Requisition ID: 7 Location: US-UT-Ogden Specialty: Physician - Leadership Position Type: Full Time HR Rep / Recruiter: Marquise Courseault Contact: Overview Responsibilities Are you a physician leader ready to elevate your career while making a meaningful impact across multiple communities? We're seeking a passionate and strategic Assistant Practice Medical Director (AMD) to join our leadership team in Ogden, Utah . This role offers a unique opportunity to partner closely with the Practice Medical Director and collaborate with a council of peers?including the Assistant Vice President of Operations?to shape the future of care delivery across three dynamic hospital sites: Ogden Regional Medical Center , Lakeview Hospital , and Davis Hospital . What You'll Do: As the AMD, you'll serve as a key clinical leader, helping to guide and support our physicians while ensuring excellence in patient care, operational efficiency, and professional development. Your responsibilities will include: Partnering with the Practice Medical Director, hospital administration, and community stakeholders to align clinical goals with organizational strategy Ensuring high standards of care across all sites Managing coverage schedules and optimizing physician productivity Leading utilization review and quality improvement initiatives Serving as a liaison to universities, medical groups, and professional societies Driving professional program development and physician engagement Coordinating clinical activities with business operations to ensure seamless care delivery The area is served by three major hospitals: Ogden Regional Medical Center - A Level II trauma center offering comprehensive emergency and surgical services Lakeview Hospital - A Level III trauma center known for personalized care and a strong focus on community health Davis Hospital and Medical Center - A full-service facility providing advanced medical care across specialties About the Area: Located just 45 minutes north of Salt Lake City, Ogden is a vibrant regional hub known for its diverse healthcare offerings and scenic beauty. Ogden appeals to those seeking a balanced lifestyle ?with proximity to nature and a welcoming community atmosphere. Whether you have a young family or you someone looking to relocate for a slower pace with big-city access, Ogden offers a compelling mix of opportunity and livability. Qualifications Board-certified in Neonatology, with a minimum of 3 years of experience. Benefits and Compensation Our clinicians enjoy a competitive compensation package, with many locations offering sign-on bonuses and relocation. Take great care of the patient, every day and every way. TM At Pediatrix & Obstetrix, that's not only our motto at work each day; it's also how we view our employees and their families. We know that our greatest asset is YOU. We take pride in offering comprehensive benefits in a vast array of plans that fit your life and lifestyle, supporting your health and overall well-being. Benefits offered include, but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs, as well as a 401k plan and Employee Stock Purchase Program. Some benefits are provided at no cost, while others require a cost share between employees and the company. Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions. Our benefit programs are just one of the many ways Pediatrix & Obstetrix helps our employees take care of themselves and their families. About Us Pediatrix Medical Group is one of the nation's leading providers of highly specialized health care for women, babies and children. Since 1979, Pediatrix has grown from a single neonatology practice to a national, multispecialty medical group. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. The group's high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives. Please Note: Fraudulent job postings/job scams are becoming increasingly common. All genuine Pediatrix job postings can be found through the Pediatrix Careers site: . Pediatrix is an Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. PI
10/24/2025
Full time
Requisition ID: 7 Location: US-UT-Ogden Specialty: Physician - Leadership Position Type: Full Time HR Rep / Recruiter: Marquise Courseault Contact: Overview Responsibilities Are you a physician leader ready to elevate your career while making a meaningful impact across multiple communities? We're seeking a passionate and strategic Assistant Practice Medical Director (AMD) to join our leadership team in Ogden, Utah . This role offers a unique opportunity to partner closely with the Practice Medical Director and collaborate with a council of peers?including the Assistant Vice President of Operations?to shape the future of care delivery across three dynamic hospital sites: Ogden Regional Medical Center , Lakeview Hospital , and Davis Hospital . What You'll Do: As the AMD, you'll serve as a key clinical leader, helping to guide and support our physicians while ensuring excellence in patient care, operational efficiency, and professional development. Your responsibilities will include: Partnering with the Practice Medical Director, hospital administration, and community stakeholders to align clinical goals with organizational strategy Ensuring high standards of care across all sites Managing coverage schedules and optimizing physician productivity Leading utilization review and quality improvement initiatives Serving as a liaison to universities, medical groups, and professional societies Driving professional program development and physician engagement Coordinating clinical activities with business operations to ensure seamless care delivery The area is served by three major hospitals: Ogden Regional Medical Center - A Level II trauma center offering comprehensive emergency and surgical services Lakeview Hospital - A Level III trauma center known for personalized care and a strong focus on community health Davis Hospital and Medical Center - A full-service facility providing advanced medical care across specialties About the Area: Located just 45 minutes north of Salt Lake City, Ogden is a vibrant regional hub known for its diverse healthcare offerings and scenic beauty. Ogden appeals to those seeking a balanced lifestyle ?with proximity to nature and a welcoming community atmosphere. Whether you have a young family or you someone looking to relocate for a slower pace with big-city access, Ogden offers a compelling mix of opportunity and livability. Qualifications Board-certified in Neonatology, with a minimum of 3 years of experience. Benefits and Compensation Our clinicians enjoy a competitive compensation package, with many locations offering sign-on bonuses and relocation. Take great care of the patient, every day and every way. TM At Pediatrix & Obstetrix, that's not only our motto at work each day; it's also how we view our employees and their families. We know that our greatest asset is YOU. We take pride in offering comprehensive benefits in a vast array of plans that fit your life and lifestyle, supporting your health and overall well-being. Benefits offered include, but are not limited to: Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs, as well as a 401k plan and Employee Stock Purchase Program. Some benefits are provided at no cost, while others require a cost share between employees and the company. Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions. Our benefit programs are just one of the many ways Pediatrix & Obstetrix helps our employees take care of themselves and their families. About Us Pediatrix Medical Group is one of the nation's leading providers of highly specialized health care for women, babies and children. Since 1979, Pediatrix has grown from a single neonatology practice to a national, multispecialty medical group. Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices. The group's high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives. Please Note: Fraudulent job postings/job scams are becoming increasingly common. All genuine Pediatrix job postings can be found through the Pediatrix Careers site: . Pediatrix is an Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. PI
About Avalon Healthcare Solutions: Avalon Healthcare Solutions is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans nationwide, the company covers over 44+ million lives and delivers 10-20% proven outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in real-time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs. Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. Avalon is a high growth company where every associate has an opportunity to make a difference. Avalon has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive quality clinical outcomes and proven savings. When you look at how we bring this to life, we offer Lab Insights solutions that work together to arm you with critical lab-driven insights to accelerate your value-driven care success. This is the first-of-its-kind suite of solutions to help you achieve the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per-member cost of healthcare. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve. For more information about Avalon, please visit . About Vice President, Account Management position: The Vice President, Account Management is responsible for overall client satisfaction, retention, and growth within an assigned book of business. This role is accountable for developing and cultivating long-term relationships with key client stakeholders and executive leaders, while monitoring program service delivery for clients and working cross-functionally within Avalon. The Vice President, Account Management is responsible for driving contract renewals, service expansion, and executing on strategic growth opportunities within the current clients. This position also drives client strategy and growth to Avalon. This role reports to the Executive Vice President, Account Management This position is eligible for remote work, but regular business travel will be required, including Avalon's corporate office located in Tampa, Florida. Vice President, Account Management - Essential Functions and Responsibilities: Build strong partnerships and rapport with all levels of the clients' organization; represent the voice of the customer Understand client's competitive environment and challenges Consult with clients to understand business priorities for expansion and innovation Develop and lead the execution of cross-functional client strategic plans, including the development of effective value propositions to increase volume and profitability from Avalon network providers Work collaboratively with clients and internal partners to translate requests into actionable strategies and tactics to improve performance and deliver value Manage client contracts, facilitate deliverables, and drive initiatives Understands complex client financial arrangements and strategies Drives contract renewals including amendment execution Proactively review performance metrics to promote client satisfaction and work to anticipate needs and exceed client's expectations Works directly with the client to understand, represent, and drive client operational requirements throughout the organization Manages the execution of standard client requirements Responsible to ensure communication of the root cause and resolution path for operational issues that impact the assigned client Maintains appropriate documentation regarding change orders, operational issues, and problem resolution Vice President, Account Management - Minimum Qualifications: 15+ years' experience in healthcare account management and/or selling into payers Bachelor's degree or significant and relevant direct work experience in lieu of degree Willingness and ability to travel up to 30% of the week to client sites and providers, as needed Strong analytical skills and proven ability to problem solve Proven experience in selling service expansion opportunities Ability to work cross-functionally to proactively communicate and to resolve issues with the appropriate sense of urgency Proven success in matrix environment Strong verbal and written communication skills Ability to interact effectively with counterparts at their assigned clients Knowledge of the healthcare industry, payers, and regulations Vice President, Account Management - Preferred Qualifications: Experience in a start-up or early-stage company helpful Knowledge of reference laboratory business, esoteric tests and processes strongly desired Experience working with Medicare and Medicaid programs Master's degree in Business, Marketing, or Healthcare Administration PM18 PI45104bbfa5-
10/23/2025
Full time
