Inland Empire Health Plan
Medical Director- Hospital & Ancillary Relations
Inland Empire Health Plan, Rancho Cucamonga, California, United States, 91739
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!
The Medical Director of Hospital & Ancillary Relations serves as a physician advisor / dyad partner to other members of the Hospital and Ancillary Relations leadership team in providing clinical leadership and guidance toward operational and quality improvement activities aimed at achieving the strategic initiatives set forth by Plan administration as they relate to hospital and ancillary services. The Medical Director of Hospital and Ancillary Relations leverages their knowledge and experience in health care operations and team dynamics to effectively collaborate with health plan and provider leaders and departments, soliciting input and support in identifying and implementing practice activities and setting appropriate standards to improve care delivery within the hospital and ancillary setting.
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 Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities
Key Responsibilities
Identify clinical practice opportunities within business unit projects and activities and apply clinical and administrative skills to guide the department in implementing strategic, organizational and departmental improvements.
Provide clinical leadership to implement, manage and achieve hospital and ancillary optimal care goals utilizing existing channels (i.e., Joint Operations Meetings, Inland Empire Alliance meetings, throughput and quality workgroups, etc.), and via development of new avenues for implementation of novel approaches to identified challenges and highlighting best practices.
Develop relationships with internal and external clinical leadership teams and focuses on mutual goals to improve the quality of medical and ancillary services to advance optimal care (i.e., pediatric strategy, quality network implementation for hospitalist, hospice, post-acute services) and promote appropriate utilization of resources.
Inform and educate hospital and ancillary clinicians about relevant changes in clinical best practices, regulatory mandates, and other relevant information to support the health plan’s strategies (i.e., palliative care initiatives, peer review program expectations).
Maintain an updated and expanded knowledge base on factors that affect hospital and ancillary services, and ensures that relevant information about social, medical, and fiscal issues are incorporated into IEHP policies, procedures, and strategies (i.e., All-Plan Letters, state and federal regulations).
Organize, coordinate, monitor, and promote the activities of the contracted medical providers to help ensure that the quality and appropriateness of services meets community standards. This may include collaboration with departmental leadership to educate and train clinicians in standards of care (i.e., specialty-specific care, evidenced-based practices, infection control practices, etc.).
Provide recommendations for research and development activities in strengthening quality improvement efforts for the medical providers in hospital and ancillary areas. (i.e., Hospitalist Pay for Performance program).
Articulate the importance and mission of the work surrounding hospice and post-acute services (i.e., SNF, long-term care, home health) to the community; specifically, how these impact hospital care quality and throughput, and Member/patient experience.
Participate in the development and delivery of educational programs geared towards improving the practice of clinicians including, but not limited to, physicians, mid-level providers, etc. in various settings.
Leverage knowledge of clinical, regulatory, social, political, and economic factors to provide feedback, as appropriate, to legislators and public policy makers about existing and proposed laws and regulations impacting hospital and ancillary care services. (i.e., payment practices).
Monitor and improve quality of care delivered by medical providers rendering care to IEHP Members via a quality assessment and performance improvement program that encourages self- evaluation, anticipates, and plans for change, and meets regulatory requirements.
Utilize results of quality assessment and performance improvement program findings to: a.
Update and improve contracts, the medical provider evaluation process, financial incentives (i.e., pay for performance or value-based care integration), policies, procedures, and practices. b.
Suggest, seek approval for and operationalize performance improvement activities aimed at closing gaps related to network adequacy, adequate utilization of available services (i.e., palliative care) and/or elevation of care delivery via innovative approaches. c.
Identify solutions to problems that utilize a collaborative approach, including integration efforts with hospital, ancillary and community resources and services.
Ensure, with other Medical Directors as appropriate, that Hospital and Ancillary Service Medical Staff and Contracted Medical Providers are providing appropriate care for IEHP Members including but not limited to availability of qualified medical consultative staff and oversight of their medical staff quality performance.
