Sr. Medical Director, Medical Policy

94244 La Riviera, California Blue Shield of California

Posted 27 days ago

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Job Description

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Sr. Medical Director, Medical Policy will report to the Chief Medical Officer. In this role you will be accountable for ensuring that all medical, medication, and payment policy initiatives are in aligned with the scientific evidence and professional guidelines. You will lead a team that delivers medical policy that adapts to new clinical innovations and supports medical payment operations, and training for staff in the accurate application of medical, medication, and payment policy, pricing, and coding.  In addition to chairing the BSC Pharmacy & Therapeutics, Medical and Payment Policy Committees, you will provide clinical leadership for all evidence-based medicine functions and partner closely with leaders of other business functions to develop strategies to ensure that Blue Shield members are receiving appropriate quality care.

Your Work

In this role, you will:

  • Provide clinical thought leadership for the design and implementation of clinical policy innovation initiatives such as Coverage with Evidence Development, and the development of robust and efficient approaches to developing policies for emerging classes of technology like molecular diagnostics and mobile/digital personal health devices
  • Chair the Medical Policy and Pharmacy and Therapeutics Committees
  • Provide clinical leadership and medical consultation for the Blue Shield of California (BSC) medication management process, including working closely with the Pharmacy Services team to promote safe, effective, and cost-efficient
  • Provide medical expertise in daily clinical rounds for drug authorization case review
  • Chair the Payment Policy Committee and provide clinical leadership for the BSC Payment Policy committee, overseeing and advising about payment policies and tactical approaches to ensure accurate coding of services
  • Consult with BSC legal team to support fraud and abuse investigations, provider arbitrations, regulatory inquiries and issues, and litigation related to clinical policy, coding, or pricing issues
  • Act as BSC’s representative to the Blue Cross Blue Shield Association (BCBSA) Technology Assessment process and the Medical Policy Panel
  • Participate on the California Technology Assessment Forum and other related activities
  • Partner with Network Management and Provider Partnership teams by providing subject matter expertise for contract and benefits coding decisions, including mandated benefits, provider contract language, provider DOFRs (division of financial responsibilities), and providing clinical perspective to resolve issues with BSC providers related to clinical policy, coding, and billing. 
  • Provide subject matter expertise for pricing of new, zero-dollar, and other exceptional claims
  • Present at IPA/MG and Provider education seminars regarding medical, medication and payment policy

Your Knowledge and Experience

  • Minimum of 2 years of previous medical leadership experience
  • Minimum of 5 years of direct patient care experience post residency 
  • Minimum of 8 years of experience developing evidence-based guidelines, medical policies or performing systematic reviews of the medical literature
  • Medical degree (M.D./D.O.) required. Master’s degree in epidemiology, health services or related degree is preferred
  • Completed residency preferably in adult based primary care specialty (e.g. Internal Medicine, Family Practice)
  • Maintain active, unrestricted California State Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
  • Maintain Board Certification in one of ABMS, ABOS, or AOA recognized specialty required (preferably Internal Medicine or Family Practice)
  • Has mastery level knowledge and skills within a specific technical or professional discipline with broad understanding of other areas within the job function
  • Outstanding verbal and written communication skills
  • Ability to lead through influence in a matrixed organization
  • Experience performing utilization management reviews is preferred
  • Experience in a health plan or managed care organization is preferred

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Clinical Director (Sacramento)

95834 Arden Arcade, California Turning Point Community Programs

Posted today

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full time

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Turning Point Community Programs is seeking a Clinical Director for our Transitional Support Services South (TSS South) program in Sacramento, CA . Turning Point Community Programs (TPCP) provides integrated, cost-effective mental health services, employment and housing for adults, children and their families that promote recovery, independence and self-sufficiency. We are committed to innovative and high quality services that assist adults and children with psychiatric, emotional and/or developmental disabilities in achieving their goals. Turning Point Community Programs (TPCP) has offered a path to mental health and recovery since 1976. We help people in our community every single day - creating a better space for all types of people in need. Join our mission of offering hope, respect and support to our clients on their journey to mental health and wellness.GENERAL PURPOSE Under the administrative supervision of the Program Director, this position is responsible for the clinical supervision of Personal Service Coordinators, Interns; and assisting the Program Director in the functioning of the program.DISTINGUISHING CHARACTERISTICS This is an at-will leadership position within a program. Additionally, this position is responsible for the day-to-day supervision of assigned staff who perform the established duties of the program. This is a management position responsible for ensuring that clinical needs of members are met, and that necessary paperwork is complete and accurate.Essential Duties And Responsibilities