About Avalon Healthcare Solutions: Avalon Healthcare Solutions is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans nationwide, the company covers over 44+ million lives and delivers 10-20% proven outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in real-time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs. Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. Avalon is a high growth company where every associate has an opportunity to make a difference. Avalon has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive quality clinical outcomes and proven savings. When you look at how we bring this to life, we offer Lab Insights solutions that work together to arm you with critical lab-driven insights to accelerate your value-driven care success. This is the first-of-its-kind suite of solutions to help you achieve the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per-member cost of healthcare. You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve. For more information about Avalon, please visit . About Vice President, Account Management position: The Vice President, Account Management is responsible for overall client satisfaction, retention, and growth within an assigned book of business. This role is accountable for developing and cultivating long-term relationships with key client stakeholders and executive leaders, while monitoring program service delivery for clients and working cross-functionally within Avalon. The Vice President, Account Management is responsible for driving contract renewals, service expansion, and executing on strategic growth opportunities within the current clients. This position also drives client strategy and growth to Avalon. This role reports to the Executive Vice President, Account Management This position is eligible for remote work, but regular business travel will be required, including Avalon's corporate office located in Tampa, Florida. Vice President, Account Management - Essential Functions and Responsibilities: Build strong partnerships and rapport with all levels of the clients' organization; represent the voice of the customer Understand client's competitive environment and challenges Consult with clients to understand business priorities for expansion and innovation Develop and lead the execution of cross-functional client strategic plans, including the development of effective value propositions to increase volume and profitability from Avalon network providers Work collaboratively with clients and internal partners to translate requests into actionable strategies and tactics to improve performance and deliver value Manage client contracts, facilitate deliverables, and drive initiatives Understands complex client financial arrangements and strategies Drives contract renewals including amendment execution Proactively review performance metrics to promote client satisfaction and work to anticipate needs and exceed client's expectations Works directly with the client to understand, represent, and drive client operational requirements throughout the organization Manages the execution of standard client requirements Responsible to ensure communication of the root cause and resolution path for operational issues that impact the assigned client Maintains appropriate documentation regarding change orders, operational issues, and problem resolution Vice President, Account Management - Minimum Qualifications: 15+ years' experience in healthcare account management and/or selling into payers Bachelor's degree or significant and relevant direct work experience in lieu of degree Willingness and ability to travel up to 30% of the week to client sites and providers, as needed Strong analytical skills and proven ability to problem solve Proven experience in selling service expansion opportunities Ability to work cross-functionally to proactively communicate and to resolve issues with the appropriate sense of urgency Proven success in matrix environment Strong verbal and written communication skills Ability to interact effectively with counterparts at their assigned clients Knowledge of the healthcare industry, payers, and regulations Vice President, Account Management - Preferred Qualifications: Experience in a start-up or early-stage company helpful Knowledge of reference laboratory business, esoteric tests and processes strongly desired Experience working with Medicare and Medicaid programs Master's degree in Business, Marketing, or Healthcare Administration PM18 PI45104bbfa5-
Nemours Children s Health is seeking a strategic and collaborative physician leader to serve as Chief Medical Officer and Vice President in Pensacola, FL. The successful candidate will be a proven leader with a minimum of ten years of relevant health care leadership experience in leading initiatives in clinical, quality, safety, research, education and training. All candidates must be eligible for an unrestricted Florida medical license and DEA and have working knowledge of applicable national, state and local laws and regulatory requirements affecting medical and clinical staff. Board certification in any of the following specialties is preferred: neonatology, pediatric gastroenterology, pediatric nephrology, pediatric critical care or pediatric hospital medicine. Key Responsibilities Supports and actively leads the clinical, quality and safety, research, and education & training components of the Nemours Mission. Demonstrates strong interpersonal and collaborative leadership skills and proven ability to be viewed as a trusted clinical leader capable of driving change and achieving whole child health. Actively engages and strengthens relationships with the referring physician community. Collaborates with Nemours partner organizations in Northwest Florida and supports philanthropic endeavors. Holds primary responsibility for the operational and financial performance of the Northwest Florida physician practice. Works collaboratively with North Florida senior regional leaders to assure the efficient and safe clinical operations of Nemours multispecialty practice in Northwest Florida. Partners with CMO of the Studer Family Children s hospital (SFCH) to provide oversight of Nemours physicians and APPs practicing at SFCH. Holds primary responsibility for the clinical quality and safety of Northwest Florida operations in collaboration with the Nemours Chief Quality and Safety Officer for Central and North Florida. Provides regular reports to the Florida Board of Managers, specifically regarding initial and reappointments of clinicians to the Nemours Medical Staff in Florida. Serves as a member of the Nemours Medical Executive Committee in Florida and supports the Nemours Medical Staff Services team. Serve as a liaison with the Medical Staff and partner with the President of the Medical Staff to ensure effective Medical Staff operations, including highly engaged and effective Medical Staff committee structure and for regulatory compliance specific to the Medical Staff. Actively collaborates with Nemours other physician and administrative leaders throughout Florida and the Nemours Enterprise, partnering to achieve strategic goals and fulfilling the Nemours Mission and Vision. Leads, demonstrates, and supports the Nemours Standards of Behavior and organizational culture. Actively supports family-centered care philosophy embraced by Nemours. Actively supports and leads Nemours Continuous Improvement (CI) activities, whether specific to Northwest Florida or enterprise wide. Provides leadership to facilitate and drive a culture of high reliability and the moves to practice standardization. Actively supports the dual-region Florida network development strategy, as a key supporting member of the network operations team to expand the Nemours clinical network and develop community hospital partnerships throughout North and Central Florida. Leads the development and execution of the strategic provider recruitment plan for Northwest Florida. Nurtures personal and professional growth and development by attending appropriate conferences and establishing external professional affiliations at the State and National levels. Develops and maintains an understanding of regulations governing physician and hospital operations required by the Centers for Medicare and Medicaid Services (CMS), the Florida Agency for Health Care Administration (AHCA), other State of Florida health care regulatory and licensing agencies, and Joint Commission. Supports and advocates for the development of Nemours Graduate Medical Education (GME) and Undergraduate Medical Education (UME) programs to enable the training of highly capable and qualified medical professionals, in partnership with the Designated Institutional Official for Nemours in North Florida. Partners with North Florida President and VP for strategy/business development on expansion and purposeful growth opportunities in Northwest Florida. About the Team At Nemours Children s, our providers and associates work together across specialties, clinics and hospitals, to give children care that's among the safest, most caring and compassionate. As part of a pediatric health system with both clinical and academic partnerships, we are 100% focused on ensuring a healthier future for children. We strive for excellent outcomes across all of our medical and surgical specialties - and we measure these outcomes in order to provide consistent, top-rated care. We aspire to build a workforce of providers that support the needs of the communities we serve and create a sense of belonging for our patients and families. Nemours Children s is committed to equal opportunity in welcoming candidates of all backgrounds to apply. Any preference or exclusion based on a protected characteristic is strictly prohibited. To learn more, click here . Nemours Children s Health, Pensacola In Pensacola, Nemours Children's provides specialized pediatric care for Northwest Florida and South Alabama kids, newborns to age 18, with common and complex conditions. Our experienced teams work closely with researchers and other Nemours Children s specialists to offer the most comprehensive care possible. In addition to board-certified pediatric specialists selected as some of the Best Doctors in America , year after year, families choose us for: Advanced cardiac care as one of the few accredited pediatric transthoracic and fetal echocardiography labs in Florida Certified Center of Excellence by the American Diabetes Association (ADA) Nationally accredited Cystic Fibrosis Care Center Academic affiliation with Florida State University College of Medicine to help train tomorrow s health care leaders Pensacola, FL Living in Pensacola offers a unique blend of coastal beauty and Southern charm. The city boasts stunning white sandy beaches along the Gulf Coast, perfect for outdoor activities like swimming, surfing and relaxing. Pensacola also has a rich history, seen in its well-preserved historic downtown and attractions like the National Naval Aviation Museum. Residents enjoy a relaxed pace of life, a strong sense of community and a variety of cultural events and festivals throughout the year. About Us Nemours Children s Health is an internationally recognized children s health system. Warning: It has come to our attention that fraudulent individuals are contacting people offering false job opportunities from Nemours Children s Health. Learn More. To apply for this position and view it in more detail, please use the following URL:
10/22/2025
Full time
