Director, Community Based Programs

Salary Range: $143,972 - $223,156
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status: Exempt

Department: Health Services

Reports To: Vice President, Health Services

Location: San Jose, CA

GENERAL DESCRIPTION OF POSITION

The Director of Community Based Programs (CBP) is responsible for the direct oversight and staff management of internal and external CBP initiatives, program operations, and provider networks. The CBP Director will provide leadership and supervision necessary for strategy and managing operations to address member's Social Determinants of Health (SDOH) and health equity focused on California Advancing and Innovating Medi-Cal (CalAIM) and Population Health Management (PHM). Director shall also ensure integrated care delivery of Home and Community Based Services (HCBS) and resources including Long-Term Services & Support (LTSS) benefits.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily.

1. Ensure compliance with State, Federal, and National Committee for Quality Assurance (NCQA) accreditation standards including regulatory reporting and participation in audits and oversight including, but not limited to Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and Centers for Medicare and Medicaid Services (CMS).
2. Responsible for the development, design and implementation of priorities and annual strategic plan for CBP department and corresponding program work plans for Enhanced Care Management (ECM), Community Supports (CS) programs, SDOH activities, and Community Health Worker (CHW) benefit.
3. Maintain accountability for reporting, submission, compliance, integration, and coordination of care for LTSS, ECM, HCBS, and PHM requirements for Transitional Care Services (TCS).
4. Develop CBP department priorities, strategies and goals, and provide input within the organization for SDOH, HCBS, programs, interventions, and activities to address member's social needs.
5. Provide leadership, vision and management to optimize programs and services provided to members and to leverage opportunities and partnerships with Community-Based Organizations (CBO) and with community stakeholders.
6. Integrate CBP and HCBS operations with all other SCFHP departments/systems, including Health Services per the CalAIM PHM model of care, NCQA accreditation and develop and update corresponding policies and procedures.
7. Manage the development, onboarding, and oversight of the CBP provider network including contracted providers for at least 7 ECM Population of Focus, 14 CS programs, and the CHW supervising providers.
8. Identify health and social needs, and other trends impacting members and residents by collecting data, conducting research and analysis to update SCFHP community engagement and impact strategy as needed to meet changing needs.
9. Lead and collaborate in multi-disciplinary and cross-functional projects and teams to implement improvement efforts, quality/process improvement, optimization of utilization management, and member experience.
10. Manage operations, contracting and provider oversight for specific public initiatives and special projects including, but not limited to efforts to address housing and homelessness, set-aside housing programs, and other incentive payment programs.
11. Manage the inventory, updating and distribution of information about public and community resources for case management and other member-facing departments to address social needs of members. This includes staff training, oversight of community resource platform and participation in local meetings of providers and vendors
12. Oversee all data analytics and reporting for CBP programs including tracking and trending dashboard metrics and timely and accurate regulatory reporting.
13. Provide required training and consultation for external partners, providers, delegates and internal staff on HCBS and CBP program eligibility and processes for referral, closed loop and authorization.
14. Build strategic relationships with community-based organizations, public agencies, and key community stakeholders, increasing their understanding and appreciation of SCFHP; identify and act upon opportunities for participation or partnership in external initiatives/activities in alignment with SCFHP organizational objectives.
15. Participate in and/or represent SCFHP at off-site regulatory, association, community meetings, and events relevant to CBP, SDOH, HCBS. (e.g. County LTSS Integration Committee, In-Home Support Services Advisory Board), and other local convening's and initiatives.
16. Develop an annual budget and plan for CBP operations outlining goals, priorities, tactics, implementation and costs and manage expenses, and monitor performance with budget.
17. Ensure all clinical and quality initiatives are coordinated and meeting objectives.
18. Perform all job functions with integrity and professionalism.
19. Perform any other related duties as required or assigned.

SUPERVISORY/MANAGEMENT RESPONSBILITIES

Carries out supervisory/management responsibilities in accordance with the organization's policies, procedures, applicable regulations and laws. Responsibilities include:

1. Recruiting, interviewing, and hiring.
2. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives.
3. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance.
4. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees' needs, ensuring they have the necessary resources to do their work.
5. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews.

REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Master's Degree in Social Work, Public Administration, Public Health, or a related field or equivalent experience, training, or coursework.
2. Minimum five years of experience managing operations and staffing for medium to large-scale, interdepartmental programs and projects in a public or community based organization. (R)
3. Experience working with Medi-Cal population, managed care plans and the health care provider network. (R)
4. Experience with and knowledge of Santa Clara County public health and community based provider network and systems. (D)
5. Experience in and knowledge of community based organization network and community resources. (R)
6. Experience and expertise with the issues and best practices in SDOH, housing and homelessness, home and community based programs and public health continuum.
7. Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)
8. Self-directed with proven ability to work independently under general direction and minimal supervision; able to assume responsibility, take initiative, follow up on assignments, make appropriate decisions within the scope of the position, handle multiple projects simultaneously and assume accountability for own errors. (R)
9. Strong working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as, Excel, Teams, Google Suite and PowerPoint. (R)
10. Excellent written, verbal, and interpersonal communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R)
11. Ability to think and work under pressure and effectively prioritize and complete tasks within established timeframes. (R)
12. Ability to assume responsibility and exercise sound judgment when make decisions within the scope of this position. (R)
13. Experience leading, developing and managing strategic plans, budgets, and consultants. (R)
14. Ability to understand, analyze, and operationalize regulatory requirements. (R)
15. Experience in staff management including hiring, supervision, coaching, performance evaluation, key performance indicators and quality monitoring. (R)
16. Strong communication skills, both written and verbal with extensive experience developing and delivering presentations and reports. (R)

PHYSICAL ACTIVITIES

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies; and sit or stand for extended periods of time. (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less. (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment. (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone. (R)
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.

EOE