  • The duties listed below are intended only as illustrations of the various types of work that could be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this class
  • Provides individual and group therapy under supervision of LCSW or MFCC.
  • Assists teams with coordination and service plans that reflect measurable objectives; assists teams in prioritizing resources to complete paperwork requirements per county and outlining areas for improvement in documentation.
  • Ensures that paperwork standards are met.
  • Problem solves communication difficulties between staff and members by providing interventions to enhance communication.
  • Provides in-service training and workshops.
  • Reviews and completes Denial of Rights Forms when indicated.
  • Visits members periodically to provide direction and support.
  • Provides prompt intervention in the event of a crisis both to stop the crisis and to notify, when indicated, persons and agencies necessary for the resolution of the crisis situation; provides on-the-spot counseling that is both helpful to the members and consistent with the philosophy of the program.
  • Ensures the safety, health, and well being of the members.
  • Completes paperwork as assigned in a timely manner.
  • Enforces the policies and procedures of Turning Point Community Programs.
  • Represents the agency at County utilization review; participates in off-site trainings and provides in-service training for all staff.
  • Conducts Quality Management activities as directed by the Clinical Director and Team Leader, such as preparation for county Utilization and Review audits, internal audits, review of services provision and charting, and other projects as assigned.
  • Facilitate groups, provide individual and family therapy, and update diagnosis for clients not receiving medication management services from the program psychiatrist.
  • Ensures the safety, health, and wellbeing of the members.
Schedule: Monday - Friday, 8:30am - 5:00 pmCompensation: $37.00 - $9.26 per hourInterested? Join us at our open interviews on Wednesdays from 2-4PM, located at 10850 Gold Center Drive, Suite 325, Rancho Cordova, CA 95670
  • or-
CLICK HERE TO APPLY NOW!

Seniority level
  • Seniority level Mid-Senior level
Employment type
  • Employment type Full-time
Job function
  • Job function Health Care Provider
  • Industries Mental Health Care

Referrals increase your chances of interviewing at Turning Point Community Programs by 2x

Get notified about new Clinical Director jobs in Sacramento, CA .

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Clinical Director II (Sacramento)

95828 Arden Arcade, California Turning Point Community Programs

Posted today

Job Viewed

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Job Description

part time

Join to apply for the Clinical Director II role at Turning Point Community Programs

1 year ago Be among the first 25 applicants

Join to apply for the Clinical Director II role at Turning Point Community Programs

Turning Point Community Programs is seeking a Clinical Director II for our Therapeutic Behavior Team Kaiser (TBS Kaiser) program in Sacramento . This position is eligible for a $3000 sign-on bonus . Turning Point Community Programs (TPCP) provides integrated, cost-effective mental health services, employment and housing for adults, children and their families that promote recovery, independence and self-sufficiency. We are committed to innovative and high quality services that assist adults and children with psychiatric, emotional and/or developmental disabilities in achieving their goals. Turning Point Community Programs (TPCP) has offered a path to mental health and recovery since 1976. We help people in our community every single day - creating a better space for all types of people in need. Join our mission of offering hope, respect and support to our clients on their journey to mental health and wellness.

GENERAL PURPOSE

Under the administrative supervision of the Program Director, this position is responsible for the clinical supervision of Personal Service Coordinators, Interns; and assisting the Program Director in the functioning of the program.

DISTINGUISHING CHARACTERISTICS

This is an at-will leadership position within a program. Additionally, this position is responsible for the day-to-day supervision of assigned staff who perform the established duties of the program. This is a management position responsible for ensuring that clinical needs of members are met, and that necessary paperwork is complete and accurate.

Essential Duties And Responsibilities - (illustrative Only)

The duties listed below are intended only as illustrations of the various types of work that could be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this class.

  • Provides individual and group therapy under supervision of LCSW or MFCC.
  • Assists teams with coordination and service plans that reflect measurable objectives; assists teams in prioritizing resources to complete paperwork requirements per county and outlining areas for improvement in documentation.
  • Ensures that paperwork standards are met.
  • Problem solves communication difficulties between staff and members by providing interventions to enhance communication.
  • Provides in-service training and workshops.
  • Reviews and completes Denial of Rights Forms when indicated.
  • Visits members periodically to provide direction and support.
  • Provides prompt intervention in the event of a crisis both to stop the crisis and to notify, when indicated, persons and agencies necessary for the resolution of the crisis situation; provides on-the-spot counseling that is both helpful to the members and consistent with the philosophy of the program.
  • Ensures the safety, health, and well being of the members.
  • Completes paperwork as assigned in a timely manner.
  • Enforces the policies and procedures of Turning Point Community Programs.
  • Represents the agency at County utilization review; participates in off-site trainings and provides in-service training for all staff.
  • Conducts Quality Management activities as directed by the Clinical Director and Team Leader, such as preparation for county Utilization and Review audits, internal audits, review of services provision and charting, and other projects as assigned.
  • Facilitate groups, provide individual and family therapy, and update diagnosis for clients not receiving medication management services from the program psychiatrist.
  • Ensures the safety, health, and wellbeing of the members.