Nemours Children s Health is seeking a strategic and collaborative physician leader to serve as Chief Medical Officer and Vice President in Pensacola, FL. The successful candidate will be a proven leader with a minimum of ten years of relevant health care leadership experience in leading initiatives in clinical, quality, safety, research, education and training. All candidates must be eligible for an unrestricted Florida medical license and DEA and have working knowledge of applicable national, state and local laws and regulatory requirements affecting medical and clinical staff. Board certification in any of the following specialties is preferred: neonatology, pediatric gastroenterology, pediatric nephrology, pediatric critical care or pediatric hospital medicine. Key Responsibilities Supports and actively leads the clinical, quality and safety, research, and education & training components of the Nemours Mission. Demonstrates strong interpersonal and collaborative leadership skills and proven ability to be viewed as a trusted clinical leader capable of driving change and achieving whole child health. Actively engages and strengthens relationships with the referring physician community. Collaborates with Nemours partner organizations in Northwest Florida and supports philanthropic endeavors. Holds primary responsibility for the operational and financial performance of the Northwest Florida physician practice. Works collaboratively with North Florida senior regional leaders to assure the efficient and safe clinical operations of Nemours multispecialty practice in Northwest Florida. Partners with CMO of the Studer Family Children s hospital (SFCH) to provide oversight of Nemours physicians and APPs practicing at SFCH. Holds primary responsibility for the clinical quality and safety of Northwest Florida operations in collaboration with the Nemours Chief Quality and Safety Officer for Central and North Florida. Provides regular reports to the Florida Board of Managers, specifically regarding initial and reappointments of clinicians to the Nemours Medical Staff in Florida. Serves as a member of the Nemours Medical Executive Committee in Florida and supports the Nemours Medical Staff Services team. Serve as a liaison with the Medical Staff and partner with the President of the Medical Staff to ensure effective Medical Staff operations, including highly engaged and effective Medical Staff committee structure and for regulatory compliance specific to the Medical Staff. Actively collaborates with Nemours other physician and administrative leaders throughout Florida and the Nemours Enterprise, partnering to achieve strategic goals and fulfilling the Nemours Mission and Vision. Leads, demonstrates, and supports the Nemours Standards of Behavior and organizational culture. Actively supports family-centered care philosophy embraced by Nemours. Actively supports and leads Nemours Continuous Improvement (CI) activities, whether specific to Northwest Florida or enterprise wide. Provides leadership to facilitate and drive a culture of high reliability and the moves to practice standardization. Actively supports the dual-region Florida network development strategy, as a key supporting member of the network operations team to expand the Nemours clinical network and develop community hospital partnerships throughout North and Central Florida. Leads the development and execution of the strategic provider recruitment plan for Northwest Florida. Nurtures personal and professional growth and development by attending appropriate conferences and establishing external professional affiliations at the State and National levels. Develops and maintains an understanding of regulations governing physician and hospital operations required by the Centers for Medicare and Medicaid Services (CMS), the Florida Agency for Health Care Administration (AHCA), other State of Florida health care regulatory and licensing agencies, and Joint Commission. Supports and advocates for the development of Nemours Graduate Medical Education (GME) and Undergraduate Medical Education (UME) programs to enable the training of highly capable and qualified medical professionals, in partnership with the Designated Institutional Official for Nemours in North Florida. Partners with North Florida President and VP for strategy/business development on expansion and purposeful growth opportunities in Northwest Florida. About the Team At Nemours Children s, our providers and associates work together across specialties, clinics and hospitals, to give children care that's among the safest, most caring and compassionate. As part of a pediatric health system with both clinical and academic partnerships, we are 100% focused on ensuring a healthier future for children. We strive for excellent outcomes across all of our medical and surgical specialties - and we measure these outcomes in order to provide consistent, top-rated care. We aspire to build a workforce of providers that support the needs of the communities we serve and create a sense of belonging for our patients and families. Nemours Children s is committed to equal opportunity in welcoming candidates of all backgrounds to apply. Any preference or exclusion based on a protected characteristic is strictly prohibited. To learn more, click here . Nemours Children s Health, Pensacola In Pensacola, Nemours Children's provides specialized pediatric care for Northwest Florida and South Alabama kids, newborns to age 18, with common and complex conditions. Our experienced teams work closely with researchers and other Nemours Children s specialists to offer the most comprehensive care possible. In addition to board-certified pediatric specialists selected as some of the Best Doctors in America , year after year, families choose us for: Advanced cardiac care as one of the few accredited pediatric transthoracic and fetal echocardiography labs in Florida Certified Center of Excellence by the American Diabetes Association (ADA) Nationally accredited Cystic Fibrosis Care Center Academic affiliation with Florida State University College of Medicine to help train tomorrow s health care leaders Pensacola, FL Living in Pensacola offers a unique blend of coastal beauty and Southern charm. The city boasts stunning white sandy beaches along the Gulf Coast, perfect for outdoor activities like swimming, surfing and relaxing. Pensacola also has a rich history, seen in its well-preserved historic downtown and attractions like the National Naval Aviation Museum. Residents enjoy a relaxed pace of life, a strong sense of community and a variety of cultural events and festivals throughout the year. About Us Nemours Children s Health is an internationally recognized children s health system. Warning: It has come to our attention that fraudulent individuals are contacting people offering false job opportunities from Nemours Children s Health. Learn More. To apply for this position and view it in more detail, please use the following URL:
Parkland Health Hospital System
Grand Prairie, Texas
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/20/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/20/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/20/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/20/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/20/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/20/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/06/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/06/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Parkland Health & Hospital System
Arlington, Texas
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/06/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Parkland Health & Hospital System
Grand Prairie, Texas
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/06/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Parkland Health & Hospital System
Fort Worth, Texas
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/06/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
10/06/2025
Full time
Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Disclaimer The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job. Primary Purpose Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements. Minimum Specifications Education Graduate of an accredited school of nursing required; BSN preferred. Master's degree in healthcare, business administration or related discipline preferred. Experience Five (5) years of leadership experience in clinical operations required. Three (3) years of experience with Texas Medicaid, Medicaid and/or a Medicaid managed care organization required. STAR/STAR Kids, CHIP and Medicare/Medicare Advantage experience required. Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required. ACA/Marketplace experience preferred. Equivalent Education and/or Experience Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree. Certification/Registration/Licensure Current and unrestricted licensure as a RN in the State of Texas required. Project management or Six Sigma certification preferred. Required Tests for Placement Skills or Special Abilities Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms. Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders. Demonstrated ability to coach and influence for results. Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization. Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals. Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups. Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities. Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Knowledge of Texas Medicaid (STAR/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Ability to analyze data for purposeful improvements in health outcomes. Proficient Microsoft Office and computer skills. Responsibilities Strategy Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals. Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets. Develop integrated population health strategies in coordination with behavioral health. Identify and implement strategies and operational plans for optimal performance. Establish department goals, objectives, and standards of performance for assigned areas of responsibility. Clinical Operations Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members. Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized. Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build/maintain prior authorization tools to reduce employee and provider burden. Facilitates integration of care coordination, long-term care, acute and pharmacy services. Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum. Ensures effective inter-departmental collaboration and interaction between staff and other departments. Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting. Regulatory Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations. Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards. Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary. Works collaboratively with leadership and/or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary. Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies. Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements. Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR/TDI/OIG reports; monitoring submissions of data; monitoring pends/data rejections and correct submissions. Fiscal Management and Operating Budget Operationally responsible for the financial performance of assigned area(s). Promote activities to achieve operational efficiency. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements. Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets. Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs. Manage staffing levels within established targets. Talent Management Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve. Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work. Accountable for orientation, ongoing education and training, and competency verification for all employees. Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends. Timely completion of employee performance appraisals. Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan. Mentor, coach, and support direct reports with building teamwork, professional development . click apply for full job details
Join a Legacy of Innovation 125 Years and Counting! Daiichi Sankyo Group is dedicated to the creation and supply of innovative pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and technology. With more than 125 years of scientific expertise and a presence in more than 20 countries, Daiichi Sankyo and its 18,000 employees around the world draw upon a rich legacy of innovation and a robust pipeline of promising new medicines to help people. In addition to a strong portfolio of medicines for cardiovascular diseases, under the Group's 2025 Vision to become a "Global Pharma Innovator with Competitive Advantage in Oncology," Daiichi Sankyo is primarily focused on providing novel therapies in oncology, as well as other research areas centered around rare diseases and immune disorders. Summary The Senior Director of Clinical Operations will manage clinical operations staff to ensure the effective and efficient execution of operational aspects of clinical study planning, implementation, data delivery and reporting.Will represent DSPD Clinical Operations in a range of cross-functional groups, global functional committee(s) and initiatives intended to enhance function and company efficiency and productivity, regionally and globally. Will represent Clinical Operations on vendor governance bodies and ensure ongoing collaboration and communication with internal stakeholders.Detailing The Senior Director will ensure a robust communication plan including status and timing of operational deliverables are in place for all studies and programs. Will support the development of policies, procedures and training relevant to the Clinical Operations function. Will ensure that global and local clinical studies are executed, in adherence to Good Clinical Practices (GCPs), appropriate Standard Operating Procedures (SOPs) and relevant regulations Food and Drug Administration (FDA) regulations/EU Directive, and International Conference on Harmonization (ICH) guidelines. A key focus will be the oversight of and interactions with CROs and other external vendors to ensure studies are conducted according to the timeline, budget and quality measures set forth by the Study teams. This leader will also ensure a robust escalation and communication plan is in place for each CRO to best support each program. This position will require line management responsibility of Directors, Associate Directors, Clinical Study Managers, who are primarily responsibility for the clinical operational and overall delivery and tactical execution of the clinical studies. The senior director will ensure a strong focus on competencies supportive of project management; vendor management and stakeholder management. At this level, the