Director of Delegation Oversight

Job Title: Director Delegation Oversight
Location: Rancho Cucamonga, CA

Morgan Consulting Resources, Inc. has been retained to conduct the search for the Director of Delegation Oversight for Inland Empire Health Plan. This position is located in Rancho Cucamonga, CA.

About the organization:

Inland Empire Health Plan (IEHP) is one of the largest not-for-profit health plans in California. They serve over 1.2 million members in Riverside and San Bernardino counties through government sponsored programs including Medi-Cal (California’s Medicaid Plan) and the Cal MediConnect Plan (Medicare-Medicaid Plan).

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 – based on mutual respect and collaboration.
  • Stewardship of Public Funds: they are accountable to the public and strive for transparency and prudent fiscal management.

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

About the Director of Delegation Oversight:

Reporting to the Executive Director of Health Services Operations, the Director of Delegation Oversight is a new position in the organization. The Director will oversee a team of one manager and four analysts. This position will provide leadership, develop, implement and manage the monitoring and oversight program for services delivered through contracted, delegated entities (Independent Physician Associations (IPA), Management Services Organizations (MSO), Dental, Chiropractic and other administrative delegated contracts). The Director will be accountable to ensure compliance of IPA delegated administrative functions including adherence to reporting requirements, quality improvement activities, IT interface capabilities, IEHP operational standards, as well as policies and procedures. This position is instrumental in facilitating delegation program activities to ensure alignment with IEHP strategies, goals and objectives.

We are looking for a Director who will take a partnership approach with delegated entities to help them comply with health plan and regulatory requirements. The ability to foster collaborative relationships vertically and horizontally across the organization as well as externally will be critical to this role. Additionally, candidates who have a strong focus on mission/values are ideal for this position. Medi-Cal experience is preferred.

Major goals and projects:

  1. Integration of new auditing and monitoring models;
  2. Review of required organization reporting to ensure compliance with regulatory agencies;
  3. Prepare for anticipated CMS audit early 2019.

Minimum qualifications:

Education:

  • Master’s Degree preferred.
  • Certified HealthCare Auditor (CHA); Certified Internal Auditor (CIA) or other related certification recommended.

Experience, Knowledge, Skills and Abilities:

  • 6-10 years’ experience in an HMO or managed care environment.
  • Knowledge in Medi-Cal and Medicare Programs and CMS, NCQA, DHCS, and DMHC regulations.
  • Understanding of compliance auditing and risk assessment practices preferred.
  • Demonstrated strong coaching, motivational and interpersonal skills are required with an emphasis on service, and team and individual improvement.
  • Strong organizational skills, detail oriented, and sound decision making skills required; exceptional follow-through abilities to track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed timely.
  • Ability to critically review data and implement operational recommendations.
  • Proficient in Microsoft Office applications.
  • Strong written and oral communication skills.
  • Ability to manage multiple projects of varying complexity, priority levels and deadlines.

If someone you know has the qualifications we seek, we’d love to set up a time to talk!

Kim Phillips, Executive Recruiter/Search Consultant
Morgan Consulting Resources, Inc.
Kim@morganconsulting.com

Rosie Saenz, Executive Recruiter/Search Consultant
Morgan Consulting Resources, Inc.
rosie@morganconsulting.com

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