Schedule: Part time, 8-10 hours per week with flexible scheduling

Compensation: $1.00 - 43.51 per hour

Interested? Join us at our open interviews on Wednesdays from 2-4PM,

located at 10850 Gold Center Drive, Suite 325, Rancho Cordova, CA 95670

-or-

CLICK HERE TO APPLY NOW!

Seniority level
  • Seniority level Mid-Senior level
Employment type
  • Employment type Part-time
Job function
  • Job function Health Care Provider
  • Industries Mental Health Care

Referrals increase your chances of interviewing at Turning Point Community Programs by 2x

Get notified about new Clinical Director jobs in Sacramento, CA .

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Clinical Director - Outpatient - Mental Health 181 (Sacramento)

95817 Arden Arcade, California Telecare Corporation

Posted today

Job Viewed

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Job Description

full time
Clinical Director - Outpatient - Mental Health 181

Join to apply for the Clinical Director - Outpatient - Mental Health 181 role at Telecare Corporation

Clinical Director - Outpatient - Mental Health 181

15 hours ago Be among the first 25 applicants

Join to apply for the Clinical Director - Outpatient - Mental Health 181 role at Telecare Corporation

They made it easier for me to live, breathe, eat, and stay clean. Without them, Id be waiting somewhere, waiting for someone to give me a chance to live. - Client from Orange County Region

Join Our Compassionate Team

Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals with complex needs in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.

As part of the Telecare Family, Sacramento Outreach Adult Recovery (SOAR) serves 250 adults aged 18+ with serious, persistent mental health issues in an outpatient setting. Using a tiered treatment approach, SOAR supports members in the least restrictive environment in obtaining their hope, health and dreams.

In this Clinical Director mid-level management position and under direct supervision of the Administrator, the Clinical Director provides leadership, coordination, and clinical supervision to multidisciplinary team(s) and/or program(s). Assists Administrator with quality improvement duties.

Shifts Available

Full-Time; AM | 8:30am - 5:00pm | Monday - Friday

SIGN-ON BONUS $5,000.00

Expected starting wage range is $9,302.95 - 122,674.36. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements.

What You Bring To The Table (Must Have)

  • Two (2) years post-graduate direct clinical experience in a mental health setting
  • Must have experience working with mental health and substance use consumers, families and advisory boards
  • Masters or higher degree in Social Services
  • One (1) year in leadership role in relevant setting (inpatient or outpatient setting, as appropriate)
  • Current licensure/registration in the state of program operation (except for out-of-state applicants with existing licensure in good standing) as LCSW, LMFT, LMSW, RN, Ph.D./Psy.D.
  • Valid and current drivers license, and personal vehicle insurance with your name listed as a driver.
  • Willingness to use your personal vehicle to attend meetings, etc. (weekly mileage reimbursement at the IRS rate)

Whats In It for You*

  • Medical, Vision, Dental Insurance, 401K, Employee Stock Ownership Plan
  • Paid Time Off: For FT Employee it is 16.7 days in your first year
  • Nine Paid Holidays
  • Career growth opportunity: company has grown 10%+ yearly for the past 5 years
  • For more information visit:
What You Will Love About Working At Telecare

  • Culture of power-with not power-over
  • Your contribution is valued
  • Opportunity to work alongside a multidisciplinary team of clinical professionals
  • Personal commitment to the mission from your team and colleagues
  • Diverse mental health program types with lifelong career advancement opportunities

What You Will Do

  • Implementing and overseeing the responsibilities for clinical services and standards of care for our clients, and administrative needs of the multidisciplinary team.
  • Continually communicates with community partners and all local systems of care that are in service to our clients.
  • Oversees documentation by clinical staff and performs audits of Clinical Charts to ensure adherence to State and County Requirements.
  • Assists with New Hire Orientation and ongoing training and mentorship for all clinical staff.
  • Assists with recruitment, screening, hiring, onboarding, performance evaluations and terminations of all clinical staff

EOE AA M/F/V/Disability

  • May vary by location and position type

Full Job Description will be provided if selected for an interview.

Clinical Director, Clinical Supervision, Clinician, Assistant Program Director, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, Licensed Professional Clinical Counselor, LCSW, LMFT, LPCC

If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.

Seniority level
  • Seniority level Director
Employment type
  • Employment type Full-time
Job function
  • Job function Health Care Provider
  • Industries Mental Health Care

Referrals increase your chances of interviewing at Telecare Corporation by 2x

Get notified about new Clinical Director jobs in Sacramento, CA .