incumbent may be expected to serve as Program level Delivery Lead on large and/or complex programs, including those involving co-development (Alliance) partners. The Early Development (ED) Asset Lead will provide operational expertise for early oncology studies including FIH trials and will possess the scientific knowledge to enable operational understanding of deliverables. The ED Asset lead will be able to understand the priorities and needs of the assets within Early Development. They will provide operational insight to Program strategies across multiple assets with one or more potential indications. The ED Asset Lead will be the operational representative on governance bodies (for example Oncology Early Development committee - OEDC). As the operational governance body representative, they will contribute to the understanding of the operational impacts of study design and planning. They will identify areas of opportunities to gain efficiencies and reduce timelines and costs for associated studies. They will work closely with Directors, Study Teams, and/or CRO leadership to ensure close site relationships (such as our Network sites) and drive the CRO to quality, cost, and shortened timelines wherever possible. The ED Asset Lead will be able to appropriately manage resources across Study Management resources to ensure flexible resourcing and robust planning when possible. The ED Asset Lead will maintain strong relationships and collaboration with our DSJ counterparts. Responsibilities: Provide outstanding leadership skills based on a sound knowledge of clinical research standards and GCP. Develop operational strategies for implementation of clinical studies regionally/globally in conjunction with project teams and other cross functional departments. Ensure consistent and successful execution of all operational aspects of regional and global studies as appropriate, data delivery and reporting. Accountable for the effective support of clinical activities within the Development organization. Ensure a "Quality Mindset" is in place across the organization by focusing on detailed plans to monitor the conduct of our studies, the management of our vendors and working closely with our QA organization to implement ongoing learnings from regulatory inspections. Engage and motivate Clinical Operations employees to execute the strategy through collaboration and transparent communication. Member of the Clinical Operational leadership team and global clinical operations committee enabling cross functional and regional collaboration, delivery of regional and global objectives and implementation of process improvements. Contribute to the development and review of regional / global policies and procedures. Ensure compliance with all Company and Regulatory requirements. Work with outsourcing procurement management to optimize the vendor governance structure, incorporate performance metrics, and contribute to outsourcing discussions. May be asked to represent the Clinical Operations Department at senior management meetings on behalf of the Study Management Group Heads and/or Vice President, Clinical Development Operations. Contribute to and/or lead in the development and growth of the Study Management Organization by identifying efficiencies, cost effectiveness and improved ways of working. Provide leadership to Clinical Operations staff and to project teams for Vendor evaluation, selection , management and quality based oversight Provide guidance and training to Clinical Operational members of clinical study teams Develop best practices and lessons learned mechanisms within Clinical Operations Develop risk assessment & risk management and clinical project management competencies within Clinical Operations Work in collaboration with Quality Management and Quality Assurance to develop and implement quality activities within Clinical Operations Design, update and implement appropriate innovative and best-in-class procedures and SOP's related to clinical study planning and execution, in collaboration with relevant functions Assist in implementing TMF quality standards Assist in developing and overseeing the implementation of CAPA in relation to sponsor's audit or regulatory inspections and ensure lessons learned are developed and shared. Support the Study Management Group Heads and Vice President of Clinical Operations and above in establishing and maintaining an organizational structure and staffing to effectively accomplish the Clinical Operations goals and objectives. Responsible for the management and leadership of all staff within the Clinical Operations group including recruitment, training, mentoring, work assignments, performance evaluations and discipline of staff. Accountable for performance management, coaching and development of staff ensuring effective talent management. Plan career development and assess training requirements of Clinical Operations employees and contractors. Responsible for the development of adequate training programs to maximize employee potential. Anticipate resource issues and plan remedial action. Assist with staff training and orientation for new employees. Develop staff by assigning them with their responsibilities, establishing goals that will increase knowledge / skill levels and delegate tasks commensurate with skill level. Qualifications: Successful candidates will be able to meet the qualifications below with or without a reasonable accommodation. Education Qualifications (from an accredited college or university) Bachelor's Degree in Life Sciences and a minimum of 12 years' experience in pharmaceutical or biotechnology drug development required or Master's Degree and a minimum of 10 years' relevant experience in pharmaceutical or biotechnology drug development with a MS/MPH preferred PharmD 7 years with PharmD/PhD Experience Qualifications Experience in clinical or basic research in a Pharmaceutical company, a Medical device/Diagnostic company, Academic Research Organization (ARO) or Contract Research Organization (CRO). CRA experience is preferred. Time spent directly in a medical environment (e.g. as a Study Site Coordinator) is also considered relevant preferred Experience developing, implementing and building clinical operations infrastructure including SOPs and managing vendors preferred Records Management experience in a GCP environment preferred Technology enablement in a global business preferred Travel Ability to travel up to 20% In-house office position that may require some travel (domestic or global) Daiichi Sankyo, Inc. is an equal opportunity/affirmative action employer. Qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Salary Range: $222,150.00 - $370,250.00Download Our Benefits Summary PDF
10/04/2025
Full time
Join a Legacy of Innovation 125 Years and Counting! Daiichi Sankyo Group is dedicated to the creation and supply of innovative pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and technology. With more than 125 years of scientific expertise and a presence in more than 20 countries, Daiichi Sankyo and its 18,000 employees around the world draw upon a rich legacy of innovation and a robust pipeline of promising new medicines to help people. In addition to a strong portfolio of medicines for cardiovascular diseases, under the Group's 2025 Vision to become a "Global Pharma Innovator with Competitive Advantage in Oncology," Daiichi Sankyo is primarily focused on providing novel therapies in oncology, as well as other research areas centered around rare diseases and immune disorders. Summary The Senior Director of Clinical Operations will manage clinical operations staff to ensure the effective and efficient execution of operational aspects of clinical study planning, implementation, data delivery and reporting.Will represent DSPD Clinical Operations in a range of cross-functional groups, global functional committee(s) and initiatives intended to enhance function and company efficiency and productivity, regionally and globally. Will represent Clinical Operations on vendor governance bodies and ensure ongoing collaboration and communication with internal stakeholders.Detailing The Senior Director will ensure a robust communication plan including status and timing of operational deliverables are in place for all studies and programs. Will support the development of policies, procedures and training relevant to the Clinical Operations function. Will ensure that global and local clinical studies are executed, in adherence to Good Clinical Practices (GCPs), appropriate Standard Operating Procedures (SOPs) and relevant regulations Food and Drug Administration (FDA) regulations/EU Directive, and International Conference on Harmonization (ICH) guidelines. A key focus will be the oversight of and interactions with CROs and other external vendors to ensure studies are conducted according to the timeline, budget and quality measures set forth by the Study teams. This leader will also ensure a robust escalation and communication plan is in place for each CRO to best support each program. This position will require line management responsibility of Directors, Associate Directors, Clinical Study Managers, who are primarily responsibility for the clinical operational and overall delivery and tactical execution of the clinical studies. The senior director will ensure a strong focus on competencies supportive of project management; vendor management and stakeholder management. At this level, the incumbent may be expected to serve as Program level Delivery Lead on large and/or complex programs, including those involving co-development (Alliance) partners. The Early Development (ED) Asset Lead will provide operational expertise for early oncology studies including FIH trials and will possess the scientific knowledge to enable operational understanding of deliverables. The ED Asset lead will be able to understand the priorities and needs of the assets within Early Development. They will provide operational insight to Program strategies across multiple assets with one or more potential indications. The ED Asset Lead will be the operational representative on governance bodies (for example Oncology Early Development committee - OEDC). As the operational governance body representative, they will contribute to the understanding of the operational impacts of study design and planning. They will identify areas of opportunities to gain efficiencies and reduce timelines and costs for associated studies. They will work closely with Directors, Study Teams, and/or CRO leadership to ensure close site relationships (such as our Network sites) and drive the CRO to quality, cost, and shortened timelines wherever possible. The ED Asset Lead will be able to appropriately manage resources across Study Management resources to ensure flexible resourcing and robust planning when possible. The ED Asset Lead will maintain strong relationships and collaboration with our DSJ counterparts. Responsibilities: Provide outstanding leadership skills based on a sound knowledge of clinical research standards and GCP. Develop operational strategies for implementation of clinical studies regionally/globally in conjunction with project teams and other cross functional departments. Ensure consistent and successful execution of all operational aspects of regional and global studies as appropriate, data delivery and reporting. Accountable for the effective support of clinical activities within the Development organization. Ensure a "Quality Mindset" is in place across the organization by focusing on detailed plans to monitor the conduct of our studies, the management of our vendors and working closely with our QA organization to implement ongoing learnings from regulatory inspections. Engage and motivate Clinical Operations employees to execute the strategy through collaboration and transparent communication. Member of the Clinical Operational leadership team and global clinical operations committee enabling cross functional and regional collaboration, delivery of regional and global objectives and implementation of process improvements. Contribute to the development and review of regional / global policies and procedures. Ensure compliance with all Company and Regulatory requirements. Work with outsourcing procurement management to optimize the vendor governance structure, incorporate performance metrics, and contribute to outsourcing discussions. May be asked to represent the Clinical Operations Department at senior management meetings on behalf of the Study Management Group Heads and/or Vice President, Clinical Development Operations. Contribute to and/or lead in the development and growth of the Study Management Organization by identifying efficiencies, cost effectiveness and improved ways of working. Provide leadership to Clinical Operations staff and to project teams for Vendor evaluation, selection , management and quality based oversight Provide guidance and training to Clinical Operational members of clinical study teams Develop best practices and lessons learned mechanisms