and works with the CCO Executive to support the governance structure to be highly effective in meeting goals.* Support creation of structures to ensure effective and balanced matrixes, as well as reporting, transparency, financial viability, and accountability for clinical and operational initiatives.* Partner with CCO Medical Director to lead the Clinical Advisory Panel and other Board Committees as appropriate to ensure effective clinical input and oversee the operational implementation of all relevant projects and program initiatives.* Ensures delivery of quality performance targets for the CCO, effective input and appropriate escalation and resolution of issues.* Direct clinical transformation initiatives and staff in support of CCO strategic priorities.* Lead innovation, process review, and improvement efforts.* May serve as a chair for key projects and initiatives.Strategic/Operational Planning* Lead the internal strategic planning process in development of vision, goals, and strategic plans and success indicators.* Develop initiatives and programs, including cost savings and revenue optimization programs to support the achievement of CCO strategic initiatives.* Provide input into the strategic plans of the organization.* Maintain a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.Financial/Resource Management* Recommend and manage budgets in alignment with short- and long-term CCO plans.* Manage resources to ensure priorities are accomplished.* Approve resource allocations within budget, including people, finances, and timelines; makes decisions on exceptions.Relationship Management* Lead effective communications and matrices with CO department Vice Presidents and other internal leaders, with emphasis on Contracting, Finance, Network & Health Plan Operations, Population Health, Behavioral Health, Dental, Evaluation & Informatics, and NEMT, ensuring a collaborative culture and alignment with CCO objectives and priorities.* Build and ensure effective relationships across internal teams and external organizations for current or future integration of workplans, resources and outcomes.* Partner with internal leaders and managers in identifying improvement plans and processes.* Represent the CCO in external meetings and functions, providing productive leadership presence and effectiveness.Employee Supervision* Direct team(s) and establish team direction and goals in alignment with the organizational mission, vision, and values.* Build cohesion horizontally across CareOregon and CCO staff by managing matrixed teams.* Identify work and staffing models; recruit, hire, and oversee a team to meet work needs, using an equity, diversity, and inclusion lens.* Identify department priorities; ensure employees have information and resources to meet job expectations.* Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.* Manage, coach, motivate, and guide employees; promote employee development.* Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.* Ensure team adheres to department and organizational standards, policies, and procedures.* Evaluate employee performance and provide regular feedback to support success; recognize strong performance and addresses performance gaps and accountability (corrective action).* Perform supervisory tasks in collaboration with Human Resources as needed.### **Experience and/or Education**Required* Minimum 10 years’ operational and/or clinical work experience, including 3 years in managed care or innovative care models/quality improvementPreferred* Coursework in Public Health or Healthcare Administration or related field* Leadership experience in change management of a clinical delivery system or managed care organization* Experience in Medicaid, quality assurance, utilization review, case management, and/or risk adjustment* Experience with CareOregon or other CCO operations and deliverables* Minimum 4 years’ experience in a supervisory position## Knowledge, Skills and Abilities RequiredKnowledge* Knowledge of managed health care, applicable laws, and relationship value with provider networks* Strong understanding of how the functions of a business work and relate to one another* Understanding of financial structures, fiscal responsibility, and the economic impact of business decisionsSkills and Abilities* Ability to design and lead regional clinical integration strategy among cross-functional teams* Excellent collaboration skills for work with network providers and internal employees* Ability to build and maintain professional relationships with business, community, and internal management groups* Ability to balance strategic and operational thinking* Ability to plan, organize, manage, and monitor CCO operations* Skilled in budget management and oversight* Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives* Leadership effectiveness, analytical capability, and ability to design and implement constructive change* Ability to develop and lead staff, including hiring, goal setting, coaching, performance management, #J-18808-Ljbffr
