Health Insurance Operations Director jobs in Petaluma, CA

Petaluma Health Center is an eleven-time award winner in the North Bay Business Journal's Best Places to Work for 2020, 2019, 2018, 2017, 2016, 2015, 2014, 2013, 2012, 2011 and 2009 and we were named as one of the Healthiest Companies in the North Bay' by the North Bay Business Journal for the last 5 consecutive years.

The Petaluma Health Center's mission is to provide high quality health care with access for all in Southern Sonoma County & West Marin. We pride ourselves on our Patient-Centered care while maintaining an engaging environment for our staff. The Center accomplishes this mission through collaborative, innovative programs, services and referral resources that meet the economic needs of the entire community.

FULL TIME EMPLOYEE BENEFITS:

• 21 Days of Paid Time Off
• 10 Paid Holidays
• Medical Insurance (Entire deductible paid by us!)
• 30 Chiropractor and Acupuncture visits per year included with enrollment in our health insurance plans (Kaiser and WHA)
• Dental Insurance
• Vision Insurance
• Gym Membership Discounts at Active Wellness Center and 24-Hour Fitness!
• 401K Matching after 1 year of employment
• Flexible Spending Account, Dependent Care FSA
• Life Insurance (included at no cost to the employee)
• Long Term Disability (included at no cost to the employee)
• Employee Assistance Program (included at no cost to the employee)

Summary: Direct the overall operations and program development of the Behavioral Health, Social Service
and Complex Care Department in accordance with Joint Commission and Patient Centered Medical Home
standards. Develop and oversee health center policies and procedures to assist qualified patients in
transitions and plans of care that improve level of health and functioning. Directly supervises the Associate
Operations Director of BH, BH Leaders, Case Management Nurse Manager, Director of Homeless Services
and Patient Navigators. Provides leadership and guidance to patient navigators to enhance connections to
social services.

Areas of Responsibility:

Planning and Strategy

• Collaborate with senior leadership to plan, develop, organize, implement, evaluate, and direct the BH,

complex care and social service programs utilizing federal, state, and grant funding to ensure financial
sustainability of services

• Maintain a clear and transparent framework for qualification for services, services delivered, timeline

for entry and graduation from social services, and transition planning for patients.

• Oversee maintenance of a community and social services referral file of agencies and organizations

that aid patients

• Develop and maintain collaborative relationships with internal and external stakeholders
• Create curricula and business plans as needed for emerging treatment programs, shared

medical visits and group visits
Operational Oversight

• Responsible for the planning, supervision and coordination of BH, Social Services and Complex

Care services across all sites in collaboration with the clinical medical leadership.

• Continually evaluate and monitor full portfolio of Behavioral Health, Complex Care and Social

Services offerings to ensure ongoing program development and that patient needs are being met
and in compliance with regulatory standards

• Develops, analyzes, monitors, and presents data and reports as relevant to Clinical

and Operational leaders

• Works with managers to optimize staffing, appointment schedules, and workflows, to achieve

targeted goals for services

• Ensures departments are appropriately resourced for the efficient functioning

of clinical services in Behavioral Health and Complex Care
Management and Supervision of Staff

• Manages the Clinical Behavioral Health Leaders (LCSWs), Case Management Nurse Manager, and

Patient Navigators

• Hires, oversees training and reviews performance of staff
• Communicates to staff changes in policies and procedures
• Conducts quarterly and annual employee reviews based on job functions and e stablished productivity

and quality standards

• Day to day management
• Ensure departments have appropriate staffing
• Serve as a resource for staff: new information, questions, challenging patients and

situations, escalation path

• Provides in-service/training in revisions of policies as needed
• Assures the BH and Complex Care Department credentialing and privileging processes are carried out
• Responsible for recruitment, hiring, development and training of all BH and Complex Care staff
• Communicates with COO: personnel issues, budget updates, operational issues and recommended

solutions to issues

• Creates monthly reports on program/department activities
• Works collaboratively and effectively with directors and managers to ensure the goals, mission and

vision of the organization

• Functions as a liaison between the department employees, primary care clinical leaders, and the

Senior Leadership team
Project Management of Grants-Funded Projects:

• Ensures successful and timely implementation of grants-funded projects, drafts grant programmatic

and financial reports, and ensures that grant funding is spent in accordance to contract timeframes
Quality Improvement and Compliance:

• Assist in the development, administering, and coordinating of department policies and

procedures. Ensures adherence to PHC policies, procedures, and standards regarding:
quality improvement, customer service, patient access, productivity, confidentiality,
management of electronic medical records, billing, and facility needs.

• Keep abreast of current federal and state regulations, as well as professional standards,

and make recommendations on changes program direction as well as policies and
procedures according to new/updated regulations.

• Leads and facilitates process improvements in patient access measures, clinic flow, patient

experience and population-based initiatives

• Audits compliance to HRSA, CSM, and Joint Commission (JC) standards that regulate

services provided

• In collaboration with managers, responsible for ensuring an excellent patient experience

and that patient complaints and/or grievances are addressed and resolved in a timely and
responsive manner

• Collects, organizes and summarizes data for performance measurement, internal and external

reporting and decision-making. Works closely with Behavioral Health and Complex Care
teams to ensure that target measures and initiatives supporting the organizational strategic
plan are met

• Develops, reviews and updates policies, procedures, consent forms, processes and systems,

management, training, and evaluation plans that help support efficient clinic workflows,
productivity, quality improvement and customer service

• Manages complaints, concerns, as needed.

Financial Responsibility:

• Creates budget strategy for the BH and Complex Care Departments based on PHC strategic plan,

and develops the budget in collaboration with CMO and COO

• Accountable for ensuring financial stability of services by monitoring clinical and operational

performance goals

• Tracks and approves operational expenses within budget guidelines
• Coordinates with finance and billing department to ensure efficient and compliant billing practices
• Strategically identifies, develops, requests, and monitors grant opportunities in order to maximize

the financial health of the BH and Complex Care Departments
Additional Duties as assigned

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability
required.

Education/Experience:

• LCSW preferred
• Minimum of five (5) years of related behavioral health/social work experience
• One to Two (1-2) years of administrative experience
• Familiarity with quality and process improvement methodology
• Working knowledge of federal and state regulations that impact clinic operations, including

HIPAA, Title 22, Medi-Cal, 42 CFR and HRSA

• Effective problem solving and ability to analyze and use data for decision making
• Ability to embrace and manage diversity to build and maintain successful teams
• Effectively interact with people and develop positive relationships while being tactful,

respectful, and direct in communication

• Ability to work flexible and extended hours and travel between sites as needed
• Experience related to achieving large project and initiative goals
• Experience working in a Joint Commission Accredited Ambulatory and Behavioral Health setting with

Patient Centered Medical Home, and/or other team-based models of care preferred

• Capacity to train and mentor others with superior interpersonal skills achieving results through

a collaborative effort
Licenses and Certifications:

• Candidate must be able to successfully meet PHC’s credentialing and privileging requirements

Language Skills: Ability to effectively present information and respond to questions and requests from
patients, co-workers, and others as necessary. Bilingual in English and Spanish, both written and verbal
strongly preferred.

Compensation Range: $125,000-$145,000 yearly