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Were unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

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View Now

Clinical Director - Outpatient - Mental Health 181 (Sacramento)

95825 Arden Arcade, California Telecare

Posted today

Job Viewed

Tap Again To Close

Job Description

full time

They made it easier for me to live, breathe, eat, and stay clean. Without them, Id be waiting somewhere, waiting for someone to give me a chance to live. - Client from Orange County Region

Join Our Compassionate Team

Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals with complex needs in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.

As part of the Telecare Family, Sacramento Outreach Adult Recovery (SOAR) serves 250 adults aged 18+ with serious, persistent mental health issues in an outpatient setting. Using a tiered treatment approach, SOAR supports members in the least restrictive environment in obtaining their hope, health and dreams.

In this Clinical Director mid-level management position and under direct supervision of the Administrator, the Clinical Director provides leadership, coordination, and clinical supervision to multidisciplinary team(s) and/or program(s). Assists Administrator with quality improvement duties.

Shifts Available:

Full-Time; AM | 8:30am - 5:00pm | Monday - Friday

SIGN-ON BONUS $5,000.00

Expected starting wage range is $9,302.95 - 122,674.36. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements.

What You Bring to the Table (Must Have)

Two (2) years post-graduate direct clinical experience in a mental health setting

Must have experience working with mental health and substance use consumers, families and advisory boards

Masters or higher degree in Social Services

One (1) year in leadership role in relevant setting (inpatient or outpatient setting, as appropriate)

Current licensure/registration in the state of program operation (except for out-of-state applicants with existing licensure in good standing) as LCSW, LMFT, LMSW, RN, Ph.D./Psy.D.

Valid and current drivers license, and personal vehicle insurance with your name listed as a driver.

Willingness to use your personal vehicle to attend meetings, etc. (weekly mileage reimbursement at the IRS rate)

Whats In It for You*

Medical, Vision, Dental Insurance, 401K, Employee Stock Ownership Plan

Paid Time Off: For FT Employee it is 16.7 days in your first year

Nine Paid Holidays

Career growth opportunity: company has grown 10%+ yearly for the past 5 years

For more information visit:

What You Will Love About Working at Telecare

Culture of power-with not power-over

Your contribution is valued

Opportunity to work alongside a multidisciplinary team of clinical professionals

Personal commitment to the mission from your team and colleagues

Diverse mental health program types with lifelong career advancement opportunities

What You Will Do

Implementing and overseeing the responsibilities for clinical services and standards of care for our clients, and administrative needs of the multidisciplinary team.

Continually communicates with community partners and all local systems of care that are in service to our clients.

Oversees documentation by clinical staff and performs audits of Clinical Charts to ensure adherence to State and County Requirements.

Assists with New Hire Orientation and ongoing training and mentorship for all clinical staff.

Assists with recruitment, screening, hiring, onboarding, performance evaluations and terminations of all clinical staff

EOE AA M/F/V/Disability

*May vary by location and position type

Full Job Description will be provided if selected for an interview.

Clinical Director, Clinical Supervision, Clinician, Assistant Program Director, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, Licensed Professional Clinical Counselor, LCSW, LMFT, LPCC

If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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View Now

Clinical Director - Outpatient - Mental Health 181 (Sacramento)

95825 Arden Arcade, California MedStar Health

Posted today

Job Viewed

Tap Again To Close

Job Description

full time
Description

They made it easier for me to live, breathe, eat, and stay clean. Without them, I'd be waiting somewhere, waiting for someone to give me a chance to live. - Client from Orange County Region


Join Our Compassionate Team


Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals with complex needs in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.


As part of the Telecare Family, Sacramento Outreach Adult Recovery (SOAR) serves 250 adults aged 18+ with serious, persistent mental health issues in an outpatient setting. Using a tiered treatment approach, SOAR supports members in the least restrictive environment in obtaining their hope, health and dreams.


In this Clinical Director mid-level management position and under direct supervision of the Administrator, the Clinical Director provides leadership, coordination, and clinical supervision to multidisciplinary team(s) and/or program(s). Assists Administrator with quality improvement duties.


Shifts Available:


Full-Time; AM | 8:30am - 5:00pm | Monday - Friday


SIGN-ON BONUS $5,000.00


Expected starting wage range is $9,302.95 - 122,674.36. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements.


What You Bring to the Table (Must Have)


* Two (2) years post-graduate direct clinical experience in a mental health setting


* Must have experience working with mental health and substance use consumers, families and advisory boards


* Masters or higher degree in Social Services


* One (1) year in leadership role in relevant setting (inpatient or outpatient setting, as appropriate)


* Current licensure/registration in the state of program operation (except for out-of-state applicants with existing licensure in good standing) as LCSW, LMFT, LMSW, RN, Ph.D./Psy.D.


* Valid and current driver's license, and personal vehicle insurance with your name listed as a driver.


