Inland Empire Health Plans
Location
Rancho Cucamonga, CA | United States
Job description
Job Requisition ID: 10290
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.
1. 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.
2. 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.
3. 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.
4. 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).
5. 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).
6. 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.)
7. 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)
8. 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.
9. 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.
10. 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).
11. 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
12. Utilize results of quality assessment and performance improvement program findings to:
i. 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.
ii. 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.
iii. Identify solutions to problems that utilize a collaborative approach, including integration efforts with hospital, ancillary and community resources and services.
13. 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.
14. 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.
15. Review recovery audit denials and appeals inclusive of second level appeal letter, second level medical necessity review, and peer to peer reviews.
Leader: Administers Hires, Terminations, and Performance Reviews
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.
At least three (3) years of administrative experience preferred. Preferred 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.
Additional Master’s Degree (e.g., MS, MPH, MBA) from an accredited institution preferred.
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.)
Yes, 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.
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.
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.
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.
Hybrid
Hearing: One-on-One - FREQUENTLY
Hearing: In a group - FREQUENTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Communicate: Give instructions, advise, warn, instruct - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Communicate: Verbally engage with customer base - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Perform complex and varied tasks - CONSTANTLY
Develop and maintain positive work relationships - CONSTANTLY
Adaptability: rate of change in work tasks - FREQUENTLY
Adaptability: rate of change in work schedule - FREQUENTLY
Adaptability: rate of change in work location - FREQUENTLY
Regular and reliable attendance - CONSTANTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Regular contacts: recurring clients - FREQUENTLY
Other contacts: public exchange - FREQUENTLY
Decision-making - FREQUENTLY
Lead/Influence Others - CONSTANTLY
Work review - FREQUENTLY
Rapid Pace of work - FREQUENTLY
Control of work pace - FREQUENTLY
Pace of work with faster/slower work periods - FREQUENTLY
Problem Solving - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: Traditional - FREQUENTLY
Use of computer mouse - FREQUENTLY
Sitting - CONSTANTLY
Indoors - FREQUENTLY
Lighting - CONSTANTLY
A reasonable salary expectation is between $240,676.80 and $330,928.00, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
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