within Clinical Operations Develop risk assessment & risk management and clinical project management competencies within Clinical Operations Work in collaboration with Quality Management and Quality Assurance to develop and implement quality activities within Clinical Operations Design, update and implement appropriate innovative and best-in-class procedures and SOP's related to clinical study planning and execution, in collaboration with relevant functions Assist in implementing TMF quality standards Assist in developing and overseeing the implementation of CAPA in relation to sponsor's audit or regulatory inspections and ensure lessons learned are developed and shared. Support the Study Management Group Heads and Vice President of Clinical Operations and above in establishing and maintaining an organizational structure and staffing to effectively accomplish the Clinical Operations goals and objectives. Responsible for the management and leadership of all staff within the Clinical Operations group including recruitment, training, mentoring, work assignments, performance evaluations and discipline of staff. Accountable for performance management, coaching and development of staff ensuring effective talent management. Plan career development and assess training requirements of Clinical Operations employees and contractors. Responsible for the development of adequate training programs to maximize employee potential. Anticipate resource issues and plan remedial action. Assist with staff training and orientation for new employees. Develop staff by assigning them with their responsibilities, establishing goals that will increase knowledge / skill levels and delegate tasks commensurate with skill level. Qualifications: Successful candidates will be able to meet the qualifications below with or without a reasonable accommodation. Education Qualifications (from an accredited college or university) Bachelor's Degree in Life Sciences and a minimum of 12 years' experience in pharmaceutical or biotechnology drug development required or Master's Degree and a minimum of 10 years' relevant experience in pharmaceutical or biotechnology drug development with a MS/MPH preferred PharmD 7 years with PharmD/PhD Experience Qualifications Experience in clinical or basic research in a Pharmaceutical company, a Medical device/Diagnostic company, Academic Research Organization (ARO) or Contract Research Organization (CRO). CRA experience is preferred. Time spent directly in a medical environment (e.g. as a Study Site Coordinator) is also considered relevant preferred Experience developing, implementing and building clinical operations infrastructure including SOPs and managing vendors preferred Records Management experience in a GCP environment preferred Technology enablement in a global business preferred Travel Ability to travel up to 20% In-house office position that may require some travel (domestic or global) Daiichi Sankyo, Inc. is an equal opportunity/affirmative action employer. Qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Salary Range: $222,150.00 - $370,250.00Download Our Benefits Summary PDF
Description This position is incentive eligible. Introduction Do you have the career opportunities as a Division Laboratory Director you want with your current employer? We have an exciting opportunity for you to join Tristar Health which is part of the nation's leading provider of healthcare services, HCA Healthcare. This position requires travel within the TriStar Division. Applicants must reside in or willing to relocate to Nashville, TN to be considered. Benefits Tristar Health offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a Division Laboratory Director where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications GENERAL SUMMARY OF DUTIES: The primary responsibilities of the Division Director of Laboratory Services: Coordinates with Service Line leadership to provide assessment and consulting services to Division and Facility leadership for HCA facilities. Provides consultative services to other HBP service lines, as needed Directs activities in one or more HCA Hospitals on matters related to the provision of quality, efficient and cost effective services With an emphasis on collaboration, implements strategies and tactics to promote the development of team members Executes operational assessments as directed Manages multiple engagements concurrently, including: management of division laboratory activities, on site interviews, current state process improvement, utilization analysis, operating model implementations, current state/future gap analysis, financial analysis and budgeting, and billing analyses. Knowledgeable and capable of working with key stakeholder groups to coordinate activities including other Service Line resources, Division leadership, medical director (pathology), Performance Improvement, laboratory leaders, Supply Chain, etc. Develops and maintains strong working relationships with other operating groups within HCA such as IT&S, Supply Chain, etc. Communicate regularly as required, (weekly, biweekly or monthly) for operating reports MORs with the Service Line leadership, Division Presidents, Division CFOs and the Divisions' hospitals' CEOs. Ensure all internal approvals prior to executing recommendations. DUTIES INCLUDE BUT NOT LIMITED TO: Supports the Laboratory Service Line to execute on laboratory service opportunities in assigned division including: Implementation of laboratory test (ordering), facility test menu, and equipment platform formularies, as well as other Service Line objectives Coordination/centralization of laboratory services within geographic region, Optimization of market based contracting and adherence to HPG/HCA contracts, Reference testing vendor selection and utilization, Assessment of client and commercial outreach business profitability Billing compliance and charge capture Assists in implementing best practices regarding laboratory quality and operations Ensures facility laboratory readiness for ongoing successful regulatory accreditation. Works collaboratively with all levels of HCA, Service Lines, Divisions, and Hospital leadership to assess and identify options. Thrives in a matrixed environment Utilizes sophisticated processes and systems to gather and analyze critical information required to conduct a thorough assessment and develop comprehensive recommendations. Reviews all recommendations with Service Line leadership to ensure alignment with Service Line strategy and presents sophisticated presentations to relevant stakeholder groups. Understands the critical nature of laboratory services that are vital to the operations of HCA Hospitals and that failure to perform the duties of this position and result in the disruption and delay of vital patient care services. Leads the development and training of a team of high functioning laboratory directors who can assist in the execution of the duties delineated herein Continually monitors and stays abreast of legislative and regulatory changes affecting laboratory services. Takes initiative to develop steps and processes in an effort to proactively identify areas of opportunity. Interacts with Physician leadership to ensure practice business needs are met and performance is sustainable. Communicates the Laboratory Services suite of services effectively throughout all levels of the organization and represents the Service Line in professional manner. Executes the strategic direction of the Service Line, Division, and Hospitals' CEOs. Interacts on a regular basis with Division and facility leadership to ensure their services and clinical operations needs are met: o Works with Service Line and Division Leadership assess ability of operating models or partnerships to meet HCA enterprise financial and operational goals. Manages financial performance to budget and prior period trends and understands causes of variances. Resolving any clinical quality/operational/financial issues in a timely manner. Keeps lines of communication open between Division Leadership and the Service Line Recommends corrective action as required to eliminate negative variances. Meets regularly with direct reports to ensure their effective involvement in Service Line, division and facility strategic initiatives. What qualifications you will need: Bachelor's Degree in Medical Technology or Laboratory Science is required. Master's or above Degree in Business, Healthcare Administration, other applicable field is preferred. Professional organization association required. Clinical laboratory experience required. Minimum of 5- years' experience in laboratory, at a director level and/or laboratory consulting. Effective working knowledge of healthcare systems management, hospital/laboratory management, healthcare financial management, and third-party reimbursement issues, and clinical operations. This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved). Integrated Regional Labs is a full service providerfor clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients withtimely diagnostic information for patient care. Our infrastructure includes a fullyautomated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo,Florida, and a network of hospital based rapid-response laboratories present in fourHCA Healthcare divisions within the state of Florida. Our core laboratories support more than250 acute and rehab hospitals, physician practices, surgery centers and commercialaccounts. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for thedelivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Division Laboratory Director opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! . click apply for full job details
10/02/2025
Full time
Description This position is incentive eligible. Introduction Do you have the career opportunities as a Division Laboratory Director you want with your current employer? We have an exciting opportunity for you to join Tristar Health which is part of the nation's leading provider of healthcare services, HCA Healthcare. This position requires travel within the TriStar Division. Applicants must reside in or willing to relocate to Nashville, TN to be considered. Benefits Tristar Health offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a Division Laboratory Director where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications GENERAL SUMMARY OF DUTIES: The primary responsibilities of the Division Director of Laboratory Services: Coordinates with Service Line leadership to provide assessment and consulting services to Division and Facility leadership for HCA facilities. Provides consultative services to other HBP service lines, as needed Directs activities in one or more HCA Hospitals on matters related to the provision of quality, efficient and cost effective services With an emphasis on collaboration, implements strategies and tactics to promote the development of team members Executes operational assessments as directed Manages multiple engagements concurrently, including: management of division laboratory activities, on site interviews, current state process improvement, utilization analysis, operating model implementations, current state/future gap analysis, financial analysis and budgeting, and billing analyses. Knowledgeable and capable of working with key stakeholder groups to coordinate activities including other Service Line resources, Division leadership, medical director (pathology), Performance Improvement, laboratory leaders, Supply Chain, etc. Develops and maintains strong working relationships with other operating groups within HCA such as IT&S, Supply Chain, etc. Communicate regularly as required, (weekly, biweekly or monthly) for operating reports MORs with the Service Line leadership, Division Presidents, Division CFOs and the Divisions' hospitals' CEOs. Ensure all internal approvals prior to executing recommendations. DUTIES INCLUDE BUT NOT LIMITED TO: Supports the Laboratory Service Line to execute on laboratory service opportunities in assigned division including: Implementation of laboratory test (ordering), facility test menu, and equipment platform formularies, as well as other Service Line objectives Coordination/centralization of laboratory services within geographic region, Optimization of market based contracting and adherence to HPG/HCA contracts, Reference testing vendor selection and utilization, Assessment of client and commercial outreach business profitability Billing compliance and charge capture Assists in implementing best practices regarding laboratory quality and operations Ensures facility laboratory readiness for ongoing successful regulatory accreditation. Works collaboratively with all levels of HCA, Service Lines, Divisions, and Hospital leadership to assess and identify options. Thrives in a matrixed environment Utilizes sophisticated processes and systems to gather and analyze critical information required to conduct a thorough assessment and develop comprehensive recommendations. Reviews all recommendations with Service