* Willingness to use your personal vehicle to attend meetings, etc. (weekly mileage reimbursement at the IRS rate)


What's In It for You*


* Medical, Vision, Dental Insurance, 401K, Employee Stock Ownership Plan


* Paid Time Off: For FT Employee it is 16.7 days in your first year


* Nine Paid Holidays


* Career growth opportunity: company has grown 10%+ yearly for the past 5 years


* For more information visit:


What You Will Love About Working at Telecare


* Culture of power-with not power-over


* Your contribution is valued


* Opportunity to work alongside a multidisciplinary team of clinical professionals


* Personal commitment to the mission from your team and colleagues


* Diverse mental health program types with lifelong career advancement opportunities


What You Will Do


* Implementing and overseeing the responsibilities for clinical services and standards of care for our clients, and administrative needs of the multidisciplinary team.


* Continually communicates with community partners and all local systems of care that are in service to our clients.


* Oversees documentation by clinical staff and performs audits of Clinical Charts to ensure adherence to State and County Requirements.


* Assists with New Hire Orientation and ongoing training and mentorship for all clinical staff.


* Assists with recruitment, screening, hiring, onboarding, performance evaluations and terminations of all clinical staff


EOE AA M/F/V/Disability


*May vary by location and position type


Full Job Description will be provided if selected for an interview.


Clinical Director, Clinical Supervision, Clinician, Assistant Program Director, Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, Licensed Professional Clinical Counselor, LCSW, LMFT, LPCC


If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.




Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.


#J-18808-Ljbffr
View Now

Clinical Director II - Part-Time Hybrid (Sacramento)

95825 Arden Arcade, California Turning Point Community Programs

Posted today

Job Viewed

Tap Again To Close

Job Description

part time

Join to apply for the Clinical Director II - Part-Time Hybrid role at Turning Point Community Programs

1 year ago Be among the first 25 applicants

Join to apply for the Clinical Director II - Part-Time Hybrid role at Turning Point Community Programs

Turning Point Community Programs is seeking a part-time Clinical Director II for our Sac Kaiser TBS program in Sacramento . Turning Point Community Programs (TPCP) provides integrated, cost-effective mental health services, employment and housing for adults, children and their families that promote recovery, independence and self-sufficiency. We are committed to innovative and high quality services that assist adults and children with psychiatric, emotional and/or developmental disabilities in achieving their goals. Turning Point Community Programs (TPCP) has offered a path to mental health and recovery since 1976. We help people in our community every single day - creating a better space for all types of people in need. Join our mission of offering hope, respect and support to our clients on their journey to mental health and wellness.

Schedule : 10 hours per week, schedule has some flexiblity, Wednesdays 10-12 required. Position is hybrid.

Compensation: $41.00 - $3.51 per hour

GENERAL PURPOSE

Under the administrative supervision of the Program Director, this position is responsible for the clinical supervision of Personal Service Coordinators, Interns; and assisting the Program Director in the functioning of the program.

DISTINGUISHING CHARACTERISTICS

This is an at-will leadership position within a program. Additionally, this position is responsible for the day-to-day supervision of assigned staff who perform the established duties of the program. This is a management position responsible for ensuring that clinical needs of members are met, and that necessary paperwork is complete and accurate.

Essential Duties And Responsibilities - (illustrative Only)

The duties listed below are intended only as illustrations of the various types of work that could be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to this class

  • Provides individual and group therapy under supervision of LCSW or MFCC.
  • Assists teams with coordination and service plans that reflect measurable objectives; assists teams in prioritizing resources to complete paperwork requirements per county and outlining areas for improvement in documentation.
  • Ensures that paperwork standards are met.
  • Problem solves communication difficulties between staff and members by providing interventions to enhance communication.
  • Provides in-service training and workshops.
  • Reviews and completes Denial of Rights Forms when indicated.
  • Visits members periodically to provide direction and support.
  • Provides prompt intervention in the event of a crisis both to stop the crisis and to notify, when indicated, persons and agencies necessary for the resolution of the crisis situation; provides on-the-spot counseling that is both helpful to the members and consistent with the philosophy of the program.
  • Ensures the safety, health, and well being of the members.
  • Completes paperwork as assigned in a timely manner.
  • Enforces the policies and procedures of Turning Point Community Programs.
  • Represents the agency at County utilization review; participates in off-site trainings and provides in-service training for all staff.
  • Conducts Quality Management activities as directed by the Clinical Director and Team Leader, such as preparation for county Utilization and Review audits, internal audits, review of services provision and charting, and other projects as assigned.
  • Facilitate groups, provide individual and family therapy, and update diagnosis for clients not receiving medication management services from the program psychiatrist.
  • Ensures the safety, health, and wellbeing of the members.

