Talent.com
Vice President of Clinical Operations, Parkland Community Health Plan
Vice President of Clinical Operations, Parkland Community Health PlanParkland Health Hospital System • Irving, TX, US
serp_jobs.error_messages.no_longer_accepting
Vice President of Clinical Operations, Parkland Community Health Plan

Vice President of Clinical Operations, Parkland Community Health Plan

Parkland Health Hospital System • Irving, TX, US
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Are you looking for a career that offers both purpose and the opportunity for growth? At Parkland Community Health Plan (PCHP), we are united by a mission to provide high-quality, affordable care to those who need it most. Whether your expertise is in healthcare administration, support services, or direct care, everyone at PCHP plays a vital role in improving the health and well-being of individuals and families in our community. Since 1999, we've been dedicated to extending the Parkland Health mission by providing services to Texas STAR Medicaid and Children's Health Insurance Program (CHIP) recipients across Dallas and surrounding counties. With the support of local leaders, we've built a healthcare network where over 9,000 doctors and specialists make affordable, accessible care available to those in need. Our focus is not only on healthcare but on empowering members to live healthier lives by addressing social needs like transportation, housing, and food insecurity. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job—it's a passion to serve and improve lives every day.

Disclaimer

The following job description is designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties and responsibilities required of employees assigned to this job.

Primary Purpose

  • Responsible for providing strategic leadership to ensure the development and execution of the clinical operations strategy for Parkland Community Health Plan (PCHP). Provides leadership oversight and directs the operations for State and commercial healthcare services, (clinical operations) including service coordination, discharge planning, pharmacy, and utilization review. Accountable for ensuring compliance with contractual as well as applicable federal, state, and regulatory requirements.

Minimum Specifications

Education

  • Graduate of an accredited school of nursing required; BSN preferred.
  • Master's degree in healthcare, business administration or related discipline preferred.
  • Experience

  • Five (5) years of leadership experience in clinical operations required.
  • Three (3) years of experience with Texas Medicaid, Medicaid and / or a Medicaid managed care organization required.
  • STAR / STAR Kids, CHIP and Medicare / Medicare Advantage experience required.
  • Experience building programs to address medically complex needs including LTSS (long-term service and support) and waiver services required.
  • ACA / Marketplace experience preferred.
  • Equivalent Education and / or Experience

  • Eight (8) years of clinical leadership experience in Medicaid may be considered in lieu of a bachelor's degree.
  • Certification / Registration / Licensure

  • Current and unrestricted licensure as a RN in the State of Texas required.
  • Project management or Six Sigma certification preferred.
  • Required Tests for Placement

    Skills or Special Abilities

  • Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms.
  • Must be able to successfully articulate the clinical strategies to a wide range of audiences including the CEO, the Board of Directors, clinicians, employees, partners, regulators, and other stake holders.
  • Demonstrated ability to coach and influence for results.
  • Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization.
  • Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals.
  • Must be able to work in challenging situations involving competing interests, and high level-interdisciplinary groups.
  • Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities.
  • Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services.
  • Knowledge of Texas Medicaid (STAR / CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
  • Ability to analyze data for purposeful improvements in health outcomes.
  • Proficient Microsoft Office and computer skills.
  • Responsibilities

  • Strategy
  • Responsible for developing the ongoing strategic, operational, and service design to achieve organizational goals.

  • Works collaboratively with the Chief Medical Officer to develop and implement processes to effectively manage clinical policies to meet healthcare cost and quality targets.
  • Develop integrated population health strategies in coordination with behavioral health.
  • Identify and implement strategies and operational plans for optimal performance.
  • Establish department goals, objectives, and standards of performance for assigned areas of responsibility.
  • Clinical Operations
  • Develops and implements effective and efficient standards, protocols, processes, decision support systems, reporting benchmarks that support ongoing improvements of clinical operations functions and promotes quality cost-effective healthcare for PCHP members.

  • Manages implementation of analytical studies that quantify the benefits of Health services programs to ensure that resources are appropriately allocated, operational controls exists, and efficiencies are maximized.
  • Responsible for building, developing, and supporting UM program descriptions, medical policies development, as well as system implementation to comply with policies and build / maintain prior authorization tools to reduce employee and provider burden.
  • Facilitates integration of care coordination, long-term care, acute and pharmacy services.
  • Works with members and providers to develop an interdisciplinary team to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum.
  • Ensures effective inter-departmental collaboration and interaction between staff and other departments.
  • Work collaboratively with Provider Relations, Health Equity, and Quality Management to build utilization trend reporting.
  • Regulatory
  • Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations.

  • Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards.
  • Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary.
  • Works collaboratively with leadership and / or PCHP Compliance to investigate and respond to matters of concern or alleged violations taking corrective action as necessary.
  • Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies.
  • Periodically reviews processes and workflows for efficiency and to ensure compliance with contractual and regulatory requirements.
  • Responsible for defining requirements and technical deliverables for complex regulatory reporting such as the HHSC 278 transactions and ACUR / TDI / OIG reports; monitoring submissions of data; monitoring pends / data rejections and correct submissions.
  • Fiscal Management and Operating Budget
  • Operationally responsible for the financial performance of assigned area(s).

  • Promote activities to achieve operational efficiency.
  • Responsible for achieving business unit financial targets and requirements based on service level, state, compliance, and contractual agreements.
  • Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets.
  • Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs.
  • Manage staffing levels within established targets.
  • Talent Management
  • Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve.

  • Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work.
  • Accountable for orientation, ongoing education and training, and competency verification for all employees.
  • Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends.
  • Timely completion of employee performance appraisals.
  • Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan.
  • Mentor, coach, and support direct reports with building teamwork, professional development, and education to achieve optimal performance and develop talent.
  • Ensure employee engagement survey participation rates and results meet established targets.
  • Mandatory requirements are completed timely by employees.
  • Required licensure, certification, and / or registry are current and in good standing for all employees.
  • Employee performance is monitored and managed. Consult with the Office of Talent Management as appropriate regarding employee performance concerns and disciplinary action.
  • Professional Accountability
  • Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.

  • Adheres to organizational policies, procedures, and guidelines.
  • Completes assigned training, self-appraisal, and annual health requirements timely.
  • Adheres to hybrid work schedule requirements.
  • Attends required meetings and town halls.
  • Recognizes and communicate ethical and legal concerns through the established channels of communication.
  • Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
  • Maintains confidentiality at all times.
  • Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.
  • Job Accountabilities

  • Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
  • Stays abreast of the latest developments, advancements, and trends in the field by attending seminars / workshops, reading professional journals, actively participating in professional organizations, and / or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  • Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
  • Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
  • Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
  • Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.
  • L1-NB1

    Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

    serp_jobs.job_alerts.create_a_job

    Vice President Of • Irving, TX, US

    Job_description.internal_linking.related_jobs
    Regional Director of Care and Compliance

    Regional Director of Care and Compliance

    Caregiver • Carrollton, TX, US
    serp_jobs.job_card.full_time
    Texas-based provider of services to adults with intellectual and developmental disabilities (IDD) that supports clients with the design, delivery, and management or personalized treatment plans in ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Clinical Supervisor, BCBA - Up to 5K Sign on Bonus

    Clinical Supervisor, BCBA - Up to 5K Sign on Bonus

    Accel Therapies • Lewisville, TX, US
    serp_jobs.job_card.full_time
    Arial, sans-serif;"> Clinical Supervisor (...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Senior Vice President, Development

    Senior Vice President, Development

    American Heart Association • Irving, Texas, USA
    serp_jobs.job_card.full_time
    Since our founding in 1924 weve cut cardiovascular disease deaths in half but there is still so much more to do.To overcome todays biggest health challenges and accelerate this progress we need pas...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Inpatient Rehab Occupational Therapist

    Travel Inpatient Rehab Occupational Therapist

    Ardor Health Solutions • Lewisville, TX, US
    serp_jobs.job_card.full_time
    Ardor Health Solutions is seeking a travel Occupational Therapist for a travel job in Lewisville, Texas.Job Description & Requirements. Ardor Health Solutions is looking for a Occupational Thera...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Onsite Chief of Staff

    Onsite Chief of Staff

    IKS Health Career • Coppell, Texas, USA
    serp_jobs.job_card.full_time
    IKS Health is a leading Care Enablement Platform that enables clinicians to deliver better safer and more efficient care through a strategic blend of technology and expertise.Our solutions help pro...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    National VP, Pathology Services & Operations

    National VP, Pathology Services & Operations

    GI Alliance • Southlake, TX, United States
    serp_jobs.job_card.full_time
    A leading healthcare organization based in Texas is seeking an experienced National Vice President of Pathology Services. This role involves overseeing operational and financial performance, managin...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Director Clinical Education and Development

