Vice President, Health Services

OverviewMorgan Consulting Resources, Inc. has been retained to conduct the search for the Vice President, Health Services 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 OrganizationInland 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. IEHP supports nearly 1.6 million members enrolled in Medicaid and has a growing network of over 7,800 providers and nearly 4,000 team members. IEHP is committed to its Mission, Vision, and Values.IEHP has strong employee engagement scores and was recognized as a Great Place to Work for a third year in a row. For details, please visit iehp.org.PositionPosition Title: Vice President, Health ServicesReports To: Chief Medical OfficerDepartment: Medical DirectorsDivision: Health ServicesLocation: Rancho Cucamonga, CA (hybrid)ResponsibilitiesProvide executive medical leadership across the Health Services Departments, including direct oversight of the Utilization Management Medical Directors and strategic direction in partnership with senior and executive leaders.Collaborate with the Health Services leadership team on Utilization Management activities and complex clinical cases.Lead regulatory audits (DHCS, DMHC, CMS, NCQA).Participate in development of new business lines, rising/high-risk member programs, integrated care models, Population Health strategies, CalAIM initiatives, and oversight of provider/IPA utilization and performance.Mentor Medical Directors and clinical staff; foster professional growth and development.Represent the CMO internally and externally and serve as a medical issues spokesperson in the CMO's absence.Interface with and participate in public committees, regulatory agency leaders, State workgroups, network partners, and the medical community; engage in IEHP internal committees such as Credentialing, Peer Review, UM, and Quality.Provide clinical direction aligning with IEHP’s strategic plan; may lead specific Enterprise Goal or Strategy elements.Oversee statewide initiatives such as CalAIM and Covered California UM policies; provide clinical support on complex cases and issue resolution with providers, hospitals, and Members.Perform other duties to ensure Health Plan operations and department needs are met.LeadershipAdministers staffing actions including hires, terminations, and performance reviews.Minimum QualificationsExperienceRequired: Ten (10) years of post-residency clinical experience in a recognized medical specialty; proven leadership, mentoring, and development of a leadership-level team; at least five (5) years in medical management leadership; track record with large provider groups to improve regulatory-related clinical quality opportunities; experience with NCQA, DMHC, and DHCS audits.Preferred: Experience in a medical group, IPA, Plan, or hospital in a leadership role.EducationDoctorate of Medicine or Doctorate of Osteopathic Medicine from an accredited institution required.Professional CertificationCertification by one American Specialty Board required.Professional LicensesActive, unrestricted Physician and Surgeon's Certificate issued by the State of California Medical Board required.If certified in a state other than California, employment may proceed prior to CA certification provided an application is filed before appointment date.KnowledgeComprehensive knowledge of Medi-Cal health plan regulations; utilization management, population health, clinical quality, and managed care principles; CMS and Medi-Cal programs; administrative practices including utilization review, credentialing, and risk management.SkillsExcellent oral and written communication; strong collaboration with network providers and internal staff.Proficient with Microsoft Office; ability to communicate and lead with a data-driven approach.AbilitiesStrong communication, high energy, persistence, accountability, and data-driven decision making.Ability to implement and lead new clinical improvement approaches; lead regional population health and integration strategies; manage multidisciplinary teams; develop provider relationships; collaborate cross-functionally; influence without formal authority.Commitment and ConditionsCommitment to Team Culture: IEHP team environment requires participation in team culture, fostering professional relationships built on respect and cooperation with members and colleagues.Commitment to Quality: IEHP is committed to quality goals including HEDIS, CAHPS, and NCQA Accreditation.Working Conditions: The role may require standing, walking, sitting, manual tasks, occasional lifting up to 25 pounds, and travel as needed. Hybrid work is available upon HR approval; some in-person meetings may be required at IEHP headquarters.IEHP team members must protect PHI per IEHP policies and HIPAA regulations.The position description is representative and IEHP reserves the right to revise duties as needed. #J-18808-Ljbffr