Director, Information Technology Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV)

Job Description:

Director, Information Technology Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV)

Description

Director, Information Technology Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV)

CalOptima

Director, Information Technology - Clinical, (Utilization Management, Care Management, and Grievance & Appeals)

Join Us - Where Your Talent Meets Opportunity. We're Better Together

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Director, Information Technology - Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV) and help shape the future of healthcare where you'll be an integral part of our IT - Applications Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 50% - Leadership Functions
  • Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
  • Leads the development of IT strategy and technical roadmap and ensures its integration with overall IT and CalOptima Health strategies.
  • Works with the department's leadership team on the project portfolio and governance required to prioritize resources, including budget.
  • Acts as a trusted advisor and builds and maintains relationships with other internal and external IT and business leaders to develop a clear understanding of business needs. Ensures cost-effective delivery of IT services to meet those needs and can respond with the agility required to address changing business priorities.
  • Develops and adheres to the annual operating and capital budgets and expenditures for infrastructure to ensure consistency with the departmental and organizational strategic objectives and remain within budget. Manages labor forecasting in support of project cost accounting.
  • Champions innovative efforts in experimenting with new solutions to take advantage of business opportunities.
  • Stays abreast of leading-edge and innovative solutions to the recruitment, development and retention of the IT workforce.
  • Drives the adoption and commitment to continual service improvement.

• 45% - Program Oversight
  • Provides strategic direction and oversight for the design, development, operation and support of systems that fulfill the needs of the business, including a deep understanding of the marketplace and technology's role in supporting the assigned systems.
  • Defines, develops, and manages a comprehensive and integrated architecture for assigned systems based on best-practice processes, disciplines and toolsets.
  • Operates within the established governance process to ensure that services can continue to be delivered in line with the agreed-upon business outcomes and timelines.
  • Delivers effective service management through the definition and adoption of a governance practice that uses key performance indicators (KPIs) and metrics to track and measure the quality of service. Continually monitors metrics and the integration of them with key accountabilities to ensure consistency of approach and continual service improvement.
  • Participates in the assessment of external and internal technology capabilities required to achieve desired competitive positioning.
  • Maintains knowledge of new technologies and platforms and provides direction on what emerging technologies should be assimilated, integrated, and introduced, ensuring that technology capabilities respond to and support the needs of the business.
  • Negotiates with vendor and supplier partners to enable cost-effective and innovative contracts and solutions to achieve business goals and ensure receipt of full support in line with service agreements.

• 5% - Other
  • Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Bachelor's degree in computer science, information systems or other related field PLUS 7 years of experience within information technology leadership required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  
• 7 years of experience in an IT leader role at multiple health plans required.
  
• 7 years of experience influencing clinical business management and key stakeholders effectively across the organization required.
  
• Experience with technology and business processes required to support Utilization Management, Care Management, EMR, and other clinical tools are required.
  
• Experience in leading IT transformational initiatives in dynamic environments required.
  
• Experience managing staff of 20+ required.
  
• Experience managing large-scale consulting/contracting engagements required.
  
• Experience managing operational and project budgets (including project cost accounting) required.
  
• Experience with the technology implications of a delegated provider model required.
  
• Experience leading the implementation of Utilization and Care Management vendor systems and an extensive knowledge of best-in-class integrations required and optimal reporting/analytics.
  
• Comprehensive knowledge of the Utilization and Care Management technology vendor marketplace and the ability to compare and contrast vendors and benefits delivered.
  
• Experience crafting business cases including meticulous cost estimates and quantifiable benefits.

You'll Stand Out More If You Possess the Following:

• Experience leading a team responsible for ZeOmega's Jiva (Utilization Management and Care Management).
  
• Clinical credentials.

What the Regulatory Agencies Need You to Possess?

• N/A

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You'll enjoy competitive compensation for this particular role:
  • Pay Grade: 323 - $204,199 - $326,717 ($98.17 - $157.0756)
• This position is approved for Partial Telework. (If the position is listed as Telework, it is eligible within California)
• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
  • A generous PTO program
  • A quality work life balance
  • Various wellness programs
  • Tuition Reimbursement
  • Professional development opportunities
  • Career development opportunities
  • Flexible scheduling
  • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's Your Next Step?

All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is September 25, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

Our Commitment to You

Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.

We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.



To apply, please visit: https://jobs.caloptima.org/jobs/director-information-technology-clinical-utilization-management-care-management-and-grievance-appeals-director-iv-505-city-parkway-west-california-united-states







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