job

About the Organization:

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. In its 26th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing network of over 7,800 providers and nearly 4,000 Team Members (Employees). Through dynamic partnerships, award-winning service, and a tradition of quality care, IEHP is fully committed to its Mission, Vision, and Values.

IEHP has consistently achieved outstanding employee engagement scores from their 3,000+ Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row! For details regarding IEHP, please visit: iehp.org.

About the Position:

Reporting to the Chief Medical Officer (CMO), the Vice President, Health Services:

• Provides executive medical leadership across the Health Services Departments. This includes direct oversight and management of the Utilization Management Medical Directors as well as provision of clinical leadership and strategic direction across Health Services in partnership with various senior and executive leaders across the organization.
• Works closely with the Health Services leadership team on Utilization Management activities and complex clinical cases.
• Has a lead role in regulatory audits (DHCS, DMHC, CMS, NCQA).
• Participates in the development of potential new business lines, rising risk and high-risk member programs, integrated care models, Population Health strategies including involvement in assigned state initiatives (CalAIM), hospital relations, oversight of provider and IPA utilization and performance, strategic plan implementation, and coordination with the Quality and Grievance & Appeals Departments.
• Serves as a mentor to Medical Directors and clinical staff to foster professional growth and development.
• Represents the CMO internally and externally and serves as a spokesperson on medical issues in the absence of the CMO.

Responsibilities

• Direct and support Medical Management activities and overall clinical operations along with the potential for oversight of other business units based on organization chart restructuring.

Provide clinical expertise and strategic direction to the Utilization Management Department and partner with key leaders in the development and implementation of UM polices/procedures, clinical and non-clinical programs, interventions, and monitoring across all business lines (Medi-Cal, Dual, and Covered California) and the full spectrum of healthy, rising risk, and high-risk members’ utilization of services in all settings (outpatient, inpatient, concurrent review, and transitions of care).

• Take a leading role in ensuring compliance with regulatory requirements, audit response, and assuring audit readiness (DHCS, DMHC, CMS, NCQA) related to medical management and quality oversight.
• Serve as a Subject Matter Expert (SME) point of contact for clinical, quality, and performance issues in the IEHP network and establish ongoing relationships with network physicians, medical groups, hospitals, and County Health Systems.
• Serve as coach and mentor to support the professional growth of Medical Directors, Physician Reviewers, as well as any additional direct/indirect reports.
• Partner with the Chief Quality Officer, Chief Financial Officer, Chief Operating Officer, and peer Vice Presidents on network strategy, network performance improvement, quality improvement, medical economics, and value-based care contracts.
• Provide oversight of the clinical components of delegation oversight and partner with the Senior Director within Health Services to provide effective oversight and performance monitoring of IEHP delegate entities.

The successful candidate will be familiar with Medi-Cal health plan regulations and will possess a proven track record of working with large provider groups to improve regulatory related clinical quality opportunities, cost containment, and fraud, waste, and abuse. Of value will be past experience with NCQA, DMHC, DHCS, and CMS audits. The VP will possess very strong communication and leadership skills, with an analytical mindset, the gravitas to communicate internally and externally, and a commitment to advancing quality to improve patient care. An ability to cross collaborate and influence/persuade without formal authority is critical.

Staff: Total staff of 30; Senior Medical Director, team of Medical Directors and Physician Reviewers, Administrative Assistant, Analyst, Special Programs Manager.

Experience Requirements:

• Ten (10) years of post-residency clinical experience in a recognized medical specialty. Proven leadership experience, mentoring and developing a team at a leadership level. Of the ten (10) years of experience required:
• At least five (5) years of medical management experience in a lead role.
• Experience with NCQA, DMHC, and DHCS audits and regulatory agencies.
• Experience working in a medical group, IPA, Plan, or hospital setting in a leadership role preferred.

Educational Requirement & Professional Certification:

• Doctorate of Medicine or Doctorate of Osteopathic Medicine from an accredited institution required.
• Certification by one (1) of the American Specialty Boards required.

