Chief Medical Officer

Morgan Consulting Resources, Inc. has been retained to conduct the search for the Chief Medical Officer for Inland Empire Health Plan. This is a fantastic opportunity to join a seasoned and highly committed executive management team within an innovative organization with an outstanding reputation. The position is located in Rancho Cucamonga, CA.

About the organization:

Inland Empire Health Plan (IEHP) is a not-for-profit Medi-Cal and Medicare Health Plan headquartered in Rancho Cucamonga, California. It is one of the 10 largest Medicaid plans in the country and the largest Health Plan in the Inland Empire. In addition, IEHP is known as one of the most innovative Health Plans in the nation. With a network of more than 6,000 providers and over 2,000 team members, IEHP provides comprehensive managed health care coverage to more than 1.2 million residents of Riverside and San Bernardino counties who are enrolled in Medi-Cal or Cal MediConnect (Medicare-Medicaid Plan). Stretching 27,000 square miles, the Inland Empire – which includes Riverside and San Bernardino counties – is one of the largest growing metropolitan areas in the nation. With more than 4.4 million people, the Inland Empire is the home for IEHP members.

IEHP was created in 1994 and began operations in 1996, as the region’s first Medi-Cal managed care plan. It is a Knox-Keene licensed plan and organized as a Joint Powers Agency between the counties of San Bernardino and Riverside in the State of California. The purpose of IEHP, as stated in the Joint Powers Agreement, is to administer, within the geographic area of both counties, Medi-Cal managed care systems or other health systems, plans and programs to serve eligible residents of both counties in compliance with California state laws and regulations.

IEHP contracts with the California Department of Health Care Services (DHCS) to receive Medi-Cal funding to provide health care benefits to eligible county residents who are enrolled as members of the Health Plan. IEHP has contracted with various health care providers to provide or arrange hospital and medical services for its members. IEHP both directly contracts with providers and contracts with IPA/Medical Groups to deliver care.

IEHP’s mission is to organize and improve the delivery of quality, accessible and wellness based healthcare services for their community. Their core values include:

  • Health and Quality before Costs: they believe in placing members’ health care needs above all else.
  • Team Culture: they are a dedicated and cohesive team focused on member care and supporting their providers.
  • Think and Work LEAN: they strive to continuously improve their daily operations and delivery of healthcare services.
  • Partner with Providers: they recognize the necessity of a strong working relationship with their providers, including medical providers, Members and the community – based on mutual respect and collaboration.
  • Stewardship of Public Funds: they are accountable to the public and strive for transparency and prudent fiscal management.
  • Innovation: IEHP is dedicated to implementing new and innovative ways to serve our Members, providers and the IEHP Team.

For more information about the organization, please visit: https://ww3.iehp.org/.

About the position:

Reporting to the CEO, the CMO will be responsible for all health activities for the health plan and ensuring that high quality, accessible care is available to members. This is a highly visible role and a critical function for the CMO is to effectively manage external relationships with the counties, the state and the provider community. This leader must have outstanding communication skills and the ability to influence a variety of different audiences. The CMO will lead several large-scale initiatives and navigate changes within healthcare at the state and federal levels. The ideal candidate will be innovative, relationship driven and operate with a great deal of humility. The CMO must be clinically credible, understand how technology can positively impact care and access and provide clear leadership on quality improvement activities. We are seeking individuals with exceptional leadership skills who thrive in a community-focused, not for profit culture.

Key Accountabilities

  • Provide the clinical and strategic leadership through a collaborative, accountable process to improve the quality of care delivery as evidenced by improved external quality metrics.
  • Champion IEHP standards and expectations to influence positive change with providers and other key stakeholders to achieve improved care outcomes.
  • Develop and implement the strategic direction and structure for the medical services teams through aligned goals and objectives.
  • Lead and drive innovative solutions for program development and implementation to improve access, satisfaction and care outcomes that are sustainable and scalable.
  • Embrace and integrate clinical informatics and technological solutions to drive quality initiatives and clinical excellence.
  • Build and maintain relationships and credibility with regulators to advocate for a more balanced approach to compliance.
  • Implement or improve innovative programs that address the social determinants of health to improve Members’ health status and utilization of services.

Major Responsibilities

  • Ensure that medical care rendered by providers meets with applicable professional standards for acceptable medical care and quality that equals or exceeds the standards for medical practice developed by IEHP and approved by DHS.
  • Develop and implement medical policy for IEHP.
  • Provide direction and control of current medical practices ensuring that medical personnel of the Plan follow medical protocols and rules of conduct.
  • Monitor that IEHP Members are provided healthcare services and necessary medical attention at all locations.
  • Ensure that medical decisions by IEHP staff, and delegated entities, are rendered by qualified medical personnel, unhindered by fiscal or administrative management.
  • Consult on written medical protocol for Plan physicians to ensure adherence to standards and quality of medical care.
  • Coordinate professional interactions among practitioners and lend guidance and assistance toward correcting any deviation from medical standards.

