Gold Coast Health Plan will not sponsor applicants for work visas.
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.
POSITION SUMMARY
Under the direction of the Chief Medical Officer, the Executive Director Health Equity is responsible for leading the development and implementation of community outreach and member engagement strategies designed to address identified health inequities. The position will be responsible for developing, implementing, analyzing, and refining the Gold Coast Health Plan goals and objectives related to health equity (HE). The position will partner with functional leaders to strengthen the organization's commitment and strategy to advance health equity and reduce health disparities of our member population, as well as to remain a diverse, equitable, and inclusive organization. The role will assist in raising awareness of health inequities within our membership and establish plans to address them. The Executive Director, Health Equity will drive the imbedding and communication of health equity strategies across stakeholder groups, such as Gold Coast Health Plan Commission, employees, members, and the local community. The incumbent will build and maintain strong relationships with Gold Coast Health Plan employees, providers, and local stakeholders who will help to combat inequities.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statements
• Provides strategic leadership to ensure the development and implementation of community outreach and member engagement strategies designed to address identified health inequities
• Provides leadership in the design and implementation of organization strategies and programs to ensure Health Equity is prioritized and addressed
• Ensures all organization policy and procedures consider Health Inequities and are designed to promote Health Equity where possible, including, but not limited to:
1. Medical and other health services policies;
2. Member and provider outreach;
3. Community Advisory Committee;
4. Quality Improvement (QI) activities, including delivery system reforms;
5. Grievance and Appeals; and
6. Utilization Management (UM).
• Develops and implement policies and procedures aimed at improving Health Equity and reducing Health Disparities;
• Participates in state and industry work groups such as DHCS, DMHC, California Health Care Foundation (CHCF), National Committee for Quality Assurance (NCQA), Association for Community Affiliated Plans (ACAP), and California Association of Health Plans (CAHP)to expand influence on benefit design, regulations, and policy direction
• Engages and collaborate with organization staff, Subcontractors, Downstream Subcontractors, Network Providers, and entities including, but not limited to, local community-based organizations, local health departments, Behavioral Health and social services, Child welfare systems and Members in Health Equity efforts and initiatives;
• Implements strategies designed to identify and address root causes of Health Inequities, which includes but is not limited to systemic racism, Social Drivers of Health (SDOH), and infrastructure barriers;
• Develops targeted interventions designed to eliminate Health Inequities;
• Develops quantifiable metrics that can track and evaluate the results of the targeted interventions designed to eliminate Health Inequities;
• Designs and implement culturally specific and responsive policies, programs and service delivery models, as well as standardized guidelines and criteria to ensure health equity is prioritized and addressed.
• Oversees regulatory compliance, including monitoring, implementing and reporting for all new regulatory requirements focused on health equity and disparities. Ensures compliance with contracted services and performance metrics.
• Ensure compliance with California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Covered California, and Centers for Medicare and Medicaid Services (CMS) regulatory and contractual requirements.
• Engages and collaborates with staff, subcontractors, network providers, and entities included, but not limited to local community based organizations, local health department, behavioral health and social services, child welfare systems and members in health equity efforts and initiatives.
• Develops targeted interventions designed to eliminate health inequities and collaborates with other departments as necessary to ensure implementation. Develops quantifiable metrics that can track and evaluate the results of the targeted interventions designed to eliminate Health Inequities.
• Ensures employees, subcontractors, and Network Provider staff receive mandatory diversity, equity and inclusion training (sensitivity, diversity, communication skills, and cultural competency training). And ensure the records of such training are maintained in the Learning Management System. Creates, implements and reports on the organizational equity plan in partnership with organizational stakeholders.
• Collaborates with Human Resources and the Chief Diversity Officer, to design and implement strategies for recruiting and retaining employees and management. Collaborates with Learning and Development to develop educational and training for employees and staff.
• In collaboration with the Chief Medical Officer and Clinical Leadership Team, oversees Quality Improvement and Health Equity activities, which include, (1) analyze and evaluate the results of QI and Health Equity activities, including annual review of the results of performance measures, utilization data, and consumer satisfaction surveys. (2) institute actions to address performance deficiencies, including policy recommendations; and (3) ensure appropriate follow-up of identified performance deficiencies.
• Serve on the Diversity, Equity and Inclusion Council. Communicates clearly in writing and verbally the principles, initiatives and outcomes of the DEI work. Develops media messaging to internal and external constituencies.
• Develops communication systems to share best practices, keeping staff apprised of key initiatives and activities. Forges strong relationships and continuing communication links with other health equity advocates, and the local community.
• Represents GCHP’s commitment to equity and acts as subject matter expert at the local, state, and national level. Functions as a subject matter expert for senior leadership and report to the Medical Commission as needed.
• Works with senior leadership in deploying standardized evidence-based best practices in medicine and clinical content and ensure adoption of best practices.
POSITION QUALIFICATIONS
Minimum Qualifications:
• Master's degree in social work promoting equity, inclusion and social justice is required PLUS 6 years of related experience in the health care industry required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 5 years of progressive supervisory/management experience.
• 5 years of experience in advocating for diversity, equity, and inclusion in health care and/or other settings, and an interest and involvement in the affairs of the health care community.
• 5 years of experience in developing and implementing initiatives/programs related to health equity.
Preferred Qualifications:
• Direct work experience with the vulnerable and at-risk communities in Orange County.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
• 5 years of experience advocating for and implementing change within a multicultural environment, preferably with some experience in project planning, developing, and implementing diversity, equity, and inclusion programs, managing outcomes, and using data to inform continuous decision-making and improvement.
• Experience facilitating large multi-stakeholder collaborations related to health equity is a plus.
• Proven track record of successful project and program leadership.
• Experience with historically underrepresented, low-income, traditionally disenfranchised, and differently labeled populations in diverse environments.
Competency Statements
• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
• Applied Learning - Ability to participate in needed learning activities in a way that makes the most of the learning experience.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Customer Oriented - Ability to take care of the customers’ needs while following company procedures.
• Team Builder - Ability to convince a group of people to work toward a goal.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
SKILLS & ABILITIES
Education:
• Master's Degree Preferred, Field of Study: Nursing, Business, Public Health or Health Administration or a related field preferred, or equivalent.
• Doctorate Preferred, Field of Study: Nursing, Business, Public Health or Health Administration or a related field preferred, or equivalent.
Experience:
• 10 plus years of experience in recent relevant management experience, a majority of which should be in a senior leadership position
• Management experience within a health care organization (managed care or prepaid health system experience preferred), which must have included experience with the Medi-Cal program, general and fiscal operations, customer service and provider relations, health care information systems, and regulatory compliance.
Other Requirements:
• Knowledge of the CA Medi-Cal program & entitlement programs
• Knowledge of Utilization Management, Care Management & Disease Management programs & procedures; Knowledge of health care fiscal principles &operations
• Managed care provider payment methods & contracting; Knowledge of public policy & regulatory issues in health care; Knowledge of customer service & quality improvement methods; General knowledge of MIS applications in health care systems;
• Ability to plan, assign, direct, supervise & evaluate the work of others; Establish and maintain effective and cooperative working relationships with Gold Coast staff and others contacted in the course of the work; Assume responsibility& exercise good judgment in making decisions within the scope of authority of the position
• Effectively prioritize multiple tasks and deadlines; Ability to accurately complete tasks within established times; Ability to maintain confidential.
