The Health Services Department is seeking to fill the vacancy of Health Plan Nurse Program Director in the Contra Costa Health Plan located in Martinez, CA. Under general direction, the incumbent will plan, develop, organize and manage the day-to-day clinical programs, policies and services, as well as participate in special assignments and study projects. Other responsibilities include patient care coordination; providing clinical direction and supervision to licensed personnel; ensuring compliance with contractual, accreditation and regulatory requirements; developing and managing annual department goals; and coordinating department projects and activities to meet budgetary limits and timelines.
The ideal candidate will have a proven track record demonstrating the following:
• Proven Utilization Management experience with Medi-Cal Managed Care and Medical Insurance Organizations • Extensive knowledge in regulatory audits (DHCS, DMHC and NCQA) • Experience in a Union environment • Comprehensive knowledge of Utilization Management clinical guidelines, i.e. Medi-Cal, Apollo and Medicare
Characteristics of the ideal candidate:
• Wide-ranging experience in a health plan setting • Excellent clinical and ancillary staff supervisory experience • Effective interpersonal skills • Ability to maintain effective County, public and internal relationships
Final Filing Date: April 20, 2018
Application Filing: All applicants, including County employees, are to apply on-line at http://www.cccounty.us/hr, and submit the required information as indicated on the job announcement. All applicants must clearly demonstrate that they meet the minimum qualifications provided on the job announcement. Resumes may not be substituted for the official County application. Paper, faxed or late applications WILL NOT be accepted. To view the typical tasks, knowledge, skills and abilities associated with this position, please visit our website to see the detailed job description. EOE