Hiring: Chief Health Services Officer Company: Health Plan of San Joaquin/Mountain Valley Health Plan Location: French Camp, CA Job Posted Time: 2026-09-11 07:38:57 Employment Type: Contract / Remote Target Skills & Keywords : Compliance About the job Experience: •5 years of experience in developing & Implementing Quality, Population Health Programs in a managed care setting in a senior leadership role. •At least 5 years of experience in developing & Implementing Quality, Population Health Programs in a managed care setting in a senior leadership role. Required Skills: •Oversees operational objectives and plans; ensures the development and implementation of associated business plans and tactics. •Anticipates the need for, develops and implements relevant and effective care for utilization management, care management, social work and behavioral health programs. •Anticipates, identifies, analyzes and reports on care opportunities, issues and trends; makes appropriate recommendations; develops and implements agreed upon changes. •Collaborates with the Chief Medical Officer in the strategic planning, implementation and oversight of the Quality Improvement and Quality Management Programs. •Collaborates with the Chief Medical Officer and Medical Director(s) in identifying medical service issues that have an impact on plan benefits and their administration; provides direction in resolving medical claims review, grievances, appeals, and other Health Services issues. •In collaboration with the Chief Medical Officer, will ensure consistent application of medical criteria to utilization management decision making. •Collaborates with internal and external stakeholders to develop programs that increase awareness and provide educational opportunities to providers and members regarding HPSJ’s Quality Improvement and Health Equity Transformation Program goals and activities. •Ensures collaboration among Health Services teams and other teams with a focus on Member care. Qualifications: •Knowledge, Skills, Abilities and Competencies •Expert knowledge of and proficient skills in administering clinical operations protocols. •Expert knowledge of regulatory requirements for Medi-Cal and Medicare pertaining to utilization management, case management and behavioral health. •In depth knowledge of and ability to identify, implement, monitor and analyze relevant metrics models, and implement effective interventions based on results. •In-depth knowledge of standard contract components and contract language specific to healthcare. •In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them. •In-depth knowledge of medical management information systems and their interrelationships. •In-depth knowledge of health equity and diversity principles, concepts and best practices. •Strong knowledge of general medical policy benefits and exclusions. •Strategic mindset: ability to translate strategic concepts into actionable business plans. Compensation: •Flexible work environment (work from home / hybrid options) Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!