Medical Director, Ventura County Health Care Plan

Job Description:

Medical Director, Ventura County Health Care Plan

Description

Description

Click here to view the Brochure for Medical Director, Ventura County Health Care Plan

What We Offer
The County of Ventura offers an attractive compensation and benefits package. Aside from our base salary range, an employee within this position will also be eligible for the following:

• Educational Incentive - An educational incentive of 2.5% for completion of an associate degree, 3.5% for completion of a bachelor's degree, OR 5% for completion of a graduate degree that is not required for the position.
• Executive Annual Leave - 248 hours earned per year, increasing to 288 hours after 5 years of service, to 328 hours after 10 years of service, and to 368 hours after 15 years of service. *Credit for prior public service may be considered (Sec. 616A).
• Deferred Compensation - Eligible to participate in the County's 401(k) Shared Savings Plan and/or the Section 457 Plan. This position is eligible for up to a 3% match on your 401(k) contributions. Following five (5) years of continuous County service, an additional 2% non-elective contribution will be made to the 401(k) plan.
• Health Plans - Medical, Dental, and Vision Plans for you and your dependents. You are afforded a flexible credit allowance of up to $25,558 annually.
• Flexible Credit Allowance - This is a bi-weekly amount available to Regular employees for the purpose of purchasing medical, dental, and/or vision insurance from a group of authorized plans. Employees may also participate in the Flexible Spending Accounts which increase their spending power by reimbursing them with pre-tax dollars for IRS approved dependent care and health care expenses.
• Pension Plan - Participation in the County's defined pension plan. If eligible, you may establish reciprocity with other public retirement systems such as CalPERS.
• Holidays - 12 paid days per year in addition to an annual floating holiday.

The County
From rolling hills to sweeping ocean views, Ventura County is located on California's "Gold Coast," approximately 50 miles northwest of Los Angeles and 30 miles southeast of Santa Barbara. The near perfect Mediterranean climate with an average annual temperature of 74.2 degrees and a wonderful quality of life are a few of the reasons many of the 802,983 residents call Ventura County "home." Ventura has a diverse economic base from tourism to high-tech enterprises in beautifully planned communities, making the region one of the safest in Southern California.

The Health Care Agency
The Health Care Agency is the largest department in the County of Ventura and employs approximately 3,600 people; 1,100 of those in direct patient-care positions. The Health Care Agency is a comprehensive healthcare system that encompasses the Ventura County Medical Center (VCMC), Santa Paula Hospital, 24 primary care clinics, 11 specialty care clinics, Ambulatory Care, the Public Health Department, the Behavioral Health Department, and the Ventura County Health Care Plan. VCMC is also home to the top-rated (by Doximity and U.S. News & World Report) Family Medicine Residency Program in the United States and achieved an “All Cases” meritorious award for surgical care. It is also a West County Level II Trauma Center.

Ventura County Health Care Plan (VCHCP), a fully licensed Plan, was established in 1993 as a practical, cost-effective and innovative alternative to private health care services to eligible employees of the County and their covered dependents. The core medical services are provided by physicians and facilities associated with the Ventura County Medical Center (VCMC) and Santa Paula Hospital as well as other community providers. VCHCP also provided insurance coverage for employees of physician groups through the end of December 2022.

Medical Director, Ventura County Health Care Plan
Under general supervision of the Deputy Director Health Care Agency for the Ventura County Health Care Plan (VCHCP), will perform duties set forth in the California Knox- Keene Health Care Service Plan Act as well as regulations and Health and Safety code for VCHCP, a Department of Managed Health Care (DMHC) licensed Commercial HMO. This position is part of a team of 65 (including contractors), with no direct reports, and a $90 million dollar budget. In accordance with the National Committee on Quality Assurance (NCQA), the Medical Director, Ventura County Health Care Plan is responsible for the leadership and direction in planning, and coordinating medical reviewer staff to ensure appropriate, professional, and cost-conscious inpatient and outpatient health care to VCHCP assuring the quality of care provided to the members of the health plan by institutions, physicians, and allied professionals. As a licensed health Plan, VCHCP is required to be compliant with all regulatory requirements of any other large insurance plan.

The Successful Candidate

The ideal candidate will be collegial, engaged, and mission driven. Additionally, the successful individual will have an extensive background in licensed HMO operations, regulatory requirements, chairing various required committee meetings and leading the medical services departments through changes in the healthcare delivery landscape.

Medical Director, Ventura County Health Care Plan is an at-will classification which is exempt from the provisions of the Civil Service Ordinance. The incumbent will receive Management benefits and is exempt from overtime compensation.

To learn more about what it’s like to work for Ventura County and additional details on what we offer, click here Ventura County Lifestyle

TENTATIVE TIMELINE
OPENING DATE: May 09, 2025
CLOSING DATE: Continuous
FIRSTREVIEWOFRESUMES: Week of May 26, 2025

Examples Of Duties

Duties may include but are not limited to the following:

• Provides overall direction, guidance, and control for the medical components of VCHCP's services to ensure appropriate, professional, and cost-conscious health care.
• Develops and interprets medical policies. Coordinates and communicates matters of VCHCP medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff.
• Participates, as a member of the Senior Management Team, in developing goals, plans and policies for the organization, assuring that the medical decisions will not be unduly influenced by fiscal and administrative management.
• Ensures that comprehensive medical benefits are effectively developed and administered for VCHCP patients.
• Conducts provider credentialing and Re-Credentialing. Develops practice profile indicators. Member of Credentialing, Quality Assurance (QA) and Peer Review Committees. Presents to Standing Committee identified provider quality concerns. Implements any Committee disciplinary actions, including any remedial and punitive measures.
• Reviews results of facility site surveys performed by Provider Services Administrator. Communicates with providers deficiencies identified in practice site surveys and monitors corrective action plans submitted by providers.
• Manages and controls inpatient utilization and outpatient referrals with attention to quality and cost-effective methods. Delegates performance of routine QA/UR activities to the QA/UR Nurses based upon guidelines approved by the medical director and Plan Committee.
• Provides or arranges timely review and response to requests for VCHCP services which require physician authorization (i.e., emergency hospital admissions, elective admissions, elective surgical procedures, referrals, tests, medication approvals requiring authorization.)
• Develops utilization management standards and guidelines for approval by the Utilization Management Committee consistent with sound clinical principles and processes and with current medical and scientific information.
• Communicates standards and guidelines to VCHCP providers.
• Member of Utilization Management, Quality Assurance, Pharmacy and Therapeutics and Standing Committees.
• Provides a timely review and response to Member complaints that involve denial of services or concerns related to medical quality.
• Develops and maintains professional and effective working relationships with plan providers to optimize organizational growth and profitability. Responds to provider inquiries regarding plan decisions, clarifies related matters as appropriate.
• Develops and implements Quality Assurance Plan. Develops Quality Assurance Indicators. Member of QA, Pharmacy & Therapeutics, and Standing Committees.
• Defines and monitors compliance with quality management standards and protocols in collaboration with Network Providers and the VCHCP QA Committee.
• Approves agenda and minutes for VCHCP QA and Utilization Management Committees. Ensures that Committee activities follow the guidelines set forth in the QA and UR Plans and that Committee actions and assignments are completed in a timely manner as directed. Ensures that QA/Utilization Management Committee meetings are well attended by physicians of sufficient background and knowledge in the treatment of the medical conditions under discussion.
• Reviews all Potential Quality Issues (PQI’s) identified by the Plan and initiates the request for information (including assessment by other QA entities) needed to assess the PQI. Rates each PQI for seriousness of the incident and reports the results to the QA Committee.
• Refers issues of provider quality concerns to the Plan’s Credentials Committee and makes recommendations as to actions to be taken by the Plan.
• Implements disciplinary actions recommended by the Credentials Committee as defined by the Plan’s Policy.
• Ensures that any actions taken by the Plan against a provider for medical quality issues will be reported to the appropriate oversight bodies.
• Participates in the recruitment, interviewing, selection, and performance appraisal of VCHCP providers.
• Represents the Plan in a liaison role with other agencies and individuals as apparent or assigned.
• Provides consultation to VCHCP management and staff as requested.
• Attends the meetings of the Standing Committee, the Plan’s oversight committee. Presents the Plan’s Utilization and Quality Reports and relays concerns identified by the Plan’s Staff.
• Participates in Plan inter-rater reviews.
• Promotes Health Equity, Population Health Management, and quality standards.
• Performs related duties as assigned.

Typical Qualifications

QUALIFICATION(S):

• Doctor of Medicine or Osteopathy Degree,
• Current physician license to practice medicine in the State of California without restrictions, and
• Completed residency in primary care field of specialization (i.e. Family Practice, Internal Medicine, Pediatrics or Obstetrics/Gynecology).

Additional qualification requirement(s):

• Must be Board certified in California
• Thorough knowledge of the current principles and techniques of diagnosis and treatment
• Experience with managed care
• Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs
• At least three (3) years of direct patient care medical practice experience
• At least three (3) years of administrative experience

Desired Qualification(s):

• National Committee for Quality Assurance accreditation experience
• Experience/knowledge of pharmacy and plan formulary

Recruitment Process

To apply for this exceptional career opportunity, please send a resume and a cover letter that illustrates your experience as a Board-Certified Doctor of Medicine and includes the following:

• Experience with managed care
• Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs
• Direct patient care medical practice experience
• Administrative experience
• National Committee for Quality Assurance accreditation experience
• Experience/knowledge of pharmacy and plan formulary

If interested, you may do one of the following:

• E-mail your current resume and cover letter to: Liz.Gonzalez@ventura.org
• Submit an online application at www.ventura.org/jobs and attach your current resume and cover letter.

Resume Evaluation
The first review of resumes is anticipated to be the week of May 26, 2025, to determine whether or not the stated requirements are met. All relevant work experience, training and education need to be included in order to determine eligibility.

Interview Process
Following a structured evaluation of the resumes, the most qualified candidates will be invited to a panel interview. The top candidates, as determined by the panel, will then be invited to a second interview with County executive management. The interviews may be consolidated into one process or expanded into multiple interviews contingent upon the size and quantity of the candidate pool.

Background Investigation
The selected candidate may be subjected to a thorough background investigation which may include inquiry into past employment, education, criminal background information, and driving record. In addition, the successful candidate may be subjected to Live Scan fingerprinting.

For further information about this recruitment, please contact Liz Gonzalez by email Liz.Gonzalez@ventura.org or by telephone at (805) 677-5153.

EQUAL EMPLOYMENT OPPORTUNITY
The County of Ventura is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding, and related medical conditions), and sexual orientation.
NEOGOV

YOUR BENEFITS AS A COUNTY OF VENTURA EMPLOYEE

EXECUTIVE AND SENIOR MANAGEMENT LEVEL (Groups 1 & 2)

To learn more about Benefits, Retirement, and the Memorandum of Agreement (MOA), see links below.

• Benefits website or you may call (805) 654-2570.
• Retirement FAQ's
• Memorandum of Agreement

Union Codes: MA, MB2

Salary:

$219,417.77 - $307,184.88 Annually