Salary range: A reasonable starting salary expectation is between $320,174 – $448,219, based upon related/relevant experience and internal equity.

Meaningful Interest Points About Rancho Cucamonga:

Rancho Cucamonga has all the amenities and qualities that make for a family-friendly city. The public schools in the city are performing slightly above the national average. In fact, the average test score here is 2% higher than the national average and the student-teacher ratio is 23:1. And in 2018, this city was part of the happiest towns to live in the United States. This is a result of its wellbeing, community and environment, and income and employment. The city continues to excel over the years. For example, in 2020, the national civic league named it one of the Ten All-America cities due to its efforts and improvements in healthcare and wellbeing.

The centralized location of the town is one of the best perks, no matter where you are heading out to! From Rancho Cucamonga, you can get to San Diego in less than two hours, Palms Springs in just slightly above an hour, and Los Angeles in only 45 minutes by car. The town isn’t only close to major cities, but you can easily access beaches and mountains from here.

If you or someone you know has the qualifications for this role, I would love to set up a time to talk. Thank you so much for your time.

Lisa Coyne, Principal
Morgan Consulting Resources, Inc.
lisa@morganconsulting.com

Position Description

Company: Inland Empire Health Plan
Position: Vice President, Health Services
Reports to: Chief Medical Officer
Department: Medical Directors
Division: Health Services
Location: Rancho Cucamonga, CA (hybrid)

Position Summary

Reporting to the Chief Medical Officer (CMO), the Vice President, Health Services:

• Provides executive medical leadership across the Health Services Departments. This includes direct oversight and management of the Utilization Management Medical Directors as well as provision of clinical leadership and strategic direction across Health Services in partnership with various senior and executive leaders across the organization.
• Works closely with the Health Services leadership team on Utilization Management activities and complex clinical cases.
• Has a lead role in regulatory audits (DHCS, DMHC, CMS, NCQA).
• Participates in the development of potential new business lines, rising risk and high-risk member programs, integrated care models, Population Health strategies including involvement in assigned state initiatives (CalAIM), hospital relations, oversight of provider and IPA utilization and performance, strategic plan implementation, and coordination with the Quality and Grievance & Appeals Departments.
• Serves as a mentor to Medical Directors and clinical staff to foster professional growth and development.
• Represents the CMO internally and externally and serves as a spokesperson on medical issues in the absence of the CMO.

Responsibilities

• Direct and support Medical Management activities and overall clinical operations along with the potential for oversight of other business units based on organization chart restructuring.
• Provide clinical expertise and strategic direction to the Utilization Management Department and partner with key leaders in the development and implementation of UM polices/procedures, clinical and non-clinical programs, interventions, and monitoring across all business lines (Medi-Cal, Dual, and Covered California) and the full spectrum of healthy, rising risk, and high-risk members’ utilization of services in all settings (outpatient, inpatient, concurrent review, and transitions of care).
• Take a leading role in ensuring compliance with regulatory requirements, audit response, and assuring audit readiness (DHCS, DMHC, CMS, NCQA) related to medical management and quality oversight.
• Serve as a Subject Matter Expert (SME) point of contact for clinical, quality, and performance issues in the IEHP network and establish ongoing relationships with network physicians, medical groups, hospitals, and County Health Systems.
• Serve as coach and mentor to support the professional growth of Medical directors, Physician Reviewers, as well as any additional direct/indirect reports.
• Partner with the Chief Quality Officer, Chief Financial Officer, Chief Operating Officer, and peer Vice Presidents on network strategy, network performance improvement, quality improvement, medical economics, and value-based care contracts.
• Provide oversight of the clinical components of delegation oversight and partner with the Senior Director within Health Services to provide effective oversight and performance monitoring of IEHP delegate entities.