Collaborate with Health Services to hold practitioners accountable for their utilization management activities (admissions, and transfers, including related orders and contracted facility case mix), engagement in interdisciplinary teams, performance, and practice, including corrective actions and adequate documentation of patient care as needed.
Review recovery audit denials and appeals inclusive of second level appeal letter, second level medical necessity review, and peer to peer reviews.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
Qualifications Education & Requirements
Five (5) years of post-residency or licensure experience in a recognized specialty that includes but is not limited to Family Medicine, Internal Medicine, Pediatrics, and Emergency Medicine
Experience in quality, care coordination, utilization management in an inpatient, ACO or FQHC environment
Strong product and program management experience, product delivery, product environments, and management consulting
Preferred: At least three (3) years of administrative experience. Experience is in a variety of clinical settings including inpatient, outpatient practice, and community-based care settings
Medical Degree in a clinically related field (e.g., MD, DO) from an accredited institution required
Preferred: Additional Master’s Degree (e.g., MS, MPH, MBA) from an accredited institution
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.)
Key Qualifications
Valid California Driver’s License preferred
Strong knowledge and understanding of:
Medical practice and understanding of clinical operations in the hospital and ancillary setting
Various regulatory bodies and setting-specific requirements, including DHCS, NCQA, CMS, TJC/DNV.
Current trends in health care and clinical operations
Administrative practices and procedures including but not limited to quality assessment and improvement, care coordination, 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, principles, and literature in the broad field of medical sciences
Overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties
Excellent Word, Excel, and PowerPoint skills. Superb communication skills, including oral and written presentation. Strong leadership skills
Proven ability to:
Communicate difficult concepts in a concise, elegant, and effective ways to key stakeholders, including providers, to reach consensus
Be a team player with an ability to build trust with internal and external stakeholders
Educate and train
Be compassionate
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday – Thursday onsite in Rancho Cucamonga, CA.)
Pay Range USD $246,355.20 - USD $344,905.60 /Yr.
#J-18808-Ljbffr
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!
The Medical Director of Hospital & Ancillary Relations serves as a physician advisor / dyad partner to other members of the Hospital and Ancillary Relations leadership team in providing clinical leadership and guidance toward operational and quality improvement activities aimed at achieving the strategic initiatives set forth by Plan administration as they relate to hospital and ancillary services. The Medical Director of Hospital and Ancillary Relations leverages their knowledge and experience in health care operations and team dynamics to effectively collaborate with health plan and provider leaders and departments, soliciting input and support in identifying and implementing practice activities and setting appropriate standards to improve care delivery within the hospital and ancillary setting.
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 Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.
CalPERS retirement
457(b) option with a contribution match
Generous paid time off- vacation, holidays, sick
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Paid life insurance for employees with additional options
Short-term, and long-term disability options
Pet care insurance
Flexible Spending Account – Health Care/Childcare
Wellness programs that promote a healthy work-life balance
Career advancement opportunities and professional development
Competitive salary with annual merit increase
Team bonus opportunities
Key Responsibilities
Identify clinical practice opportunities within business unit projects and activities and apply clinical and administrative skills to guide the department in implementing strategic, organizational and departmental improvements.
Provide clinical leadership to implement, manage and achieve hospital and ancillary optimal care goals utilizing existing channels (i.e., Joint Operations Meetings, Inland Empire Alliance meetings, throughput and quality workgroups, etc.), and via development of new avenues for implementation of novel approaches to identified challenges and highlighting best practices.
Develop relationships with internal and external clinical leadership teams and focuses on mutual goals to improve the quality of medical and ancillary services to advance optimal care (i.e., pediatric strategy, quality network implementation for hospitalist, hospice, post-acute services) and promote appropriate utilization of resources.
Inform and educate hospital and ancillary clinicians about relevant changes in clinical best practices, regulatory mandates, and other relevant information to support the health plan’s strategies (i.e., palliative care initiatives, peer review program expectations).
Maintain an updated and expanded knowledge base on factors that affect hospital and ancillary services, and ensures that relevant information about social, medical, and fiscal issues are incorporated into IEHP policies, procedures, and strategies (i.e., All-Plan Letters, state and federal regulations).
