Vice President, Health Services

Job title: Vice President, Health Services in Rancho Cucamonga, CA at Inland Empire Health Plan

Company: Inland Empire Health Plan

Job description: Overview:What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!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.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. Additional Benefits:PerksIEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Key Responsibilities:1. 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.2. Provide clinical expertise and strategic direction to the Utilization Management Department, and partners 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).3. 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.4. Serve as a Subject Matter Expert (SME) point of contact for clinical, quality and performance issues in the IEHP network, and establishes ongoing relationships with network physicians, medical groups, hospitals, and County Health Systems.5. Serve as coach and mentor to support the professional growth of Medical directors, Physician Reviewers, as well as any additional direct/ indirect reports.6. 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.7. Provide oversight of the clinical components of delegation oversight, and partners with the Senior Director within Health Services to provide effective oversight and performance monitoring of IEHP delegate entities.8. 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.9. 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.10. Oversee and support key functions in the development and implementation of statewide initiatives such as CalAIM and Covered California UM polices.11. Provide clinical support on complex clinical cases, including outreach to providers, hospitals, and Members to resolve issues.12. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications:Education & Requirements

• 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.
• Experience with regulatory agencies
• Experience working in a medical group, IPA, Plan, or hospital setting in a leadership role preferred
• Doctorate of Medicine or Doctorate of Osteopathic Medicine from an accredited institution required
• Certification by one (1) of the American Specialty Boards
• 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

Key Qualifications

• Must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points
• Possesses strong 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
• Excellent oral and communication skills, including active listening
• Excellent collaboration skills for work with network providers and internal employees
• Proficient in Microsoft Office Suite, includes 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
• 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.
• 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

Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location:This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range: USD $320,174.40 - USD $448,219.20 /Yr.

Expected salary:

Location: Rancho Cucamonga, CA

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