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Job description
Position Summary
Director of Health Services (Assistant Insurance Services Administrator) manages the daily operations of the Quality Assurance, Utilization Management, and Case & Disease Management departments within the Ventura County Health Care Plan. The role provides strategic oversight of clinical operations, quality improvement, and regulatory compliance under the Knox‑Keene Act, Title 28 CCR, and Department of Managed Health Care (DMHC) requirements. This is an onsite senior leadership position with a typical Monday through Friday 8:00 am to 5:00 pm schedule.
Duties
Direct oversight and responsibility for Quality Assurance, Utilization Management, and Case & Disease Management department deliverables.
Provide strategic oversight of clinical operations, quality improvement, and regulatory compliance as it relates to clinical operations.
Develop policies and procedures for the assignment area.
Ensure compliance with Federal and State regulations, including the Knox‑Keene Health Care Service Plan Act, Title 28 California Code of Regulations, DMHC requirements, and National Committee for Quality Assurance (NCQA) accreditation standards.
Prepare and oversee the development of management reports, tracking and trending analyses, and other data‑driven evaluations to support decision-making and performance improvement.
Collaborate with the Medical Director and supervising clinical staff to ensure appropriate medical policies and clinical guidelines are utilized when making determinations related to authorization requests.
Assist staff in making complex clinical decisions, through appropriate use of policies/procedures and Plan Administrator or Medical Director input.
Provide clinical oversight of Case Management and activities related to Healthcare Effectiveness Data and Information Set (HEDIS) measures and interventions.
Provide leadership and oversight of Health Care Plan personnel through recruiting, hiring, training, mentoring, and evaluating licensed clinical professionals and administrative staff to achieve departmental and organizational objectives.
Guide organizational and regulatory changes, ensuring consistent implementation of new programs, policies, procedures, and care management strategies.
Maintain updated internal operating procedures.
Lead and participate in all required committees and subcommittees, including but not limited to Quality Assurance, Pharmacy and Therapeutics, and Utilization Management.
Develop and implement departmental performance improvement indicators and goals.
Perform other related duties as required.
Required Qualifications
Bachelor’s degree in business, public health, nursing, health administration, or a closely related field.
Five (5) years of progressively responsible health care administration/management experience.
At least two (2) years of direct supervision and personnel management experience.
Demonstrated knowledge of the Knox‑Keene Act, DMHC regulations, and HEDIS.
Current, valid license as a Registered Nurse issued by the State of California.
Preferred Qualifications
Knowledge of National Committee for Quality Assurance (NCQA).
Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Geo Access surveys.
Master’s degree in business administration or healthcare management.
Knowledge, Skills, and Abilities
Comprehensive knowledge of health care and insurance industry trends, health care plan policies and procedures, the Knox‑Keene Act, DMHC regulations, and HEDIS. Ability to direct the work of others, collaborate effectively, analyze statistical data, implement change based on findings, represent the department on committees, establish and maintain effective relationships with staff and external stakeholders, and communicate clearly both orally and in writing.
Benefits
Bilingual Incentive – eligible for bilingual incentive depending on operational needs and certification of skill.
Educational Incentive – 2.5% for associate degree, 3.5% for bachelor’s degree, or 5% for graduate degree completion.
Deferred Compensation – eligible to participate in the County’s 401(k) Shared Savings Plan and/or the Section 457 Plan.
Health Plans – flexible credit allowance for purchasing medical, dental, and/or vision insurance.
Flexible Spending Accounts – participation in accounts reimbursing pre‑tax dollars for dependent care and health care expenses.
Pension Plan – contributions to the County’s Retirement Plan and Social Security; potential reciprocity with other public retirement systems.
Holidays – 13 paid days per year, including a floating holiday.
Equal Employment Opportunity
The County of Ventura is an equal opportunity employer to all, regardless of age, ancestry, color, disability, gender, sexual orientation, and other protected characteristics.
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.