Physician / Administration / California / Permanent / Health Plan Medical Director Job

3 weeks ago

Rancho Cucamonga, United States IEHP Full time

1. Develop and implement medical policy for utilization management activities and functions, including benefit manual statement, policies and procedures, and Utilization Management Subcommittee Guidelines. Provide training and consultation for both internal staff and medical personnel of the Plan regarding policy application.2. Provide direction and control of current medical practices ensuring that medical personnel of the Plan follow medical protocols and rules of conduct.3. Ensure assigned patients are provided healthcare services and necessary medical attention at all locations.4. Collaborates with Contracting Department to ensure full and appropriate primary, specialty, and ancillary care network adequacy for Members.5. Ensures that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management. Provides clinical oversight and direction over credentialing process.6. Ensures that medical care rendered by providers meets with applicable professional standards for acceptable medical care and quality.7. Consults on written medical protocol for Plan physicians to ensure adherence to current standards and quality of medical care. Coordinates professional interactions among practitioners and lends assistance toward correcting any deviation from medical standards.8. Interacts regularly with inpatient hospitalist groups, PCP & specialists to ensure appropriate medical care is provided and utilization standards are met.9. Develops and manages a formal Utilization Management Program for the Plan and its Providers. This Program includes protocol, procedures, oversight, and training in the following areas: a. Provider Selection b. Credentialing c. Peer Review Activities d. Referral Management e. Pre-admission authorization f. Prospective, concurrent, and retrospective review g. Utilization review reporting and evaluation h. Case Management i. Provider Incentive Programs j. Chairperson/ Co-Chair of the HEDIS Improvement Committee, Quality Management Committee, Quality Improvement Committee, Credentialing Committee, Grievance Trend Committee k. Participates on the Pharmacy and Therapeutics Subcommittee l. NCQA Accreditation.10. Act as a liaison to Provider Relations as a link between IEHP and individual physician, IPAs, medical groups, and hospitals.11. Adjudicate medically related grievances and appeals that flow through the Member grievance and appeals process.12. Review State mandated benefits to ensure IEHP is in full compliance through its Providers.13. Assist Compliance on sanctioned and excluded Provider management. Responsibilities include oversight of safe transitions of care for Members and communication with regulatory agencies and impacted departments (e.g., Pharmacy, Claims, Care Management, Utilization Management, etc.).14. Provide physician level guidance on organizational improvement initiatives, including LEAN activities and Process Improvement Team projects.

  • Medical Director

    3 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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 Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral...

  • Medical Director

    7 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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 Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral...

  • Medical Director

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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 Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral...

  • Medical Director

    5 days ago

    Rancho Cucamonga, CA, United States Inland Empire Health Plan Full time

    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 Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP...

  • Director of Psychiatry- Medical Director

    5 days ago

    Rancho Cucamonga, CA, United States Inland Empire Health Plan Full time

    The Medical Director of Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral health activities in all lines of business. Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and...

  • Medical Director

    2 weeks ago

    Rancho Cucamonga, United States IEHP Full time

    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 Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral...

  • Medical Director- Hospital

    4 weeks ago

    Rancho Cucamonga, California, United States Inland Empire Health Plan Full time

    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!    Excitingly lead as the Medical Director of Hospital & Ancillary Relations, Steering clinical leadership towards operational and quality...

  • Medical Director- Hospital

    3 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plans Full time

    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! Excitingly lead as the Medical Director of Hospital & Ancillary Relations, Steering clinical leadership towards operational and quality improvement. Drive...

  • Director, Product Implementation

    4 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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!Under the direction of the Senior Director of Commercial Products, the Director, Product Implementation - Medicare & Commercial, will lead the annual product...

  • Medical Director- Hospital

    2 weeks ago

    Rancho Cucamonga, United States IEHP Full time

    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! Excitingly lead as the Medical Director of Hospital & Ancillary Relations, Steering clinical leadership towards operational and quality improvement. Drive...

  • Director, Product Implementation

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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! Under the direction of the Senior Director of Commercial Products, the Director, Product Implementation - Medicare & Commercial, will lead the annual product renewal and...

  • Director, Product Implementation

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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!Under the direction of the Senior Director of Commercial Products, the Director, Product Implementation - Medicare & Commercial, will lead the annual product...

  • Director, Product Development

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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! Under the direction of the Senior Director, Commercial Products, the Director, Product Development will be responsible for developing product portfolios for all IEHP...

  • Director, Product Development

    3 weeks ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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!Under the direction of the Senior Director, Commercial Products, the Director, Product Development will be responsible for developing product portfolios for...

  • Director, Product Implementation

    7 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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! Under the direction of the Senior Director of Commercial Products, the Director, Product Implementation - Medicare & Commercial, will lead the annual product...

  • Director, Product Development

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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! Under the direction of the Senior Director, Commercial Products, the Director, Product Development will be responsible for developing product portfolios for...

  • Director, Product Development

    7 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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!Under the direction of the Senior Director, Commercial Products, the Director, Product Development will be responsible for developing product portfolios for...

  • Director, Product Implementation

    2 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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! Under the direction of the Senior Director of Commercial Products, the Director, Product Implementation - Medicare & Commercial, will lead the annual product...

  • Manager, Claims Processing

    1 week ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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 Manager, Claims Processing - Covered California is responsible for oversight and direction of claims and auditing activities of the Covered California...

  • Director, Product Development

    2 days ago

    Rancho Cucamonga, United States Inland Empire Health Plan Full time

    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! Under the direction of the Senior Director, Commercial Products, the Director, Product Development will be responsible for developing product portfolios for...