Line leadership to ensure alignment with Service Line strategy and presents sophisticated presentations to relevant stakeholder groups. Understands the critical nature of laboratory services that are vital to the operations of HCA Hospitals and that failure to perform the duties of this position and result in the disruption and delay of vital patient care services. Leads the development and training of a team of high functioning laboratory directors who can assist in the execution of the duties delineated herein Continually monitors and stays abreast of legislative and regulatory changes affecting laboratory services. Takes initiative to develop steps and processes in an effort to proactively identify areas of opportunity. Interacts with Physician leadership to ensure practice business needs are met and performance is sustainable. Communicates the Laboratory Services suite of services effectively throughout all levels of the organization and represents the Service Line in professional manner. Executes the strategic direction of the Service Line, Division, and Hospitals' CEOs. Interacts on a regular basis with Division and facility leadership to ensure their services and clinical operations needs are met: o Works with Service Line and Division Leadership assess ability of operating models or partnerships to meet HCA enterprise financial and operational goals. Manages financial performance to budget and prior period trends and understands causes of variances. Resolving any clinical quality/operational/financial issues in a timely manner. Keeps lines of communication open between Division Leadership and the Service Line Recommends corrective action as required to eliminate negative variances. Meets regularly with direct reports to ensure their effective involvement in Service Line, division and facility strategic initiatives. What qualifications you will need: Bachelor's Degree in Medical Technology or Laboratory Science is required. Master's or above Degree in Business, Healthcare Administration, other applicable field is preferred. Professional organization association required. Clinical laboratory experience required. Minimum of 5- years' experience in laboratory, at a director level and/or laboratory consulting. Effective working knowledge of healthcare systems management, hospital/laboratory management, healthcare financial management, and third-party reimbursement issues, and clinical operations. This role requires you to be fully vaccinated for COVID-19 based on local, state and /or federal law or regulations (unless a medical or religious exemption is approved). Integrated Regional Labs is a full service providerfor clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients withtimely diagnostic information for patient care. Our infrastructure includes a fullyautomated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo,Florida, and a network of hospital based rapid-response laboratories present in fourHCA Healthcare divisions within the state of Florida. Our core laboratories support more than250 acute and rehab hospitals, physician practices, surgery centers and commercialaccounts. HCA Healthcare has been recognized as one of the World's Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for thedelivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Division Laboratory Director opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! . click apply for full job details
Northwell Health Physician Partners
New York, New York
Dr. John Q. Young, Chair and Senior Vice President of Behavioral Health and Dr. Manish Sapra, Executive Director of Northwell Health's Behavioral Health Service Line, with the support of Northwell Executive Leadership, invites applications and nominations for the position of Vice President of Quality, Behavioral Health. In partnership with the Chair, Department of Psychiatry, administrative and clinical hospital executives and quality teams, the Vice President of Quality will serve as the system Behavioral Health (BH) leader for quality, and, as such, will be responsible for developing and implementing a BH strategic plan for quality in alignment with Northwell's overall quality strategy. The strategy will include oversight and monitoring, data analytics and metrics, training and execution of performance improvement methodology, process for prioritization, and ensuring all clinical quality and safety standards are met. Quality will be addressed in multiple dimensions including efficiency, effectiveness, equity, timeliness, safety, and patient and-family centered oversight of system-wide committee constructs. The Vice President of Quality will participate in clinical quality improvement and patient safety activities in alignment with corporate quality, institutional priorities, local quality departments, and Northwell institutional Departments of Psychiatry. Additionally, the new VP of Quality will assist in performance improvement and quality assurance studies. Northwell Health is New York State's largest private employer and one of the nation's largest integrated health care systems, delivers world-class clinical care throughout the New York metropolitan area, pioneering research at the Feinstein Institute for Medical Research, and is educating the next generation of medical professionals through the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. Behavioral Health at Northwell Northwell's mission is to improve the mental health of the patients and communities Northwell serves through a full continuum of high-quality, comprehensive clinical services in all of Northwell's hospitals, outpatient programs and practices. Hospital services include over 624 inpatient beds (74 SUD beds) across 7 hospitals, consult services in each of the 23 hospitals and emergency departments, a robust telepsychiatry program, partial hospitalization and intensive outpatient programs, and a full range of outpatient services (>600K visits per year and growing) for all ages and disorders. Northwell Health has two hospitals that specialize in behavioral health: Zucker Hillside Hospital, a 236-bed facility in Glen Oaks, NY and South Oaks Hospital, a 202-bed facility in Amityville, NY. To improve access and facilitate earlier diagnosis and treatment, the Department prioritizes integrating behavioral health into settings where people routinely engage such as primary care (adult, pediatric and OB- GYN) and schools. BH has embedded collaborative care behavioral health specialists in 84+ primary care (adult and pediatric) practices; and has co-located behavioral health in medical specialty settings such as oncology, transplant surgery, and obstetrics. The School Mental Program provides prevention and wellness programs and same day access to psychiatric services for over 220,000 K-12th grade students across 54 school districts. The Behavioral Health College Partnership collaborates with over 100 higher education institutions in the greater New York region to provide outpatient care as well as rapid inpatient care for college students experiencing a psychiatric crisis. The Vice President of Quality for Behavioral Health (BH) is a strategic leadership role responsible for driving a culture of continuous quality improvement and ensuring the delivery of exceptional, safe, and patient-centered care across all Behavioral Health facilities within Northwell Health. This role will champion a data-driven approach to quality, leveraging analytics and best practices to optimize clinical outcomes, enhance patient experience, and ensure compliance with all regulatory requirements. The VP of Quality will work collaboratively with BH leadership, facility leads for quality, and system-wide quality teams, to develop and implement innovative solutions that elevate the standard of BH care within Northwell and position the organization as a leader in the field. The VP of Quality for the BHSL will lead a dedicated team of quality professionals and collaborate extensively with existing resources within both the BH service line and Northwell Health as a whole. This role requires a dynamic and experienced leader with a deep understanding of behavioral health quality, a passion for driving improvement, and the ability to influence and inspire change across a large and complex organization. Additionally: M.D. or PhD Completed ACGME-accredited residency in Psychiatry, or, PhD in clinical psychology Currently or eligible licensed provider in the State of New York. Minimum of five (5) years of progressive senior management experience in Medical & Healthcare Administration. Subject matter expertise and progressive management experience in behavioral health quality. The Selection Committee invites inquiries, nominations, and applications for the position. Prospects should provide 1) an electronic version of their curriculum vitae and 2) a letter of interest, summarizing key achievements related to quality iniatives, administrative leadership, clinical care, and strategy. Confidential review of nominations and expressions of interest will begin immediately and will continue until an appointment is made. To receive consideration for the position, please email all materials to with "Vice President of Quality, Behavioral Health" in the subject line no later than November 31, 2024. It is the policy of Northwell Health to provide equal employment opportunity and treat all employees equally regardless of age, race, creed/religion, color, national origin, alienage or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, generic information or genetic predisposition or carrier status, marital status, partnership status, a victim of domestic violence, or other characteristics protected by applicable law. Northwell Health leaders, including the CEO, are committed to the principles of Equal Employment Opportunity and Affirmative Action. The base salary range for this position is $150,000 to $450,000. . The salary of the finalist selected for this role will be determined based on various factors, including but not limited to scope of role, level of experience, education, specialty/subspeciality, credentials, academic accomplishments, clinical productivity, quality metrics, patient experience, site/location internal equity, budget, and subject to Fair Market Value evaluation. The base compensation range listed is a good faith determination of potential base compensation at the time of this job advertisement and may be modified in the future Compensation Information: $150000.00 / Annually - $450000.00 / Annually
10/02/2025
Full time
Dr. John Q. Young, Chair and Senior Vice President of Behavioral Health and Dr. Manish Sapra, Executive Director of Northwell Health's Behavioral Health Service Line, with the support of Northwell Executive Leadership, invites applications and nominations for the position of Vice President of Quality, Behavioral Health. In partnership with the Chair, Department of Psychiatry, administrative and clinical hospital executives and quality teams, the Vice President of Quality will serve as the system Behavioral Health (BH) leader for quality, and, as such, will be responsible for developing and implementing a BH strategic plan for quality in alignment with Northwell's overall quality strategy. The strategy will include oversight and monitoring, data analytics and metrics, training and execution of performance improvement methodology, process for prioritization, and ensuring all clinical quality and safety standards are met. Quality will be addressed in multiple dimensions including efficiency, effectiveness, equity, timeliness, safety, and patient and-family centered oversight of system-wide committee constructs. The Vice President of Quality will participate in clinical quality improvement and patient safety activities in alignment with corporate quality, institutional priorities, local quality departments, and Northwell institutional Departments of Psychiatry. Additionally, the new VP of Quality will assist in performance improvement and quality assurance studies. Northwell Health is New York State's largest private employer and one of the nation's largest integrated health care systems, delivers world-class clinical care throughout the New York metropolitan area, pioneering research at the Feinstein Institute for Medical Research, and is educating the next generation of medical professionals through the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. Behavioral Health at Northwell Northwell's mission is to improve the mental health of the patients and communities Northwell serves through a full continuum of high-quality, comprehensive clinical services in all of Northwell's hospitals, outpatient programs and practices. Hospital services include over 624 inpatient beds (74 SUD beds) across 7 hospitals, consult services in each of the 23 hospitals and emergency departments, a robust telepsychiatry program, partial hospitalization and intensive outpatient programs, and a full range of outpatient services (>600K visits per year and growing) for all ages and disorders. Northwell Health