EXECUTIVE DIRECTOR, UC SELF-FUNDED HEALTH PLANS

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Department Overview
Systemwide Benefits Programs & Strategy manages and creates health benefits strategy and programs that enhance the well-being of our employees and their families. The Benefits Programs and Strategy unit is made up of three areas: Health and Welfare Benefits, Retirement Savings Programs, Benefits Information Systems. The unit is responsible for the development, design, maintenance and financials of the university-wide health and welfare programs and policies governing the faculty and staff plans; development of guidelines and practices to ensure that the programs are in compliance with university policies and applicable federal and state laws and regulations; management of the vendors administering the health and welfare and Retirement Savings programs assuring the quality of contracted services, compliance activities and reporting associated with the third party vendors. Also, all three areas in Benefits Programs and Strategy serve as consultants and subject matter experts to faculty, unions, senior management and campus/medical center HR. In addition, the unit provides business systems support for the administration of health and welfare programs and operations as well as retirement programs and operations. Benefits Programs and Strategy also manages UC Retirement At Your Service (UCRAYS), which is the retirement portal that serves faculty, staff and retirees.

Position Summary
The University of California is evolving its employee health benefits with the ever changing landscape of health care, due in part to the passage of the Affordable Care Act in 2014. UC has chosen to move from fully-insured to self-insured health benefits for its employees. UC is taking risk for all its health plans except Kaiser, covering about 200,000 employees, retirees, spouses and dependents. The members are enrolled in an ACO arrangement with an HMO, high deductible plans, PPO and companion Medicare plans. Members are encouraged through the plan designs to see UC providers. In return, the UC academic medical centers have offered significant discounts to the plans for their services. UC Health has pledged to provide innovation and population health management to meet these goals. The Executive Director provides leadership for these plans and is responsible for their success. In 2015, the University spent $1.3 billion in premiums to provide coverage for the services provided by the plans. The unit budget is $6.5 million. Employee health plans leverage our mutually beneficial relationship with our Medical Centers. Self-funding provides control and ability to impact the quality of care to employees and retirees; customize products to meet our needs and ultimately saves money, while keeping more of the dollars spent on services within the UC System. This role is responsible for the overall leadership and direction of all UC-self-insured employee and medical resident programs as performed by subordinate managers. The Executive Director sets the strategic direction through recommendations to an Executive Steering Committee and co-chairs the Joint Operating Committee with the Vice President of Human Resources. This role creates, develops and implements programs to meet changing demands and ensures protection and cost consideration of our plan members. The ideal candidate will provide overall leadership, direction, and support to UC Health staff and Executive Sponsors, to achieve its collective mission. The Executive Director ensures and fosters strong relationships with collaborative partners, increased visibility and financial strength of the self-insured plans within our organization. The Executive Director leads a team that has built a strong shared collaborative culture and practice among its staff and campus partners. Our organizational culture deeply values communication across the organization, inclusiveness, integrity, personal and professional growth, empowerment, creativity, initiative and collaboration. Please note this is a hybrid position.

Key Responsibilities

20% Financial Operations and Sustainability - Provides fiscal oversight of the health plans, including contracts, budgets, and statements of financial position. Ensures sustainable financial health of the self-funded health plans. Oversees use of stop loss insurance to limit UC risk, if applicable. Manages organizational budget and financial statements in consultation with Office of the President staff, consultants and constituents. Provides regular and transparent communication to leadership, staff and campuses about organizational finances. Leads a budgetary process that includes ongoing assessment of budgetary goals and actual performance and adjusts as needed in collaboration with staff. Directs staff and consultants to prepare monthly/quarterly report cards for executive sponsors and Joint Operating Committee; leads Program Directors to ensure the best in class operations are in place and that overall monitoring of financial and regulatory requirements associated with self-insured plans are in place.

20% Strategy - Oversees staff who monitor contracted network and is decision maker about tiering and discounts, in consultation with the Executive Steering Committee. Spearheads short-, medium- and long-term strategies for UC Care, Blue & Gold and other self-insured plans. Key relationship holder and figurehead representing the self-funded plans with campuses, specifically ones with medical centers; reports on operations of self-funded and risk bearing plans to medical center leadership; integrates with the campus Medical Directors to ensure medical management and utilization practices are in place; helps navigate working across the 10 campus and 5 medical center system; travels to each campus and medical center as needed and builds relationship with campus partners. Develops plan benefit design and programs that encourage employee members to use UC providers.