Interested? Join us at our open interviews on Wednesdays from 2-4PM,

located at 10850 Gold Center Drive, Suite 325, Rancho Cordova, CA 95670

-or-

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Water Justice Clinical Director (ACAD PRG MGT OFCR 5)

95617 Davis, California University of California-Davis

Posted 6 days ago

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Job Description

Apply for Job Job ID 79518
Location Davis
Full/Part Time Full Time
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Job Summary

FOR HR USE ONLY

EEO/AA Statement

A Culture of Opportunity and Belonging

At UC Davis, we're committed to solving life's most urgent challenges and building a healthier, more resilient world. We believe in growing through every challenge, continually striving to improve, and welcoming new perspectives that strengthen our community. We recognize that a vibrant and innovative organization values both individual strengths and shared purpose. The best ideas often emerge when people with different experiences come together.

As you consider joining UC Davis, we invite you to explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education. We believe you belong here. The University of California, Davis is an Equal Opportunity Employer. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

To view the University of California's Anti-Discrimination Policy, please visit:

Because we want you to feel seen and valued, our recruitment process at UC Davis supports openness and authenticity. Research shows that some individuals hesitate to apply unless they meet every qualification. You may be an excellent fit for this role-or the next one. We encourage you to apply even if your experience doesn't match every listed requirement. #YouBelongHere

To learn more about our background check program, please visit:

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Director, Clinical Quality

94278 Sacramento, California Evolent

Posted 3 days ago

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Job Description

**Your Future Evolves Here**
Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business.
Join Evolent for the mission. Stay for the culture.
**What You'll Be Doing:**
The Director, Clinical Quality is a pivotal role, spearheading continuous clinical quality improvement initiatives and managing high-priority quality improvement projects, encompassing primary and specialty care and integration. Utilizing the DMAIC (Define, Measure, Analyze, Improve, Control) process, this role will work cross-functionally to enhance patient outcomes, streamline processes, and foster a culture of clinical excellence in member care. The role also involves driving the development and implementation of clinical performance metrics, ensuring effective quality measurement, data analysis, and the execution of actionable improvement strategies to enhance clinical outcomes and operational efficiency. Additionally, the Director, Clinical Quality will support a portfolio of performance initiatives to achieve strategic and financial goals.
**Key Responsibilities:**
**Innovation:**
Develops common set of core quality metrics for core sub-specialties that align with national measure to improve patient outcomes and minimize provider complexity.
o Oncology
o Cardiology
o MSK
o Radiology
**Stakeholder Collaboration:**
o Serve as a liaison between clinical teams, analytics, partner operations, strategic accounts, and leadership to ensure alignment on quality improvement priorities and goals.
o Synthesize and present findings to leadership and develop visually appealing content that effectively communicates findings and recommendations.
o Facilitate regular communication and updates on metric development, trends, and improvement initiatives.
o Engage cross-department leaders and stakeholders to design and execute initiatives across clients/markets.
**Documentation and Communication:**
o Create clear, accessible, and actionable documentation for clinical performance metrics.
o Communicate progress and results of quality initiatives to stakeholders, including executive leadership and clinical teams.
**Quality Data Analysis and Insights:**
o Analyze quality data to identify trends, variations, and opportunities for improvement.
o Interpret findings and collaborate with stakeholders to understand root causes and potential impacts.
o Use available data to determine whether implemented initiatives achieve metrics of success, working cross-functionally to refine approach as needed.
**Quality Improvement Initiatives:**
o Develop and implement action plans based on data-driven insights to address identified trends and gaps in performance.
o Partner with clinical, operational, and analytics teams to monitor the impact of improvement efforts and refine strategies as needed.
o Define & Understand Scope: Establish clear project objectives and goals in alignment with organizational priorities. Collaborate with Medical Directors and analytics teams to identify key clinical performance metrics.
o Measure and Analyze: Collect data to measure current process performance and establish baselines. Analyze quality data to identify trends, variations, and improvement opportunities. Understand root causes and impacts.
o Improve and Control: Implement evidence-based interventions to enhance quality and reduce variability. Monitor key performance indicators to sustain improvements and make necessary adjustments.
**Performance Management:**
o Manage high-priority performance initiatives through all phases of design and execution, including post-go-live tracking, to realize strategic and financial goals.
o Maintain a catalog of performance initiatives, including their description, high-level sizing, and other key criteria for prioritization.
o Develop and maintain project management processes, tools, and templates for performance initiatives.
o Ensure strict compliance with federal and state regulations and company policies, procedures, and processes.
**Qualifications (Required and Preferred):**
- Bachelor's degree in healthcare administration, nursing, public health, or a related field. In lieu of degree, 5+ years of experience in clinical quality or process improvement.
- 2+ years of clinical quality improvement experience in healthcare, preferably with a focus on specialty care and quality.
- Strong analytical skills with proficiency in statistical analysis and process mapping.
- Excellent leadership, communication, and interpersonal skills.
- Ability to work independently and collaboratively in a fast-paced, dynamic environment.
- Certification in Six Sigma, Lean, or other quality improvement methodologies (preferred).
- Strong project management skills: history of taking initiative and effectively managing projects and processes.
- Experience with managed care, specialty care, cardiology, and/or provider engagement.
- Experience with medical expense reporting and initiative development.
- Strong Microsoft PowerPoint, Excel, and Word skills.
- Outstanding written and oral presentation skills.
**Key Competencies:**
- Deep understanding of quality improvement frameworks (e.g., Lean, Six Sigma, PDSA cycles).
- Proficiency in data analysis tools and software (e.g., Excel, BI Portal, or similar).
- Strong organizational and project management skills to manage multiple initiatives simultaneously.
- A commitment to advancing clinical excellence and improving patient outcomes.
**To comply with HIPAA security standards (45 C.F.R. sec. 164.308 (a) (3)), identity verification may be required as part of the application process. This is collected for compliance and security purposes and only reviewed if an applicant advances to the final interview state. Reasonable accommodations are available upon request.**
**Technical Requirements:**
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
**Evolent is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.** **If you need reasonable accommodation to access the information provided on this website, please contact** ** ** **for further assistance.**
The expected base salary/wage range for this position is $122,500. This position is also eligible for a bonus component that would be dependent on pre-defined performance factors. As part of our total compensation package, Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees. All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.
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Director, Clinical Operations