has two hospitals that specialize in behavioral health: Zucker Hillside Hospital, a 236-bed facility in Glen Oaks, NY and South Oaks Hospital, a 202-bed facility in Amityville, NY. To improve access and facilitate earlier diagnosis and treatment, the Department prioritizes integrating behavioral health into settings where people routinely engage such as primary care (adult, pediatric and OB- GYN) and schools. BH has embedded collaborative care behavioral health specialists in 84+ primary care (adult and pediatric) practices; and has co-located behavioral health in medical specialty settings such as oncology, transplant surgery, and obstetrics. The School Mental Program provides prevention and wellness programs and same day access to psychiatric services for over 220,000 K-12th grade students across 54 school districts. The Behavioral Health College Partnership collaborates with over 100 higher education institutions in the greater New York region to provide outpatient care as well as rapid inpatient care for college students experiencing a psychiatric crisis. The Vice President of Quality for Behavioral Health (BH) is a strategic leadership role responsible for driving a culture of continuous quality improvement and ensuring the delivery of exceptional, safe, and patient-centered care across all Behavioral Health facilities within Northwell Health. This role will champion a data-driven approach to quality, leveraging analytics and best practices to optimize clinical outcomes, enhance patient experience, and ensure compliance with all regulatory requirements. The VP of Quality will work collaboratively with BH leadership, facility leads for quality, and system-wide quality teams, to develop and implement innovative solutions that elevate the standard of BH care within Northwell and position the organization as a leader in the field. The VP of Quality for the BHSL will lead a dedicated team of quality professionals and collaborate extensively with existing resources within both the BH service line and Northwell Health as a whole. This role requires a dynamic and experienced leader with a deep understanding of behavioral health quality, a passion for driving improvement, and the ability to influence and inspire change across a large and complex organization. Additionally: M.D. or PhD Completed ACGME-accredited residency in Psychiatry, or, PhD in clinical psychology Currently or eligible licensed provider in the State of New York. Minimum of five (5) years of progressive senior management experience in Medical & Healthcare Administration. Subject matter expertise and progressive management experience in behavioral health quality. The Selection Committee invites inquiries, nominations, and applications for the position. Prospects should provide 1) an electronic version of their curriculum vitae and 2) a letter of interest, summarizing key achievements related to quality iniatives, administrative leadership, clinical care, and strategy. Confidential review of nominations and expressions of interest will begin immediately and will continue until an appointment is made. To receive consideration for the position, please email all materials to with "Vice President of Quality, Behavioral Health" in the subject line no later than November 31, 2024. It is the policy of Northwell Health to provide equal employment opportunity and treat all employees equally regardless of age, race, creed/religion, color, national origin, alienage or citizenship status, sexual orientation, military or veteran status, sex/gender, gender identity, gender expression, disability, generic information or genetic predisposition or carrier status, marital status, partnership status, a victim of domestic violence, or other characteristics protected by applicable law. Northwell Health leaders, including the CEO, are committed to the principles of Equal Employment Opportunity and Affirmative Action. The base salary range for this position is $150,000 to $450,000. . The salary of the finalist selected for this role will be determined based on various factors, including but not limited to scope of role, level of experience, education, specialty/subspeciality, credentials, academic accomplishments, clinical productivity, quality metrics, patient experience, site/location internal equity, budget, and subject to Fair Market Value evaluation. The base compensation range listed is a good faith determination of potential base compensation at the time of this job advertisement and may be modified in the future Compensation Information: $150000.00 / Annually - $450000.00 / Annually
Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity of our community. TMH is the region's healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the region's only: Level II Trauma Center Primary Stroke Center Level III Neonatal Intensive Care Pediatric Intensive Care The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle. Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices. Qualifications Education: Required: Bachelor's degree in business, healthcare administration, nursing, or a related field from an accredited college or university. Preferred: Master's degree in business, healthcare administration, nursing, or a related field from an accredited university. Experience: Required: Seven (7) years of leadership experience in cardiovascular services in a major health care organization, preferably in both ambulatory and hospital settings Preferred: Clinical and operational experience in cardiology operations. Strong organizational, communications, team building, analytical, and business development skills. Committed to change (to enhance service line and organizational performance). Certification/License/Registry: Required: None. Incentives: We're thankful for what you do for us. Here's what we can do for you: This position is performance based annual bonus eligible Sign-on bonus and transition allowance eligible Health Insurance (Medical, Dental & Vision) Retirement Contributions Matching Up to 6% 401(a)/403(b) Annual Raise Tuition Reimbursement Scholarship Opportunities Paid Time Off Childcare (TMH owned onsite facility) Premier Health and Fitness Club (TMH owned offsite facility) Wellness Programs and Colleague Discounts Restrictions may apply Workplace Type: On-site (employees come to work in-person). Additional Information: Only candidates who meet the requirements will be contacted for further consideration. This vacancy is not eligible for sponsorship. TMH will not sponsor or transfer visas for this position. Responsibilities Location: Tallahassee, FL As the Assistant Vice President of Cardovascular Services you will play a pivotal role in supporting and assisting the President/Chief Operations Officer in planning and implementing strategic business plans, infrastructure, and related matters. Responsible for driving strategic initiatives and overseeing the planning, implementation, and maintenance of cardiovascular services. If you are a seasoned leader with a deep understanding of cardovascular care, we invite you to apply for this exciting opportunity! The Assistant Vice President of Cardovascular Services is responsible for: Setting clear expectations for staff members; developing job specific customer service expectations and behaviors for positions supervised. Directs program development, profit and loss, revenue generation, and expenditure control to optimize the resources utilization at minimum cost. Develops comprehensive business plan; develops, assesses, and pursues opportunities consistent with said business plan. Leads service line quality improvement. Manages and directs multiple cost center/departmental activities to accomplish individual unit objectives and overall integrated organizational objectives. Leads service line strategy; provides strategic leadership and operational oversight for comprehensive cardiovascular service lines across the care continuum. Establishes appropriate service line performance measures; reports on the same regularly. Leads service line growth, fiscal accountability, and innovation. Demonstrates i ntegrity, c ompassion, a ccountability, r espect, and e xcellence (I CARE values). Communicates information timely via appropriate channels. Displays an understanding of diversity. Manages departmental budget. Meet goals/expectations established over the previous year. Manages human resources. Meets or exceeds all The Joint Commission (TJC) requirements. Solves problems; recommends sound solutions. Enhances and contributes to a safe environment for all colleagues, visitors, and patients. Performs miscellaneous duties not expressly described herein. Reports to: President/Chief Operations Officer Supervises: Director/Cardiovascular Labs Director/Invasive Cardiology RN/Nurse Manager RN Registered Nurse /Navigators RN/Structural Heart Program Manager Analyst/Reimbursement Office Manager
10/01/2025
Full time
Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity of our community. TMH is the region's healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the region's only: Level II Trauma Center Primary Stroke Center Level III Neonatal Intensive Care Pediatric Intensive Care The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle. Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices. Qualifications Education: Required: Bachelor's degree in business, healthcare administration, nursing, or a related field from an accredited college or university. Preferred: Master's degree in business, healthcare administration, nursing, or a related field from an accredited university. Experience: Required: Seven (7) years of leadership experience in cardiovascular services in a major health care organization, preferably in both ambulatory and hospital settings Preferred: Clinical and operational experience in cardiology operations. Strong organizational, communications, team building, analytical, and business development skills. Committed to change (to enhance service line and organizational performance). Certification/License/Registry: Required: None. Incentives: We're thankful for what you do for us. Here's what we can do for you: This position is performance based annual bonus eligible Sign-on bonus and transition allowance eligible Health Insurance (Medical, Dental & Vision) Retirement Contributions Matching Up to 6% 401(a)/403(b) Annual Raise Tuition Reimbursement Scholarship Opportunities Paid Time Off Childcare (TMH owned onsite facility) Premier Health and Fitness Club (TMH owned offsite facility) Wellness Programs and Colleague Discounts Restrictions may apply Workplace Type: On-site (employees come to work in-person). Additional Information: Only candidates who meet the requirements will be contacted for further consideration. This vacancy is not eligible for sponsorship. TMH will not sponsor or transfer visas for this position. Responsibilities Location: Tallahassee, FL As the Assistant Vice President of Cardovascular Services you will play a pivotal role in supporting and assisting the President/Chief Operations Officer in planning and implementing strategic business plans, infrastructure, and related matters. Responsible for driving strategic initiatives and overseeing the planning, implementation, and maintenance of cardiovascular services. If you are a seasoned leader with a deep understanding of cardovascular care, we invite you to apply for this exciting opportunity! The Assistant Vice President of Cardovascular Services is responsible for: Setting clear expectations for staff members; developing job specific customer service expectations and behaviors for positions supervised. Directs program development, profit and loss, revenue generation, and expenditure control to optimize the resources utilization at minimum cost. Develops comprehensive business plan; develops, assesses, and pursues opportunities consistent with said business plan. Leads service line quality improvement. Manages and directs multiple cost center/departmental activities to accomplish individual unit objectives and overall integrated organizational objectives. Leads service line strategy; provides strategic leadership and operational oversight for comprehensive cardiovascular service lines across the care continuum. Establishes appropriate service line performance measures; reports on the same regularly. Leads service line growth, fiscal accountability, and innovation. Demonstrates i ntegrity, c ompassion, a ccountability, r espect, and e xcellence (I CARE values). Communicates information timely via appropriate channels. Displays an understanding of diversity. Manages departmental budget. Meet goals/expectations established over the previous year. Manages human resources. Meets or exceeds all The Joint Commission (TJC) requirements. Solves problems; recommends sound solutions. Enhances and contributes to a safe environment for all colleagues, visitors, and patients. Performs miscellaneous duties not expressly described herein. Reports to: President/Chief Operations Officer Supervises: Director/Cardiovascular Labs Director/Invasive Cardiology RN/Nurse Manager RN Registered Nurse /Navigators RN/Structural Heart Program Manager Analyst/Reimbursement Office Manager
