Chief Clinical Assurance Division Leader

2 months ago


Davis, California, United States Department of Health Care Services Full time
About this Role:

The Department of Health Care Services is seeking a highly skilled and experienced professional to serve as the Chief, Clinical Assurance Division (CAD). This is a key leadership position that requires a strong understanding of healthcare policy, utilization management, and clinical assurance.

Key Responsibilities:
  • Develop and implement utilization management strategies for Medi-Cal fee-for-service members in partnership with the DHCS Health Care Benefits and Eligibility (HCBE) program.
  • Lead the CAD team in the administration of Treatment Authorization Requests (TARs), the TAR-free program, and post-payment utilization control of Medi-Cal benefits.
  • Collaborate with stakeholders to ensure compliance with regulatory requirements and optimize healthcare outcomes.
  • Develop and maintain relationships with key stakeholders, including healthcare providers, payers, and government agencies.
  • Stay up-to-date with industry trends, best practices, and regulatory changes to ensure the CAD team is equipped to meet the evolving needs of the healthcare system.
Requirements:
  • Master's degree in a related field, such as healthcare administration, public health, or a related field.
  • Minimum 5 years of experience in healthcare policy, utilization management, or a related field.
  • Proven track record of leadership and management experience, with a strong ability to motivate and direct teams.
  • Excellent communication and interpersonal skills, with the ability to build and maintain relationships with diverse stakeholders.
  • Strong analytical and problem-solving skills, with the ability to interpret complex data and develop effective solutions.


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