Job Description
Job Description Morgan Consulting Resources, Inc. has been retained to conduct the search for the
Vice President, Medical Management/Deputy CMO for
Inland Empire Health Plan . The role is based in Rancho Cucamonga, CA. A hybrid schedule is available allowing for three days in the office and two days working remotely.
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, Medical Management (Deputy CMO):
- Acts as the Deputy Chief Medical Officer and represents the CMO internally and externally and serves as a spokesperson on medical issues in the absence of the CMO.
- Provides executive medical leadership across the Health Services Departments. This includes direct oversight and management of the Utilization Management (UM) 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.
- Serves as the clinical technical expert for clinically related federal and state requirements as it pertains to medical management, and operational expert in implementing changes to the UM process.
- Works closely with the Health Services leadership team on Utilization Management activities and complex clinical (medical and pharmacy) 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.
- Serves as an accountable leader for escalated member related issues.
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. This includes ongoing operational process improvement across the utilization management continuum.
- 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(medical and pharmacy) 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 (NCQA and Medicare Stars) and performance issues in the IEHP network, and establishes 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 partners 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.
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; two Senior Medical Directors, 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.
- 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 working in a Medicaid plan 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
Job Tags
Live in, Work at office, Remote work,