Director of Health Services - Ventura County Health Care Plan

Job Description:

Director of Health Services - Ventura County Health Care Plan

Description

Description

THE POSITION

Under general direction of the Health Care Plan Administrator, responsible for managing the daily operations of the Quality Assurance, Utilization Management, and Case & Disease Management departments within the Ventura County Health Care Plan.

The Director of Health Services - Ventura County Health Care Plan is a senior leadership position responsible for ensuring The Health Plan delivers high-quality, compliant, and equitable care. This role provides strategic oversight of clinical operations, quality improvement, and regulatory compliance under the Knox-Keene Act, Title 28 CCR, and Department of Managed Health Care (DMHC) requirements.

NOTE: This is an onsite position with a typical schedule of Monday through Friday 8:00 am to 5:00 pm.

IDEAL CANDIDATE

The ideal candidate is an experienced nurse and healthcare leader with a strong background in managed care, health plan operations, and clinical program administration. They possess comprehensive knowledge of quality improvement, utilization management, case and disease management, and regulatory compliance, with demonstrated experience ensuring adherence to Knox-Keene Act, Title 28 California Code of Regulations, and Department of Managed Health Care (DMHC) requirements.

PAYROLL TITLE: Assistant Insurance Services Administrator

DISTINGUISHING CHARACTERISTICS
The Assistant Insurance Services Administrator classification differs from the Health Care Plan Administrator in that the former classification manages day-to-day operations of an area or department within the County's Health Care Plan. The classification is further distinguished from the Health Care Plan Administrator in that the latter has ultimate responsibility to ensure regulatory compliance and appropriate administration of the County's Health Care Plan.

WHAT WE OFFER
The County of Ventura offers an attractive compensation and benefits package. In addition to the annual salary an employee within these positions may also be eligible for the following:

• Bilingual Incentive - Incumbents may be eligible for bilingual incentive depending upon operational needs and certification of skill.
• Educational Incentive - Incumbents may also be eligible for 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 for educational attainments not specifically required by the position.
• Deferred Compensation - Eligible to participate in the County's 401(k) Shared Savings Plan and/or the Section 457 Plan.
• Health Plans - Full-time employees are afforded a flexible credit allowance for purchasing medical, dental, and/or vision insurance from a group of authorized plans.
• Flexible Spending Accounts - Choice of participation in the Flexible Spending Accounts which increase spending power through reimbursement of pre-tax dollars for IRS approved dependent care and health care expenses.
• Pension Plan - Both the County and employees contribute to the County's Retirement Plan and to Social Security. If eligible, reciprocity may be established with other public retirement systems, such as PERS.
• Holidays - 13 paid days per year which includes a scheduled floating holiday.

AGENCY/DEPARTMENT: Health Care Agency - Ventura County Health Care Plan

Assistant Insurance Services Administrator is a Management position and is exempt from overtime. This classification is eligible for benefits at the MB3 level.

The eligible list established from this recruitment may be used to fill current and future Regular, Temporary, Fixed-term, Intermittent, and Extra-help vacancies for this position only. There is currently one (1) Regular vacancy.

TENTATIVE SCHEDULE:
OPENING DATE: June 10, 2026
CLOSING DATE: June 24, 2026 at 5:00 p.m.

Examples Of Duties

Duties may include, but are not limited to the following:

• Directs oversight and responsibility for Quality Assurance, Utilization Management, and Case & Disease Management department deliverables;
• Provides strategic oversight of clinical operations, quality improvement, and regulatory compliance as it relates to clinical operations;
• Develops policies and procedures for assignment area;
• Ensures compliance with Federal and State regulations, including Knox-Keene Health Care Service Plan Act, Title 28 California Code of Regulations, Department of Managed Health Care (DMHC) requirements, and National Committee for Quality Assurance (NCQA) accreditation standards;
• Prepares and oversees the development of management reports, tracking and trending analyses, and other data-driven evaluations to support decision-making and performance improvement;
• Collaborates with the Medical Director and supervising clinical staff to ensure appropriate medical policies and clinical guidelines are utilized when making determinations related to authorization requests;
• Assists staff in making complex clinical decisions, through appropriate use of policies/procedures and Plan Administrator or Medical Director input;
• Provides clinical oversight of Case Management and activities related to Healthcare Effectiveness Data and Information Set (HEDIS) measures and interventions;
• Provides leadership and oversight of Health Care Plan personnel through recruiting, hiring, training, mentoring, and evaluating licensed clinical professionals and administrative staff to achieve departmental and organizational objectives;
• Guides organizational and regulatory changes, ensuring consistent implementation of new programs, policies, procedures, and care management strategies;
• Maintains updated internal operating procedures;
• Leads and participates in all required committees and sub committees including, but not limited to Quality Assurance, Pharmacy and Therapeutics, and Utilization Management;
• Develops and implements departmental performance improvement indicators and goals; and
• Performs other related duties as required.

Typical Qualifications

These are entrance requirements to the exam process and ensure neither continuance in the process nor placement on an eligible list.