• Interface with and participate in public committees, leaders of regulatory agencies, State workgroups, network partners and the medical community. Play a key role in IEHP internal committees such as Credentialing, Peer Review, UM, and Quality.
• Partner with the CMO and Vice President of Health Services Clinical Integration to provide clinical direction of Health Services that aligns with IEHP’s strategic plan and goals. May lead specific Strategic Plan Enterprise Goal and/or Strategy elements.
• Oversee and support key functions in the development and implementation of statewide initiatives such as CalAIM and Covered California UM polices.
• Provide clinical support on complex clinical cases, including outreach to providers, hospitals, and Members to resolve issues.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Leadership Responsibilities:

• Leader: Administers, Hires, Terminations, and Performance Reviews.

Minimum Qualifications

Experience:

• Required: Ten (10) years of post-residency clinical experience in a recognized medical specialty. Proven leadership experience, mentoring, and developing a team at a leadership level. Of the ten (10) years of experience required, at least five (5) years of medical management experience in a lead role. The successful candidate will possess a proven track record of working with large provider groups to improve regulatory related clinical quality opportunities. Experience with NCQA, DMHC, and DHCS audits and regulatory agencies.
• Preferred: Experience working in a medical group, IPA, Plan, or hospital setting in a leadership role preferred.

Education:

• Doctorate of Medicine or Doctorate of Osteopathic Medicine from an accredited institution required.

Professional Certification:

• Certification by one (1) of the American Specialty Boards required.

Professional Licenses:

• Possession of an active, unrestricted, and unencumbered Physician’s and Surgeon’s Certificate issued by the State of California Medical Board required.
• A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California Physician and Surgeon’s Certificate is filed in the state of California prior to date of appointment at IEHP.

 

 

Knowledge:

Possesses comprehensive knowledge of:

• Medi-Cal Health Plan Regulations.
• Utilization management, evidence-based care models, population health, clinical quality, and Managed Care principles.
• CMS and Medi-Cal program.
• Administrative practices and procedures (including, but not limited to, utilization review, peer review, credentialing and risk management; rules regulations, policies, and standards related to managed care).
• Principles of effective supervision and organization; methods, techniques, practices, and literature in the broad field of medical sciences; and overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties.

Skills:

• Excellent oral and communication skills, including active listening.
• Excellent collaboration skills for work with network providers and internal employees.
• Proficient in Microsoft Office Suite, including Microcomputer applications such as Microsoft Word, Excel, and Access helpful.
• The VP will possess very strong communication and leadership skills, with an analytical mindset, the gravitas to communicate internally and externally, and a commitment to advancing quality to improve patient care.

Abilities:

• Highly effective and active communicator who works well with people at all levels.
• High-energy, persistent, assertive, data driven, accountable, and focused.
• Demonstrated ability to:
• Implement and lead new and improved clinical approaches to improvement of care and service quality.
• Design, lead, and implement overall regional population health and integration strategies.
• Lead multidisciplinary teams, even when Team Members are not in direct line of authority.
• Engage and develop relationships with network providers, with a high degree of patience.
• Be highly collaborative, cross-functional, and systematic.
• Work with high degree of diplomacy, credibility, and persuasiveness to consistently cultivate effective working relationship.
• Effectively express ideas and gain their acceptance.
• Be proactive and action oriented.
• Drive performance and be persistent in accomplishing difficult tasks.
• Actively seek out and support collaborative thinking and problem solving with others in the organization.
• Operate with an open leadership style.
• An ability to influence and persuade without formal authority is critical.

Commitment to Team Culture:

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members, and associates outside of our organization.

Commitment to Quality:

The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Working Conditions:

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch, or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

IEHP Team Members are expected to ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures related to HIPAA compliance.

The position purpose, principal accountabilities, essential functions, minimum qualifications, and the requirements listed in this position description are representative only and are not exhaustive of the tasks that a Team Member may be required to perform. IEHP reserves the right to revise this job description at any time and to require Team Members to perform other tasks as circumstances or conditions of its business considerations or work environment change.

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