20% Leadership and Management - Co-leads monthly Joint Operating Committee meetings under the shared governance structure with Human Resources. Reports and makes recommendations to cross-functional Executive Steering Committee on plan operations. Provides expert consultative services to the Faculty Health & Welfare Healthcare Task Force and Academic Council meetings by presenting on plan operations and other items as requested. Drives and ensures ongoing program quality, consistent program evaluation, and advocates for adequate financial and personnel capacity to sustain programmatic work. Provides guidance, counsel and support to staff in developing, sustaining and refining programmatic work. Actively nurtures a work environment and organizational culture of empowerment, collaboration, personal and professional growth, direct and transparent communication, self-care and mutual support. Manages a staff of 5-9 people and additional consultants. Maintains consistent and transparent systems of staff evaluation and feedback. Drives and ensures effective systems to track results, outcomes and successes used for both internal and external communications. Supports growth that matches the organizational and programmatic strategic planning goals and ensures regular evaluation of progress toward these goals. Leads the administrative team in advancing the organization's financial and organizational goals. Facilitates cross collaboration and integration between programs to further the mission and vision of the University. Regularly interacts with senior management across the system.

20% Plan Administration - Leads staff in RFP process for plan administrators, manages staff during implementation of new administrators. Sets policy and is the ultimate point person for plan administrator partners for problem resolution. Negotiates rates with UC providers. Creates and oversees implementation of new plans as needed.

15% Rate Setting, Determination of Benefits and Employee Contribution Strategy - Leads annual process to set rates for self-funded plans, including interacting with Human Resources, consultants and other key stakeholders. Primary decision-maker on covered benefits, changes in network. Key contributor to determination of employee contribution methodology.

5% Clinical Programs and Population Health Management - In conjunction with the Chief Medical Officer of Self-Funded Plans, create innovative programs to improve employee health and control cost, such as wellness, behavioral health and integrated medicine. Represents UC Health in negotiations with health plans relative to the success of ACO arrangements with UC providers. Makes and implements pharmacy plan benefit changes upon recommendations from the Chief Medical Officer, PBM and other pharmacy managers as necessary.

Experience
Preferred Qualifications

• Ten years experience managing the implementation and administration of health benefit programs, preferably self-funded plans. Extensive experience in the combination of private health plans, healthcare finance, delivery systems; preference for individuals having worked with the design, implementation and operation of health plan programs. In-depth experience with Population Health Management, Health Information Technology, mobile health solutions, health data analytics. Demonstrated knowledge of federal and state health care laws, regulations affecting physician and non-physician practice, facility operations, health plan administration, political processes and legislative activity, financing and administration. Demonstrated strong project management skills and implementation expertise.

• Minimum 2 years working at the systemwide level in Benefits

Skills and Abilities
Preferred Qualifications

• Must possess demonstrated in-depth knowledge of self-insurance and demonstrated ability to translate knowledge into long-term strategic initiatives that can be implemented across the system.

• Demonstrated and sophisticated ability to build consensus on strategies among leaders/peers/staff and across different reporting structures and entities. Able to drive executive teams and multidisciplinary groups.

• Excellent communication both verbally and in writing as evidenced by the ability to communicate with campus and health care constituents at all levels, including the C suite.

• Strong and effective presentations skills, understanding of presentation techniques and best practices, monitors and incorporates new developments related to presentation technology and techniques.

• Meticulous attention to detail as demonstrated by regularly verifying all work thoroughly to ensure accuracy; skill to follow up on unresolved issues.

• Demonstrated general knowledge of legal, insurance and health plan terminology and concepts.

• Proven experience influencing stakeholders and successfully negotiating policy positions or business development activities to achieve objectives. Drives work through strong leadership, influencing skills and strong healthcare knowledge.

• In-depth experience in health plan strategy (e.g. product development, markets, branding, government partnerships) or leading health plan operations (e.g. membership management / benefits administration and optimization, revenue cycle).

• Strong business acumen with excellent strategic and analytical thinking capacity.

Education
Required Qualifications

• Bachelor's degree in Business Administration, Public Health Administration, Human Resources, Educational Administration or an allied field and at least fifteen years of related health experience for an organization or an equivalent combination of education, training, and experience. In place of the above requirements, the incumbent may possess any combination of relevant education and expe