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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.
Perks
IEHP 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
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!