Chief Quality Officer

Reporting directly to the CEO, the Chief Quality Officer is responsible for developing and implementing the clinical and operational quality and accreditation programs within the health plan in the spirit of IEHP’s Mission, Vision and Values. This includes establishing and operationalizing the quality strategy such as monitoring and evaluating the quality and appropriateness of care and service and assessing for continuous improvement. Responsibilities include the development of new, innovative solutions and quality measures in preventative health and improved quality of Member lives. The individual would initiate, oversee and as appropriate lead initiatives for continuous quality improvement and evaluating the effectiveness of interventions across the continuum of care to members, providers and internally. The Chief Quality Officer provides leadership, develops strategies and oversees programs for accreditation, monitoring, HEDIS operations, reporting, quality scorecard reporting and quality-related new business development. The Chief Quality Officer promotes a culture of continuous clinical excellence. The Chief Quality Officer provides organizational leadership for implementation of the comprehensive Quality Improvement program for the health plan and works collaboratively with the Chief Medical Officer and other key leaders to develop and implement a quality strategy which supports ongoing systemic process improvement.

We are looking for a servant leader with a strong clinical background to champion quality within IEHP in support of the organization’s long-term strategic plan. The Chief Quality Officer will have the resources and latitude needed to impact change and drive innovation. The ideal candidate must have experience developing/implementing quality initiatives and a strong understanding of how to utilize data to create opportunities to better support the overall health of the communities IEHP serves. The Chief Quality Officer must have the ability to develop productive and meaningful external relationships and positively engage the provider community. This individual must have a deep commitment to reducing health disparities and strongly support IEHP’s transformative care strategy spanning preventative, hospital and chronic care.

Licensure: Candidates who do not have a CA medical or nursing license will be given time to obtain one after starting employment.

Reporting to this position: VP of Quality; Positions reporting to the VP of Quality include: Senior Director, Quality Systems; Director of Health Services Evaluation; Director, Healthcare Informatics; Director, Quality Informatics; Manager of Quality Systems. Total department: 114 employees.

Works closest with: Chief Executive Officer, Chief Medical Officer, Chief Operating Officer.

External relationships: Providers, Hospitals, Healthcare Technology organizations, Accreditation entities, Regulatory entities, etc.

Essential Functions:

  • Establishes objectives and annual goals in conjunction with the Executive team.
  • Promotes organization-wide understanding, communication and coordination of the Quality Improvement (QI) program.
  • Oversees the quality dashboard reporting including analyzing the validity of quality management data/reports.
  • Provides leadership for the development, implementation and evaluation of quality improvement action plans for clinical and operational quality improvement activities.
  • Oversees the member risk program.
  • Oversees the health services quality monitoring program in conjunction with the regulatory and internal audit areas including participation in peer review, as needed.
  • Oversees Health Employer Data Information Sets (HEDIS) operations and reporting and provides leadership to achieve target improvement goals.
  • Provides QI leadership representation in new business activities (RFP responses, new market/product development and state contract changes, etc.).
  • Provides organizational leadership to excel with National Committee for Quality Assurance (NCQA) standards and/or other accrediting bodies.
  • Provides leadership support and offers recommendations for provider recredentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions.

Education and Experience:

Education:

  • Graduate degree in business administration (MBA), nursing (MSN), public administration (MPA), or medical doctor (MD/DO) required.
  • Valid, unrestricted Physician’s and Surgeon’s Certificate or RN license issued by the State of California. (A physician or nurse 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 or RN license is filed in the state of California prior to date of appointment.)
  • For MD/DO applicants, Physician’s and Surgeon’s certification by one of the American Specialty Boards.

Experience:

  • Minimum of 10 or more years of current progressive, operational experience in quality management, quality improvement, risk management and/or utilization management in a managed care setting with a focus on excellent process methodology.
  • Five years of strong senior level leadership/management experience is required.
  • Demonstrated management of multiple regulatory and accreditation areas covering a broad range of populations (multi-state preferred).
  • Experience with new program formulation and expansion of current programs including management and on-going monitoring of quality and performance.

About the Area:

The Inland Empire in Southern California covers more than 27,000 sq. mi. and is home to 4.2 million people, making it the 13th largest metropolitan area in the United States. Inland of and adjacent to Los Angeles, it includes the cities of western Riverside County and southwestern San Bernardino County. The nearby San Bernardino Mountains, home to Lake Arrowhead and Big Bear lake, are a popular destination both for summer activities and winter skiing and snowboarding. Various locations in the Inland Empire provide venues for cultural performances and entertainment.

Rancho Cucamonga is located just south of the foothills of the San Gabriel Mountains and Angeles National Forest in San Bernardino County. The city’s favorable location and host of public amenities have earned it numerous distinctions. Money Magazine ranked Rancho Cucamonga among its “Best Places to Live”. The city’s four public high schools earned the Silver distinction in a 2015 ranking of the nation’s high schools by U.S. News & World Report, while in 2017 the California Department of Education announced that all four high schools were being named California Gold Ribbon Schools. The Southern California weather does not disappoint – Rancho experiences an average of 287 sunny days per year.

For more information, see here.