Talent.com
Vice President of Clinical Operations, Parkland Community Health Plan
Vice President of Clinical Operations, Parkland Community Health PlanParkland Health and Hospital System • Plano, 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 and Hospital System • Plano, 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 • Plano, TX, US

    Job_description.internal_linking.related_jobs
    Director, Radiology Operations

    Director, Radiology Operations

    Parkland Health and Hospital System • Dallas, TX, United States
    serp_jobs.job_card.full_time
    Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Director, Pulmonary Hypertension & Vascular Program

    Director, Pulmonary Hypertension & Vascular Program

    Ohioacc • Dallas, TX, United States
    serp_jobs.job_card.full_time
    A leading academic medical center in Dallas is seeking a Pulmonary Hypertension Specialist to lead its expanding Pulmonary Vascular Disease Program. This role focuses on evaluating and managing pati...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Health Care Consulting Director- Revenue Cycle

    Health Care Consulting Director- Revenue Cycle

    Moss Adams LLP • Dallas, TX, United States
    serp_jobs.job_card.full_time
    Job Description - Health Care Consulting Director- Revenue Cycle (28383).Kansas City, KS; Napa, CA; Pasadena, CA; Salt Lake City, UT. New York, NY; Woodland Hills, CA; Spokane, WA; San Diego, CA; B...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Director of Operations - Multifamily

    Director of Operations - Multifamily

    University Partners • Dallas, TX, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Director of Operations Job Description The Director of Operations will report and support the VP of Asset Management and implement best practices in operations and ensure operational consiste...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days
    Clinical Director - ABA Therapy

    Clinical Director - ABA Therapy

    Bright achievements • McKinney, TX, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    A leading provider of Applied Behavior Analysis (ABA) therapy dedicated to improving the lives of individuals with autism and related disorders. Our center near Dallas, Texas, offers a support...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Director of Healthcare Operations

    Director of Healthcare Operations

    Beacon Hill • Plano, 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
    Commercial Roofing VP of Operations

    Commercial Roofing VP of Operations

    Gpac • Dallas, Texas, United States
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    We are seeking a driven and experienced.This is a rare opportunity to join a highly respected commercial roofing contractor with solid client relationships, a strong reputation, and a backlog of wo...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Vice President of Operations - Pizza

    Vice President of Operations - Pizza

    Leap Brands • Dallas, TX, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Leap Brands is working with a private equity backed pizza brand that is looking for a strong Vice President of Operations to join their team. They are dedicated to providing exceptional dining exper...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    VP of program Delivery

    VP of program Delivery

    Stelvio Inc. • Frisco, TX, United States
    serp_jobs.job_card.full_time
    Job Title : VP of program Delivery.As the VP of program Delivery , you will play a pivotal role in the oversight and management of all programs within our organization. This leadership position deman...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
    Clinical Manager, Treatment Initiation

    Clinical Manager, Treatment Initiation

    ACES • Plano, TX, US
    serp_jobs.job_card.full_time
    Salary : $89,000-$94,000 (plus up to $19,000 in annual incentives based on performance).ACES is a rapidly growing company of autism services that is dedicated to enhancing the quality of life for in...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_less • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Sr. Director of Technology and AI – Clinical Systems

    Sr. Director of Technology and AI – Clinical Systems

    Blue Signal Search • Dallas, TX, United States
    serp_jobs.job_card.full_time
    Director of Technology and AI – Clinical Systems.Hybrid in Dallas, TX (metro area) with remote flexibility for outstanding candidates across the United States. A nationwide leader in women’s health ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    VP of Operations - Texas

    VP of Operations - Texas

    Sparrow Partners • Dallas, TX, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    VP, Operations Are you a strategic thinker who is skilled at disciplined execution and scaling processes to set your team up for success during periods of rapid growth? Are you a servant lead...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Clinical Research Operations Manager (Plano)

    Clinical Research Operations Manager (Plano)

    ACRC Trials • Plano, TX, United States
    serp_jobs.job_card.full_time
    ACRC Trials is an investigator site network of award-winning physician practices and clinics, specializing in vaccine trials, Phase II-IV pharmaceutical and device studies.Our location at West Plan...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
    Vascular Area Clinical Leader (Dallas / Phoenix)

    Vascular Area Clinical Leader (Dallas / Phoenix)

    Solventum • Dallas, TX, United States
    serp_jobs.job_card.full_time
    Thank you for your interest in joining Solventum.Solventum is a new healthcare company with a long legacy of solving big challenges that improve lives and help healthcare professionals perform at t...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Vice President of Operations

    Vice President of Operations

    Delasco LLC • Plano, TX, USA
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    We're Hiring : Vice President of Operations.Full-time | Executive Leadership.Delasco, a leading provider of dermatology and esthetic supplies, is seeking an experienced and results-driven.This is an...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Assistant Clinic Director

    Assistant Clinic Director

    IV Nutrition • McKinney, TX, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    McKinney, TX Position Type : Full-Time | Leadership Track Reports To : Clinic Director About the Role This is more than a job—it’s the launchpad for a purpose-driven career in functional ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Regional Director of Operations

    Regional Director of Operations

    Delta Dallas • Addison, TX, US
    serp_jobs.job_card.full_time
    Regional Director of Operations– Healthcare - Dallas, TX (only local candidates will be considered).Our client in specialized healthcare, is seeking a dynamic and strategic.Regional Director of Ope...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Bilingual Clinical Director / BCBA

    Bilingual Clinical Director / BCBA

    ICBD • Plano, TX, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    Bilingual Clinical Director (BCBA) – Texas ABA Centers.Are you a BCBA interested in taking your career in a new direction? Our Clinical Director is responsible for monitoring the daily clinica...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days