Hourly Pay Range: $120.43 - $186.67 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors. Position Highlights: Position: Vice President, Perioperative & Anesthesia Services Location: Arlington Heights Full time Hours: Monday - Friday, 8:00am - 5:00pm Required Travel: Regular travel between Endeavor Health's eight acute care hospitals Job Summary: The Vice President (VP) of Perioperative and Anesthesia Services has the overall responsibility for providing the strategic vision and implementation of a consistent, optimized and differentiated surgical platform across the system. The VP of Perioperative and Anesthesia Services works closely with the Perioperative Services Executive Sponsor and Physician Executive dyad partner(s) to execute and elevate the surgical services platform systemwide. This leader oversees a team of perioperative and anesthesia leaders across Endeavor Health's eight acute care hospitals, which collectively include 115 operating rooms and a staff of more than 2,500 team members, all maintaining 24-hour accountability for the operational, fiscal and administrative functions of the clinical perioperative service line. The VP of Perioperative and Anesthesia Services is a senior leader that works across a matrixed leadership health system for 24-hour accountability for the operational functions and directs program and strategic planning for all of the Endeavor Health operating rooms. Oversight includes the support functions that enable high quality, safe, seamless, and efficient operations including Sterile Processing Departments, Ambulatory Surgery Departments, Post Anesthesia Care Units, Recovery, Anesthesia, Pre-Procedure Services, Surgical Assistants and Surgical Advanced Practice Providers, in addition to the business and analytics functions associated with these service lines. The VP ensures a strategy for growth of surgical and interventional procedure cases while ensuring organizational objectives of safe, seamless and personal care are achieved. This leader collaborates with physician practice and other service line leaders to ensure organizational metrics are met that pertain to this scope of service and ensuring high quality, safe, excellent experiences for patients, families, physicians and staff in a cost-efficient manner. This position works in a matrix management system across the service line and is accountable to local entity leaders to ensure both horizontal service line and local entity needs are met. The VP of Perioperative and Anesthesia Services is responsible for facilitating the coordination and integration of interdepartmental and intradepartmental care and services. What you will do: Develop and ensure execution of a standardized operating model and strategy across the system. Give direction to the perioperative leadership team to drive performance of the Service Line to achieve organizational and Service Line targets (safety, quality outcomes, experience, resource use, revenue and expense, and growth). Partner with physician dyad leadership to provide direction to support physician practice, growth, performance, and academic/research activities in the Service Line. Identify opportunities and structures to support strong relationships among physicians, nursing leadership, administrative leaders and other service line team members across the region. Optimize clinical programs and services across the system, including the creation of consistent scorecards to track performance (quality, patient experience, people, growth, efficiency, profitability). Partner with perioperative leaders, physician leaders and administrative leadership to determine optimal strategy for asset distribution, including technology, implants, and supplies, per the Service Line strategy. Identify and partner with leadership team and system key stakeholders to identify and create strategies on opportunities to bring consistency to clinical and administrative practices across the region (staffing, care protocols, access systems, etc.). Develop and share outcomes metric performance to identify opportunities for improvement within the service line and for standardization of best practice across the system. Determine strategy and priorities for operational and capital investments required to support service line priorities across the region and advances requests through Regional and System approval structures. What you will need: Education: Master's degree in Healthcare Administration, Business Administration, Nursing or other healthcare related degree Experience: Ten (10) years of relevant healthcare operations experience with a minimum of five (5) of the ten (10) years in a leadership capacity. Clinical-area specific experience. Unique or Preferred Skills: Knowledge and experience of perioperative and interventional procedure operations Ability to work in a matrix management model Ability to lead through other leaders Strong communication skills Strong analytical skills Strategic thinker Ability to adapt leadership and communication style to diverse set of stakeholders including physicians, nursing and tech staff, and other leaders Proactive in identifying trends and implementing mitigation strategies Responsive to questions and inquiries Excellent communication and interpersonal skills Proven skills in leadership, planning and quality Excellent project management, analytical and problem-solving skills Ability to work with a diverse group of healthcare professionals in a matrix environment Benefits (For full time or part time positions): Eligibility for our Annual Incentive Plan, which offers the potential to earn a certain percentage amount of your base salary based on organizational performance. Opportunity for annual increases based on performance Career Pathways to Promote Professional Growth and Development Various Medical, Dental, Pet and Vision options Tuition Reimbursement Free Parking Wellness Program Savings Plan Health Savings Account Options Retirement Options with Company Match Paid Time Off and Holiday Pay Community Involvement Opportunities Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit . When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential. Please explore our website ( ) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best". Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information. Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all. EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
10/01/2025
Full time
Hourly Pay Range: $120.43 - $186.67 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors. Position Highlights: Position: Vice President, Perioperative & Anesthesia Services Location: Arlington Heights Full time Hours: Monday - Friday, 8:00am - 5:00pm Required Travel: Regular travel between Endeavor Health's eight acute care hospitals Job Summary: The Vice President (VP) of Perioperative and Anesthesia Services has the overall responsibility for providing the strategic vision and implementation of a consistent, optimized and differentiated surgical platform across the system. The VP of Perioperative and Anesthesia Services works closely with the Perioperative Services Executive Sponsor and Physician Executive dyad partner(s) to execute and elevate the surgical services platform systemwide. This leader oversees a team of perioperative and anesthesia leaders across Endeavor Health's eight acute care hospitals, which collectively include 115 operating rooms and a staff of more than 2,500 team members, all maintaining 24-hour accountability for the operational, fiscal and administrative functions of the clinical perioperative service line. The VP of Perioperative and Anesthesia Services is a senior leader that works across a matrixed leadership health system for 24-hour accountability for the operational functions and directs program and strategic planning for all of the Endeavor Health operating rooms. Oversight includes the support functions that enable high quality, safe, seamless, and efficient operations including Sterile Processing Departments, Ambulatory Surgery Departments, Post Anesthesia Care Units, Recovery, Anesthesia, Pre-Procedure Services, Surgical Assistants and Surgical Advanced Practice Providers, in addition to the business and analytics functions associated with these service lines. The VP ensures a strategy for growth of surgical and interventional procedure cases while ensuring organizational objectives of safe, seamless and personal care are achieved. This leader collaborates with physician practice and other service line leaders to ensure organizational metrics are met that pertain to this scope of service and ensuring high quality, safe, excellent experiences for patients, families, physicians and staff in a cost-efficient manner. This position works in a matrix management system across the service line and is accountable to local entity leaders to ensure both horizontal service line and local entity needs are met. The VP of Perioperative and Anesthesia Services is responsible for facilitating the coordination and integration of interdepartmental and intradepartmental care and services. What you will do: Develop and ensure execution of a standardized operating model and strategy across the system. Give direction to the perioperative leadership team to drive performance of the Service Line to achieve organizational and Service Line targets (safety, quality outcomes, experience, resource use, revenue and expense, and growth). Partner with physician dyad leadership to provide direction to support physician practice, growth, performance, and academic/research activities in the Service Line. Identify opportunities and structures to support strong relationships among physicians, nursing leadership, administrative leaders and other service line team members across the region. Optimize clinical programs and services across the system, including the creation of consistent scorecards to track performance (quality, patient experience, people, growth, efficiency, profitability). Partner with perioperative leaders, physician leaders and administrative leadership to determine optimal strategy for asset distribution, including technology, implants, and supplies, per the Service Line strategy. Identify and partner with leadership team and system key stakeholders to identify and create strategies on opportunities to bring consistency to clinical and administrative practices across the region (staffing, care protocols, access systems, etc.). Develop and share outcomes metric performance to identify opportunities for improvement within the service line and for standardization of best practice across the system. Determine strategy and priorities for operational and capital investments required to support service line priorities across the region and advances requests through Regional and System approval structures. What you will need: Education: Master's degree in Healthcare Administration, Business Administration, Nursing or other healthcare related degree Experience: Ten (10) years of relevant healthcare operations experience with a minimum of five (5) of the ten (10) years in a leadership capacity. Clinical-area specific experience. Unique or Preferred Skills: Knowledge and experience of perioperative and interventional procedure operations Ability to work in a matrix management model Ability to lead through other leaders Strong communication skills Strong analytical skills Strategic thinker Ability to adapt leadership and communication style to diverse set of stakeholders including physicians, nursing and tech staff, and other leaders Proactive in identifying trends and implementing mitigation strategies Responsive to questions and inquiries Excellent communication and interpersonal skills Proven skills in leadership, planning and quality Excellent project management, analytical and problem-solving skills Ability to work with a diverse group of healthcare professionals in a matrix environment Benefits (For full time or part time positions): Eligibility for our Annual Incentive Plan, which offers the potential to earn a certain percentage amount of your base salary based on organizational performance. Opportunity for annual increases based on performance Career Pathways to Promote Professional Growth and Development Various Medical, Dental, Pet and Vision options Tuition Reimbursement Free Parking Wellness Program Savings Plan Health Savings Account Options Retirement Options with Company Match Paid Time Off and Holiday Pay Community Involvement Opportunities Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit . When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential. Please explore our website ( ) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best". Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information. Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all. EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.