EDUCATION, TRAINING, and EXPERIENCE:
Any combination of education, training, and experience which has led to the acquisition of the required knowledge and abilities. A typical combination would be equivalent to

• A bachelor’s degree from an accredited college or university in business, public health, nursing, health administration, or a closely related field AND
• Five (5) years' experience in progressively responsible health care administration/management

NECESSARY SPECIAL REQUIREMENTS:

• At least two (2) years of direct supervision and personnel management experience
• Demonstrated knowledge of Knox Keene Act, Department of Managed Health Care (DMHC) regulations and Healthcare Effectiveness Data and Information Set (HEDIS)
• Must possess and maintain a current, valid license as a Registered Nurse issued by the State of California

DESIRED:

• Knowledge of National Committee for Quality Assurance (NCQA)
• Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Geo Access surveys
• Master’s degree in business administration or health care management

KNOWLEDGE, SKILL, and ABILITIES:
Comprehensive knowledge of: trends and changes in the health care and insurance industries; health care plan policies and procedures; knowledge of Knox Keene Act, DMHC Regulations and HEDIS; principles and practices of personnel administration, supervisory, and management techniques; theory, techniques, and practices of professional nursing; and program evaluation methods, data collection, analysis and report writing procedures.

Comprehensive ability to: direct the work of others performing service delivery in assigned health care plan specialty areas; collaborate effectively; analyze statistical data and implement changes based on findings, problem solve and make sound decisions; represent the department on assigned committees and with service providers; establish and maintain effective working relationships with staff and health care professionals at all levels, both internal and external to the department, as well as with the general public; and communicate clearly and concisely, both orally and in writing.

Recruitment Process

FINAL FILING DATE: Your application must be received by County of Ventura Human Resources no later than 5:00 p.m. on Wednesday, June 24, 2026.

To apply online, please refer to our web site at www.venturacounty.gov/jobs . If you prefer to fill out a paper application form, please call (805) 677-5184 for application materials and submit them to County of Ventura Human Resources - Health Care Agency, 646 County Square Drive, Ventura, CA 93003.

Applicants must provide sufficient information under the Education/Work Experience portion of the application and supplemental questionnaire in order to determine eligibility. A resume may be attached to supplement your responses in the above-referenced sections; however, it may not be submitted in lieu of the application.

SUPPLEMENTAL QUESTIONNAIRE - qualifying: All applicants are required to complete and submit the questionnaire for this examination at the time of filing. The supplemental questionnaire may be used throughout the examination process to assist in determining each applicant's qualifications and acceptability for the position. Failure to complete and submit the questionnaire may result in the application being removed from consideration.

APPLICATION EVALUATION - qualifying: All applications will be reviewed to determine whether or not the stated requirements are met. Those individuals meeting the stated requirements will be invited to continue to the next step in the screening and selection process.

TRAINING and EXPERIENCE EVALUATION: A Training and Experience Evaluation (T&E) is a structured evaluation of the job application materials submitted by a candidate, including the written responses to the supplemental questionnaire. The T&E is NOT a determination of whether the candidate meets the stated requirements; rather, the T&E is one method for determining who are the better qualified among those who have shown that they meet the stated requirements. In a T&E, applications are either scored or rank ordered according to criteria that most closely meet the business needs of the department. Candidates are typically scored/ranked in relation to one another; consequently, when the pool of candidates is exceptionally strong, many qualified candidates may receive a score or rank which is moderate or even low resulting in them not being advanced in the process.

ORAL EXAMINATION - 100%: A job-related oral examination may be conducted to evaluate and compare participating candidates' knowledge, skills, and abilities in relation to those factors which job analysis has determined to be essential for successful performance of the job. Candidates must earn a score of seventy percent (70%) or higher to qualify for placement on the eligible list.

NOTE: The selection process will likely consist of an Oral Exam, which may be preceded or replaced with the score from a Training and Experience Evaluation (T&E), contingent upon the size and quality of the candidate pool. In a typical T&E, your training and experience are evaluated in relation to the background, experience and factors identified for successful job performance during a job analysis. For this reason, it is recommended that your application materials clearly show your relevant background and specialized knowledge, skills, and abilities. It is also highly recommended that the supplemental questions within the application are completed with care and diligence. If the T&E replaces the oral exam candidates must earn a score of seventy percent (70%) or higher to qualify for placement on the eligible list.

If there are three (3) or fewer qualified applicants, an oral examination may not be conducted. Instead, a score of 70% is assigned to each application, and each applicant is placed on the eligible list.

Applicants successfully completing the examination process may be placed on an eligible list for up to a period of one (1) year.

BACKGROUND INVESTIGATION: A thorough pre-employment, post offer background investigation which may include inquiry into past employment, education, criminal background information and driving record may be required for this position.

For further information about this recruitment, please contact Maritza David by e-mail at [email protected] or by telephone at (805) 677-5162.

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.

YOUR BENEFITS AS A COUNTY OF VENTURA EMPLOYEE

MANAGEMENT

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:MB3, MB4, MS, MT,MCC, MU

Closing Date/Time: 6/24/2026 5:00 PM Pacific

Salary:

$136,254.50 - $188,799.17 Annually