Requirements

Education/License: Valid, unrestricted Physician’s and Surgeon’s Certificate issued by the State of California. (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). Certification by one of the American Specialty Boards; a primary care specialty is preferred. Valid California Driver’s license and valid automobile insurance.

Experience: A minimum of five (5) years of post-residency experience in a recognized medical specialty, which must have included at least three years of medical administrative experience. Preferred experience is in primary care, such as family practice, pediatrics, or internal medicine.

If you or someone you know has the qualifications for this role, I’d love to set up a time to talk. Thank you so much for your time.

Lisa Coyne, Principal
lisa@morganconsulting.com

POSITION DESCRIPTION

Company: Inland Empire Health Plan
Position: Chief Medical Officer
Reports to: Chief Executive Officer
Department: Medical Services
Division: Medical Services
Location: Rancho Cucamonga, CA

Position Purpose

The Chief Medical Officer is responsible for the direction and oversight of all medical activities of IEHP.

Key Accountabilities

  • Provide the clinical and strategic leadership through a collaborative, accountable process to improve the quality of care delivery as evidenced by improved external quality metrics.
  • Champion IEHP standards and expectations to influence positive change with providers and other key stakeholders to achieve improved care outcomes.
  • Develop and implement the strategic direction and structure for the medical services teams through aligned goals and objectives.
  • Lead and drive innovative solutions for program development and implementation to improve access, satisfaction and care outcomes that are sustainable and scalable.
  • Embrace and integrate clinical informatics and technological solutions to drive quality initiatives and clinical excellence
  • Build and maintain relationships and credibility with regulators to advocate for a more balanced approach to compliance.
  • Implement or improve innovative programs that address the social determinants of health to improve Members’ health status and utilization of services.

Major Responsibilities

  • Ensure that medical care rendered by providers meets with applicable professional standards for acceptable medical care and quality that equals or exceeds the standards for medical practice developed by IEHP and approved by DHS.
  • Develop and implement medical policy for IEHP.
  • Provide direction and control of current medical practices ensuring that medical personnel of the Plan follow medical protocols and rules of conduct.
  • Monitor that IEHP Members are provided healthcare services and necessary medical attention at all locations.
  • Ensure that medical decisions by IEHP staff, and delegated entities, are rendered by qualified medical personnel, unhindered by fiscal or administrative management.
  • Consult on written medical protocol for Plan physicians to ensure adherence to standards and quality of medical care.
  • Coordinate professional interactions among practitioners and lend guidance and assistance toward correcting any deviation from medical standards.
  • Adjudicate medically related grievances/appeals that flow through the Member Grievance Process.
  • Review State mandated benefits to ensure IEHP is in full compliance through its providers.
  • Provide medical direction and supervision of all Medical Services audits.
  • Develop and manage a formal Quality Management Program for IEHP and its Provider This Program includes protocol, procedures, oversight, and training in the following areas:
    • Provider Selection
    • Credentialing
    • Quality Studies
    • Quality Management Program for Providers, including standards and norms with professionally recognized standard of practices
    • Peer Review Activities
    • Provider Incentive Programs
    • Chairperson of the Quality Management Committee and oversight of all related subcommittees.
  • Acts as a liaison to Provider Relations as a link between IEHP and individual physician, IPAs, medical groups and hospitals.
  • Act as liaison to plan marketing for strategy that involves benefits or providers.
  • Any other duties as required to ensure IEHP’s operations are successful.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.

Minimum Qualifications

Education/License: Valid, unrestricted Physician’s and Surgeon’s Certificate issued by the State of California. (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). Certification by one of the American Specialty Boards; a primary care specialty is preferred. Valid California Driver’s license and valid automobile insurance.

Experience: A minimum of five (5) years of post-residency experience in a recognized medical specialty, which must have included at least three years of medical administrative experience. Preferred experience is in primary care, such as family practice, pediatrics, or internal medicine.

Knowledge/Skills Required: Administrative practices and procedures (including but not limited to quality assessment and improvement, 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; and overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties.

Essential Functions

Physical Activities: Travel within California.

Commitment to Team Culture: 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.

The position purpose, principal accountabilities, essential functions, minimum qualifications and the requirements listed in this job description are representative only, and are not exhaustive of the tasks that a Team Member may be required to perform. IEHP reserves the right to revise this job description at any time, and to require Team Members to perform other tasks as circumstances or conditions of its business considerations or work environment change.

E.O.E.

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