    Director Clinical Education and Development

    #REF! • Euless, Texas, USA
    serp_jobs.job_card.full_time
    Director Clinical Education and Development.Are you looking for a rewarding career with top-notch benefitsWe are looking for a qualifiedManager. The Director of Clinical Education and Development is...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Vice President Physician Practice Operations - Corporate Physician Group

    Vice President Physician Practice Operations - Corporate Physician Group

    CHRISTUS Health • Irving, TX, United States
    serp_jobs.job_card.full_time
    Under direction of the assigned regional Chief Operating Officer in CHRISTUS Health this position develops and implements the operational performance improvement plans for the assigned region(s), a...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Clinic Director

    Clinic Director

    ATI Holdings • Duncanville, Texas, USA
    serp_jobs.job_card.full_time
    Lead with Purpose as a Clinic Director at ATI Physical Therapy!.Are you a licensed Therapist ready to take your career to the next level Join ATI the leaders in physical therapy and inspire a team ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Director of Wellness

    Director of Wellness

    Vitality Living • Arlington, Texas, USA
    serp_jobs.job_card.full_time
    Join Our Team at Vitality Living as a Director of Wellness at Vitality Living Arlington Community!.At Vitality Living we are more than just a place of work. we are a vibrant community dedicated to ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Travel Inpatient Rehab Occupational Therapist

    Travel Inpatient Rehab Occupational Therapist

    Ethos Medical Staffing • Lewisville, TX, US
    serp_jobs.job_card.full_time
    Ethos Medical Staffing is seeking a travel Occupational Therapist for a travel job in Lewisville, Texas.Job Description & Requirements. Ethos Medical Staffing Job ID #34843018.Pay package is bas...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Director of Nursing

    Director of Nursing

    Zollege • Arlington, TX, US
    serp_jobs.job_card.full_time
    Be a foundational leader : you'll shape and launch the first accredited LVN / LPN program at Zollege, making a real impact in nursing education and workforce readiness. At Zollege, we believe higher ed...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Physical Therapist - Clinic Director

    Physical Therapist - Clinic Director

    Upstream Rehabilitation • The Colony, TX, United States
    serp_jobs.job_card.full_time
    Lead a team of amazing Physical Therapists as the Clinic Director with Peak Physical Therapy in The Colony!.Sign-on-Bonus of $7,500 to be offered at signing!. Will be managing another Physical Thera...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Director of Healthcare Operations

    Director of Healthcare Operations

    Beacon Hill • Arlington, TX, US
    serp_jobs.job_card.permanent
    Our client, a healthcare provider is seeking a permanent Director of Operations to work out of their corporate offices in North Austin, TX. This role is onsite 5 days a week from the hours of 9 : 00 a...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Director / Vice President of Operations (Outdoor Equipment Manufacturer)

    Director / Vice President of Operations (Outdoor Equipment Manufacturer)

    Direct Sales Recruiting, LLC • Arlington, TX, United States
    serp_jobs.job_card.full_time
    Director / Vice President of Operations (Outdoor Equipment Manufacturer).Director / Vice President of Operations (Outdoor Equipment Manufacturer). Get AI-powered advice on this job and more exclusiv...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    VP of Operations

    VP of Operations

    TradeJobsWorkForce • 75381 Dallas, TX, US
    serp_jobs.job_card.full_time
    VP of Operations Job Duties : Oversee day-to-day company operations.Define and implement operati...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    INTERIM PROGRAM DIRECTOR (PRN) - Nationwide Travel

    INTERIM PROGRAM DIRECTOR (PRN) - Nationwide Travel

    Universal Health Services, Inc. • Lewisville, TX, United States
    serp_jobs.job_card.full_time +1
    Interim Program Director of Behavioral Health (PRN) - Nationwide Travel (75% or more).Interim Program Director of Behavioral Health (PRN). Program Director is hired, and hours of work and days are s...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Therapist Supervisor

    Therapist Supervisor

    Gotham Enterprises Ltd • Arlington, TX, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Monday–Friday, 9 : 00 AM – 5 : 00 PM.Join a growing behavioral health organization in Arlington, Texas as a Clinical Supervisor. You’ll oversee a team of therapists, ensuring quality service delivery, r...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days