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Job Title

Director, Regional Operations

Exemption Status

Exempt

Management Level

Director

Direct Reports

Sr Planning & Operations Specialist, Network Support Manager

Manager Title

Vice President, CareOregon Metro

Department

CareOregon Metro

Requisition

25072

Pay & Benefits

Estimated hiring range $152,415 - $186,285 / year, 10% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits

Posting Notes

This is a Hybrid role with 2 days onsite at our Downtown Portland office.

Job Summary

This position is responsible for directing the integration and execution of network, clinical and operational strategy for a Coordinated Care Organization (CCO). Work is focused on enterprise-wide engagement, as well as regional operations. Primary duties include operational planning and oversight, as well as resource, relationship, and people management. This position operates as a core member of the leadership team, working closely with the Medical Director, Behavioral Health Director, and Community Health Partnerships Director to assure financial sustainability and integration of CCO-funded programs, including Quality Pool payments, risk share funds, VBPs and/or other CCO-derived investments for clinical performance. The position is a part of the leadership matrix within the CCO and CareOregon to meet CCO strategic initiatives and mission. This position also provides input into strategic plans for the broader organization.

Essential Responsibilities

Technical Leadership

+ Leads the execution of strategic initiatives, plans, and goals in alignment with organizational vision and goals.

+ Directs work of various departmental staff and regional partners to design and implement clinical initiatives that further quality, access, equity and/or cost and utilization goals for Medicaid and Medicare LOB.

+ Develops internal systems and measures to ensure effective, efficient, and compliant CCO operations.

+ Develops, regularly monitors, and reports on metrics performance and other CCO measures including regulatory reporting required by the CCO.

+ Implements and oversees effective systems to ensure access, program integrity, quality of clinical care, utilization management, compliance with OARs and other regulatory standards, systems, and technology security.

+ Partners with CareOregon departments and CCO leadership teams to develop, implement, direct, and oversee programs and policies that provide clinical and operational integration to accomplish CCO strategic goals.

+ Reports to CCO Board of Directors on collaborative initiatives and works with the CCO Executive to support the governance structure to be highly effective in meeting goals.

+ Supports creation of structures to ensure effective and balanced matrix, as well as reporting, transparency, financial viability, and accountability for clinical and operational initiatives.

+ Partners with CCO Medical Director to lead the Clinical Advisory Panel and other Board Committees as appropriate to ensure effective clinical input and oversee the operational implementation of all relevant projects and program initiatives.

+ Ensures delivery of quality performance targets for the CCO, effective input and appropriate escalation and resolution of issues.

+ Directs clinical transformation initiatives and staff in support of CCO strategic priorities.

+ Leads innovation, process review, and improvement efforts.

+ May serve as a chair for key projects and initiatives.

Strategic/Operational Planning

+ Leads the internal strategic planning process in development of vision, goals, and strategic plans and success indicators.

+ Develops initiatives and programs, including cost savings and revenue optimization programs to support achievement of CCO strategic initiatives.

+ Provides input into the strategic plans of the organization.

+ Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

+ Recommends and manages budgets in alignment with short and long-term CCO plans.

+ Manages resources to ensure priorities are accomplished.

+ Approves resource allocations within budget, including people, finances, and timelines; makes decisions on exceptions.

Relationship Management

+ Leads effective communications and matrices with CO department Vice Presidents and other internal leaders, with emphasis on Contracting, Finance, Network & Health Plan Operations, Population Health, Behavioral Health, Dental, Evaluation & Informatics, and NEMT, ensuring a collaborative culture and alignment with CCO objectives and priorities.

+ Builds and ensures effective relationships across internal teams and external organizations for current or future integration of workplans, resources and outcomes.

+ Partners with internal leaders and managers in identifying improvement plans and processes.

+ Represents the CCO in external meetings and functions, providing productive leadership presence and effectiveness.

Employee Supervision

+ Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.

+ Builds cohesion horizontally across CareOregon and CCO staff by managing matrixed teams.

+ Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.

+ Identifies department priorities; ensures employees have information and resources to meet job expectations.

+ Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.

+ Manages, coaches, motivates, and guides employees; promotes employee development.

+ Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.

+ Ensures team adheres to department and organizational standards, policies, and procedures.

+ Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).

+ Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

+ Perform work in alignment with the organization’s mission, vision and values.

+ Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.

+ Strive to meet annual business goals in support of the organization’s strategic goals.

+ Adhere to the organization’s policies, procedures and other relevant compliance needs.

+ Perform other duties as needed.

Experience and/or Education

Required

+ Minimum 10 years’ operational and/or clinical work experience, including 3 years in managed care or innovative care models/quality improvement

Preferred

+ Coursework in Public Health or Healthcare Administration or related field

+ Leadership experience in change management of a clinical delivery system or managed care organization

+ Experience in Medicaid, quality assurance, utilization review, case management, and/or risk adjustment

+ Experience with CareOregon or other CCO operations and deliverables

+ Minimum 2+ years’ experience in a supervisory position

+ Experience with managed care

+ Strong communication and collaboration skill

Knowledge, Skills and Abilities Required

Knowledge

+ Knowledge of managed health care, applicable laws, and relationship value with provider networks

+ Strong understanding of how the functions of a business work and relate to one another

+ Understanding of financial structures, fiscal responsibility, and the economic impact of business decisions

Skills and Abilities

+ Ability to design and lead regional clinical integration strategy among cross-functional teams

+ Excellent collaboration skills for work with network providers and internal employees

+ Ability to build and maintain professional relationships with business, community, and internal management groups

+ Ability to balance strategic and operational thinking

+ Ability to plan, organize, manage, and monitor CCO operations

+ Skilled in budget management and oversight

+ Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives

+ Leadership effectiveness, analytical capability, and ability to design and implement constructive change

+ Ability to develop and lead staff, including hiring, goal setting, coaching, performance management, and development

+ Ability to communicate effectively, both verbally and in writing, including strong presentation skills

+ Skilled in how to confidently diffuse difficult situations and resolve high exposure complaints

+ Ability to work with a high degree of diplomacy, credibility, and persuasiveness to consistently cultivate effective working relationships; ability to express ideas and gain acceptance

+ Ability to work in an environment with diverse individuals and groups

+ Motivated to work in a setting with a social mission

+ Persistent, assertive, data driven and focused

+ Ability to be proactive and action oriented; ability to drive performance and is persistent in accomplishing difficult tasks

+ Basic computer skills, including spreadsheet and word processing

+ Ability to work effectively with diverse individuals and groups

+ Ability to learn, focus, understand, and evaluate information and determine appropriate actions

+ Ability to accept direction and feedback, as well as tolerate and manage stress

+ Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure

Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person

Hazards: May include, but not limited to, physical, ergonomic, and biological hazards.

Equipment: General office equipment and/or mobile technology

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Hybrid-Office 1 day/week

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.