Organize, coordinate, monitor, and promote the activities of the contracted medical providers to help ensure that the quality and appropriateness of services meets community standards. This may include collaboration with departmental leadership to educate and train clinicians in standards of care (i.e., specialty-specific care, evidenced-based practices, infection control practices, etc.).
Provide recommendations for research and development activities in strengthening quality improvement efforts for the medical providers in hospital and ancillary areas. (i.e., Hospitalist Pay for Performance program).
Articulate the importance and mission of the work surrounding hospice and post-acute services (i.e., SNF, long-term care, home health) to the community; specifically, how these impact hospital care quality and throughput, and Member/patient experience.
Participate in the development and delivery of educational programs geared towards improving the practice of clinicians including, but not limited to, physicians, mid-level providers, etc. in various settings.
Leverage knowledge of clinical, regulatory, social, political, and economic factors to provide feedback, as appropriate, to legislators and public policy makers about existing and proposed laws and regulations impacting hospital and ancillary care services. (i.e., payment practices).
Monitor and improve quality of care delivered by medical providers rendering care to IEHP Members via a quality assessment and performance improvement program that encourages self- evaluation, anticipates, and plans for change, and meets regulatory requirements.
Utilize results of quality assessment and performance improvement program findings to: a.
Update and improve contracts, the medical provider evaluation process, financial incentives (i.e., pay for performance or value-based care integration), policies, procedures, and practices. b.
Suggest, seek approval for and operationalize performance improvement activities aimed at closing gaps related to network adequacy, adequate utilization of available services (i.e., palliative care) and/or elevation of care delivery via innovative approaches. c.
Identify solutions to problems that utilize a collaborative approach, including integration efforts with hospital, ancillary and community resources and services.
Ensure, with other Medical Directors as appropriate, that Hospital and Ancillary Service Medical Staff and Contracted Medical Providers are providing appropriate care for IEHP Members including but not limited to availability of qualified medical consultative staff and oversight of their medical staff quality performance.
Collaborate with Health Services to hold practitioners accountable for their utilization management activities (admissions, and transfers, including related orders and contracted facility case mix), engagement in interdisciplinary teams, performance, and practice, including corrective actions and adequate documentation of patient care as needed.
Review recovery audit denials and appeals inclusive of second level appeal letter, second level medical necessity review, and peer to peer reviews.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
Qualifications Education & Requirements
Five (5) years of post-residency or licensure experience in a recognized specialty that includes but is not limited to Family Medicine, Internal Medicine, Pediatrics, and Emergency Medicine
Experience in quality, care coordination, utilization management in an inpatient, ACO or FQHC environment
Strong product and program management experience, product delivery, product environments, and management consulting
Preferred: At least three (3) years of administrative experience. Experience is in a variety of clinical settings including inpatient, outpatient practice, and community-based care settings
Medical Degree in a clinically related field (e.g., MD, DO) from an accredited institution required
Preferred: Additional Master’s Degree (e.g., MS, MPH, MBA) from an accredited institution
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.)
Key Qualifications
Valid California Driver’s License preferred
Strong knowledge and understanding of:
Medical practice and understanding of clinical operations in the hospital and ancillary setting
Various regulatory bodies and setting-specific requirements, including DHCS, NCQA, CMS, TJC/DNV.
Current trends in health care and clinical operations
Administrative practices and procedures including but not limited to quality assessment and improvement, care coordination, 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, principles, and literature in the broad field of medical sciences
Overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties
Excellent Word, Excel, and PowerPoint skills. Superb communication skills, including oral and written presentation. Strong leadership skills
Proven ability to:
Communicate difficult concepts in a concise, elegant, and effective ways to key stakeholders, including providers, to reach consensus
Be a team player with an ability to build trust with internal and external stakeholders
Educate and train
Be compassionate
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday – Thursday onsite in Rancho Cucamonga, CA.)
Pay Range USD $246,355.20 - USD $344,905.60 /Yr.
#J-18808-Ljbffr