Director, Information Technology Clinical, (...

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

Created: 2025-10-06