NOTE: This position is for the CPCCO region which includes Columbia, Clatsop, and Tillamook counties.**Estimated Hiring Range:**$152,415.00 - $186,285.00**Bonus Target:**Bonus - SIP Target, 10% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.---------------------------------------------------------------## **Essential Responsibilities**Technical Leadership* Lead the execution of strategic initiatives, plans, and goals in alignment with organizational vision and goals.* Direct work of various departmental staff and regional partners to design and implement clinical initiatives that further quality, access, equity and/or cost and utilization goals for Medicaid and Medicare LOB.* Develop internal systems and measures to ensure effective, efficient, and compliant CCO operations.* Develop, regularly monitor, and report on metrics performance and other CCO measures including regulatory reporting required by the CCO.* Implement and oversee effective systems to ensure access, program integrity, quality of clinical care, utilization management, compliance with OARs and other regulatory standards, systems, and technology security.* Partner with CareOregon departments and CCO leadership teams to develop, implement, direct, and oversee programs and policies that provide clinical and operational integration to accomplish CCO strategic goals.* Report to CCO Board of Directors on collaborative initiatives and works with the CCO Executive to support the governance structure to be highly effective in meeting goals.* Support creation of structures to ensure effective and balanced matrixes, as well as reporting, transparency, financial viability, and accountability for clinical and operational initiatives.* Partner with CCO Medical Director to lead the Clinical Advisory Panel and other Board Committees as appropriate to ensure effective clinical input and oversee the operational implementation of all relevant projects and program initiatives.* Ensures delivery of quality performance targets for the CCO, effective input and appropriate escalation and resolution of issues.* Direct clinical transformation initiatives and staff in support of CCO strategic priorities.* Lead innovation, process review, and improvement efforts.* May serve as a chair for key projects and initiatives.Strategic/Operational Planning* Lead the internal strategic planning process in development of vision, goals, and strategic plans and success indicators.* Develop initiatives and programs, including cost savings and revenue optimization programs to support the achievement of CCO strategic initiatives.* Provide input into the strategic plans of the organization.* Maintain a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.Financial/Resource Management* Recommend and manage budgets in alignment with short- and long-term CCO plans.* Manage resources to ensure priorities are accomplished.* Approve resource allocations within budget, including people, finances, and timelines; makes decisions on exceptions.Relationship Management* Lead effective communications and matrices with CO department Vice Presidents and other internal leaders, with emphasis on Contracting, Finance, Network & Health Plan Operations, Population Health, Behavioral Health, Dental, Evaluation & Informatics, and NEMT, ensuring a collaborative culture and alignment with CCO objectives and priorities.* Build and ensure effective relationships across internal teams and external organizations for current or future integration of workplans, resources and outcomes.* Partner with internal leaders and managers in identifying improvement plans and processes.* Represent the CCO in external meetings and functions, providing productive leadership presence and effectiveness.Employee Supervision* Direct team(s) and establish team direction and goals in alignment with the organizational mission, vision, and values.* Build cohesion horizontally across CareOregon and CCO staff by managing matrixed teams.* Identify work and staffing models; recruit, hire, and oversee a team to meet work needs, using an equity, diversity, and inclusion lens.* Identify department priorities; ensure employees have information and resources to meet job expectations.* Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.* Manage, coach, motivate, and guide employees; promote employee development.* Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.* Ensure team adheres to department and organizational standards, policies, and procedures.* Evaluate employee performance and provide regular feedback to support success; recognize strong performance and addresses performance gaps and accountability (corrective action).* Perform supervisory tasks in collaboration with Human Resources as needed.### **Experience and/or Education**Required* Minimum 10 years’ operational and/or clinical work experience, including 3 years in managed care or innovative care models/quality improvementPreferred* Coursework in Public Health or Healthcare Administration or related field* Leadership experience in change management of a clinical delivery system or managed care organization* Experience in Medicaid, quality assurance, utilization review, case management, and/or risk adjustment* Experience with CareOregon or other CCO operations and deliverables* Minimum 4 years’ experience in a supervisory position## Knowledge, Skills and Abilities RequiredKnowledge* Knowledge of managed health care, applicable laws, and relationship value with provider networks* Strong understanding of how the functions of a business work and relate to one another* Understanding of financial structures, fiscal responsibility, and the economic impact of business decisionsSkills and Abilities* Ability to design and lead regional clinical integration strategy among cross-functional teams* Excellent collaboration skills for work with network providers and internal employees* Ability to build and maintain professional relationships with business, community, and internal management groups* Ability to balance strategic and operational thinking* Ability to plan, organize, manage, and monitor CCO operations* Skilled in budget management and oversight* Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives* Leadership effectiveness, analytical capability, and ability to design and implement constructive change* Ability to develop and lead staff, including hiring, goal setting, coaching, performance management, #J-18808-Ljbffr