94278 Sacramento, California Bausch + Lomb

Posted 3 days ago

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Job Description

Bausch + Lomb (NYSE/TSX: BLCO) is a leading global eye health company dedicated to protecting and enhancing the gift of sight for millions of people around the world-from the moment of birth through every phase of life. Our mission is simple, yet powerful: helping you see better, to live better.
Our comprehensive portfolio of over 400 products is fully integrated and built to serve our customers across the full spectrum of their eye health needs throughout their lives. Our iconic brand is built on the deep trust and loyalty of our customers established over our 170-year history. We have a significant global research, development, manufacturing and commercial footprint of approximately 13,000 employees and a presence in approximately 100 countries, extending our reach to billions of potential customers across the globe. We have long been associated with many of the most significant advances in eye health, and we believe we are well positioned to continue leading the advancement of eye health in the future.
**Position Summary** **:**
Is responsible for the implementation and oversight of clinical study operations by organizing and coordinating with other relevant parties the planning, implementation, management, execution and completion of clinical studies according to applicable regulations and guidance, ICH and GCP, and Bausch & Lomb SOPs within agreed-upon timeframes and budget. Also responsible for effective communication within the corporation (and with external entities, where appropriate) of the issues and actions related to the successful completion of these studies. May serve as the primary project team representative for Clinical Operations.
**Major areas of Responsibility** **:**
Clinical Operations:
+ Manage and/or oversee the development process for critical study documents (e.g., protocol, amendments, IB, ICF, and CRFs). Will also work closely with members of other functional areas to provide input on study-related documents and issues (DMP, SAP, drug/device supplies, CSR, etc.).
+ Provides clinical operations input in the identification, evaluation, and selection of CROs and vendors (e.g., central labs, central IRB, IVRS, etc.).
+ Manage the identification, evaluation, and selection of investigators/sites.
+ Ongoing assessment, evaluation and management of internal and external resources.
+ Ensure study supply requirements are met.
+ Responsible for the appropriate communication with and maintenance of clinical study sites including training of site personnel in the study protocol and other study-specific procedures.
+ Supervise clinical operations team to ensure all study activities are completed in accordance with applicable regulations and guidance, ICH, GCP and B&L SOPs.
+ Communicate with relevant global team members, other B&L departments (e.g., R&D/Project Management, Clinical/Medical Affairs, Biometrics, Regulatory Affairs, Quality Assurance, Pharmacovigilance/GPSS and Drug/Device Safety, and Clinical Supplies), and external consultants to ensure study objectives are being met and provide the operations director and/or senior management with timely updates on progress and changes in scope, schedule, and resources.
+ Organize investigator and expert meetings relevant to the indication and assist with the organization and management of DSMBs and Data Review Committees, as necessary.
+ Prepare study timelines and budgets and ensuring study execution is aligned with these targets.
+ Supervise clinical staff and vendors to ensure all study activities are completed in accordance with applicable regulations and guidance, ICH, GCP and B&L SOPs.
+ Responsible for the quality of all study-related documentation (e.g., Trial Master File, site qualification and initiation visits reports, interim monitoring visit reports, clinical monitoring plan, informed consents, CRF completion guidelines, pharmacy manual, etc.) during study start-up and throughout the life of the project to ensure that procedures are followed in an appropriate and consistent manner.
+ Oversee the preparation of procedures for the conduct and monitoring of clinical research such as Clinical Monitoring Plans, procedures for reporting of adverse events, CRF completion guidelines, Study Manual, etc.
+ Liaise with PVG/GPSS and provide clinical operations support and guidance for the ongoing surveillance of the safety of patients in clinical trials by reviewing reported AEs and SAEs and assure proper reporting of the events to the IRBs/REBs/ECs.
+ Liaise with Data Management to review data discrepancies and ensure that data clarification forms (queries) are appropriately handled by the CRAs and responded to by the site/investigator in a timely manner. May assist in the review of queries to determine criticality of the DCF during data clean-up and lock process.
+ Liaise with vendors and study site personnel and clinical investigators to provide study related guidance and answers to operational issues.
