Service, Care Experience Leader
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- Conducts detailed analyses for barriers to high service and access performance; works with department managers to develop effective action plans.
- Facilitates identification of and transfer of successful practices in service and access across departments.
- Monitors and assesses service and access trends locally in the Service Area, as well as the external Southern California market.
- Makes thoughtful recommendations to develop and/or adjust current strategy to meet the changing business environment.
- Sets service and access targets based on benchmarks to increase the Service Area's competitive edge.
- Coaches, manages and develops training materials to build a culture of extraordinary customer service.
- Makes formal presentations to various senior level audiences.
- Ensures NCQA and TJC standards for service and access are met.
- Ensures compliance with regulatory standards, including TJC, NCQA, DMHC, and Medicare, to include responsibility for accurate Encounter coding.
- Manages utilization of appointment resources, overseeing development of demand/supply models and consulting to Chiefs and MSAAT on Effective Utilization of resources, in order to maximize member value and meet regulatory requirements.
- Designs and implements systems improvements which result in a superior care experience by improving patient flow, clinical support , customer service, etc.
- Optimizes Quality patient care through monitoring of systems for access and service, including closed loop message system, Optimal Office Practice Systems, Forms and letters system, etc.
- Provides smooth assimilation of new members into a service area.
- Collaborates with the service area management team to develop the overall strategic business plan.
- Assures short and long-range goals are met by establishing and controlling the processes and systems and ensuring managers are meeting their accountability's.
- Monitors and assesses quality and utilization trends, external environment and internal practices, makes recommendations to develop/adjust strategy to meet the changing business and market conditions.
- Develops, coaches and manages a staff dedicated to providing expertise and customer service.
- Minimum seven (7) years of experience in operational management roles in a health plan or multifaceted health care system and multi-provider settings.
- Master's degree in business, health care, public administration, or related field OR six (6) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Thorough knowledge of quality assurance, quality improvement, utilization review, risk management, and accreditation and licensing process required.
- Thorough knowledge of federal and state laws and regulations.
- Ability to design and implement systems which support access and service.
- Able to determine key business issues and develop effective departmental action plans from multi-disciplinary perspectives.
- Able to think strategically in structuring work results and effecting change.
- Demonstrates ability to lead and manage others through influence and collaboration.
- Contributes to the organization's attainment of service and access goals.
- Participates with peers to ensure the rapid transfer of best practices.
- Excellent leadership, facilitation, and consulting skills.
- Excellent verbal and written communication skills and interpersonal skills.
- Works closely with physician and operational leaders to assist them in meeting performance targets and customer expectations.
- Must be able to work in a Labor/Management Partnership environment.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.