Budgets and Forecasts:
+ Provide input to Finance to forecast study expenditures and resourcing needs.
+ Review RFPs and proposals from external vendors.
+ Ensure subordinates and vendors manage and monitor study related expenses to meet forecast.
Regulatory Reports:
+ Provide Clinical Operations support in the timely coordination and execution of clinical study reports.
+ Assist in the review of regulatory reports to ensure that reports accurately reflect proper interpretation of the clinical study findings.
+ Assist to ensure annual IND/IDE and IB/ROPI updates are completed in an accurate and timely manner.
+ Provide Clinical Operations support to the Regulatory Affairs department.
Leadership:
+ Manage in-house team of CRAs, CTAs and/or CTMs for one or more studies to ensure execution of all studies in a timely and efficient manner.
+ Provide leadership, training, and development support to the study team.
+ May lead meetings (face-to-face, teleconferences, etc.) with external vendors ensuring problems are identified and issues are resolved quickly and efficiently.
+ May serve as a representative on internal committees/teams for Clinical Operations or cross-functional activities.
+ Foster a dynamic, matrixed working environment by appropriately challenging processes, inspiring a shared vision, enabling others to act, leading by example, and encouraging study team members to meet and/or exceed expectations.
+ Encourage professional growth of personnel through regular training sessions, and by acting as a resource to clinical staff. May lead training sessions.
+ Provide guidance and comments on SOPs revisions. May act as a leader of a SOP sub-committee for SOP revisions.
+ May visit sites with CRAs as needed to provide hands-on training as well as to discuss study related issues and problems with the Principal Investigator and/or site staff.
+ Share/present knowledge and information with appropriate departmental, project, or study team members for training purposes.
**POSITION REQUIREMENTS** **:**
+ Strong knowledge of Good Clinical Practices (GCP), clinical trials management (including site monitoring), scientific methods, research design, regulatory compliance, and clinical data management.
+ Minimum 10-12 years experience in the industry with a minimum of 6 years of managing clinical trials.
+ Minimum of 5 - 6 years experience in managing and training clinical personnel (Executive CRAs, CRAs, project assistants).
+ Experience leading device studies in Ophthalmology is a plus
+ Strong planning and organizational skills with ability to multi-task and plan activities as it relates to management of clinical trials.
+ Experience leading and working within cross-functional teams.
+ Experience in managing CROs and external vendors.
+ Excellent written and verbal communication skills and strong interpersonal skills in order to interface with physicians, outside vendors, consultants, team members and various audiences.
+ Ability to problem solve, build teams, and to lead and motivate others.
+ Effectively work independently as well as within a team matrix.
+ Financial management skills as applicable to overseeing project expenditures and forecasts.
+ Advanced computer skills (Microsoft applications, spreadsheets and data displays, etc.)
+ Willing and able to travel.
**We offer competitive salary & excellent benefits including:**
+ Medical, Dental, Eye Health, Disability and Life Insurance begins on your hire date
+ 401K Plan with company match and ongoing company contribution
+ Paid time off - vacation (3 weeks - prorated upon hire), floating holidays and sick time
+ Employee Stock Purchase Plan with company match
+ Employee Incentive Bonus
+ Tuition Reimbursement (select degrees)
+ Ongoing performance feedback and annual compensation review
This position may be available in the following location(s): ((location_obj))
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
For U.S. locations that require disclosure of compensation, the starting pay for this role is between $170,000.00 and $205,000.00. The estimated salary range reflects an anticipated range for this position. The actual base salary offered may depend on a variety of factors. U.S. based employees may be eligible for short-term and/or long-term incentives. They may also be eligible to participate in medical, dental, vision insurance, disability and life insurance, a 401(k) plan and company match, a tuition reimbursement program (select degrees), company holidays, and well-being benefits, among others. U.S. based employees are also eligible to receive sick time, floating holidays and paid vacation.
Job Applicants should be aware of job offer scams perpetrated through the use of the Internet and social media platforms. To learn more please read Bausch + Lomb's Job Offer Fraud Statement ( .
Our Benefit Programs:Employee Benefits: Bausch + Lomb ( must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.
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