Medical Director – Care Management (Outpatient)

Morgan Consulting Resources, Inc. has been retained to conduct the search for a Care Management (Outpatient) Medical Director role 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 Position:

Reporting to the Deputy Chief Medical Officer, the Medical Director will be responsible for overseeing outpatient utilization management, quality assurance, and complex care management. S/he will establish effective relationships with the provider community and develop internal systems to ensure the delivery of high quality care to members. The Medical Director will continue to strengthen the outpatient UM program and partner with key internal stakeholders and operations to maximize efficiencies and foster clear cross-departmental communication. The ideal candidate will be member-centric and have a strong commitment to working with medically and socially complex populations. The ability to lead by influence and build strong internal and external relationships will be critical to the success of the Medical Director. S/he must be proactive, positive, and highly collaborative and thrive in a mission-driven culture that values communication and transparency.

Essential Responsibilities:

  • Lead care management quality improvement efforts while helping to assure appropriate and efficient health care delivery for IEHP members, manage health care delivery for IEHP members, and support IEHP strategic goals.
  • Provide clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight, consultation, and training within the care management team.
  • Serve as a primary clinical educator and mentor, and facilitate achievement of appropriate patient care goals through guiding nurses in the job they do and conducting peer-to-peer communication with practicing physicians.
  • Analyze member and population data to guide and manage program direction, such as ensuring that members enroll in clinical programs indicated by their clinical need, and monitor performance.
  • Provide the oversight, direction, coordination, and integration of quality and patient care throughout organization.
  • Identify high utilization of services in outpatient providers and evaluate necessity while working with physicians to improve quality of care.
  • Coordinate Health Plan Programs with provider to improve outpatient management of complex patients.
  • Establish provider performance metrics and collaborate with outpatient providers to improve care delivery to member.
  • Contribute to visioning for IEHP and help execute entity strategic plans, and for partnering with executives, directors, and department leaders in the continuously improving clinical outcomes and reducing risk.
  • Detailed understanding of Care Management programs and ability to work with clinical outcomes and reduce risk.

Qualifications:

  • Valid, unrestricted Physician’s and Surgeon’s license <x{(}>(</x{(}>MD/DO) issued by the State of California. <x{(}>(</x{(}>A physician certified in a state other than California may be employed prior to receipt of a California license provided that an application for a California physician and surgeon’s license is filed in the state of California prior to date of appointment.)
  • Certification by one of the American Specialty Boards, preferably in Internal Medicine or Family Practice; hospitalist experience required.
  • Minimum of five years’ experience in medical practice or equivalent, which must have included at least one year of medical leadership experience.
  • Experience in care of people with chronic illness or disabilities preferred.
  • Current knowledge of Chronic Care issues and best practices preferred.
  • Strong knowledge of Medi-Cal and CMS regulations.
  • Medical Director for an IPA, medical group or HMO highly desirable. Hospital admits and discharge and utilization management experience is a plus.
  • Experience with Quality Improvement, Project Management, and Team Management.
  • Microcomputer applications such Office Product Suite helpful.

About the Area:

Rancho Cucamonga, CA is a wonderful place for professionals to live and raise a family. Home to picturesque mountain backdrops and topped several “best places to live” lists due to its large array of cultural attractions, outdoor activities, restaurants/nightlife and safety. Inland Empire Health Plan’s main office is a walkable distance to several neighborhoods.

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

Lisa Coyne, Principal
Morgan Consulting Resources
lisa@morganconsulting.com

Kim Phillips, Executive Recruiter
Morgan Consulting Resources
kim@morganconsulting.com

POSITION DESCRIPTION

Company: Inland Empire Health Plan
Position: Care Management Medical Director
Reports To: Deputy Chief Medical Officer
Department: Utilization Management/Care Management
Division: Health Services
Location: Rancho Cucamonga, CA

Position Purpose

To build a high functioning interdisciplinary team that oversees Care Management services. The Medical Director of Care Management is responsible for providing clinical expertise and business direction in support of the Health Services programs which promote the delivery of high-quality medical care. The Care Management Medical Director will work collaboratively with leadership of Case Management, Utilization Management, Practice Transformation, Population Health and other health services departments.

Principal Accountabilities

  • Lead Care Management quality improvement efforts while helping to manage health plan medical costs, assuring appropriate and efficient health care delivery for IEHP members, and support IEHP strategic goals.
  • Provide clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight, consultation, and training within the care management team.
  • Serve as a primary clinical educator and mentor, and facilitate achievement of appropriate patient care goals through guiding nurses in the job they do and conducting peer-to-peer communication with practicing physicians.
  • Analyze member and population data to guide and manage program direction such as ensuring that members enroll in clinical programs indicated by their clinical need and monitor performance.
  • Provide the oversight, direction, coordination and integration of quality and patient care throughout organization.
  • Identify high utilization of services in outpatient providers and evaluate necessity while working with Physicians to improve quality of care.
  • Coordinate Health Plan Programs with provider to improve outpatient management of complex patients.
  • Establish provider performance metrics and collaborate with outpatient providers to improve care delivery to member.
  • Contribute to the visioning for IEHP and help execute entity strategic plans, and for partner with executives, directors and department leaders in continuously improving clinical outcomes and reducing risk.
  • Detailed understanding of Care Management programs and ability to work with clinical teams for custom solutions or programs.
  • Collaborate with internal colleagues and external constituents to develop and implement campaigns and initiatives related to advancing care management within the organization.
  • Provide medical direction and guidance to the Care Management Department in the areas of inpatient case management, ambulatory case management, utilization management, clinical documentation improvement, and clinical charge capture.
  • Lead, develop, direct and implement clinical and non-clinical activities that impact health care quality cost and outcomes. Identify and develop opportunities for innovation to increase effectiveness and quality.
  • Assist Care Coordinators, Social Workers and Case Managers to resolve case management issues requiring physician intervention.
  • Implement standard of care protocols of chronic disease management and coordinate education with community providers and IPAs.
  • Provide physician level guidance on organizational improvement initiatives, including LEAN activities and Process Improvement Team projects.
  • Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures relating to HIPAA compliance.
  • Any other duties as required to ensure the Plan operations are successful.

Minimum Qualifications

Education/License:

  • Valid, unrestricted Physician’s and Surgeon’s license (MD/DO) issued by the State of California. (A physician certified in a state other than California may be employed prior to receipt of a California license provided that an application for a California physician and surgeon’s license is filed in the state of California prior to date of appointment.)
  • Certification by one of the American Specialty Boards, preferably in Internal Medicine or Family Practice; hospitalist experience required.

Experience:

  • Five (5) or more years of post-residency experience in a recognized medical specialty, which must have included at least one year of medical leadership experience.
  • Strong knowledge of Medi-Cal and CMS regulations.
  • Experience in care of people with chronic illness or disabilities preferred.
  • Current knowledge of Chronic Care issues and best practices preferred.
  • Medical Director for an IPA, medical group or HMO highly desirable. Hospital admit & discharge and utilization management experience is a plus.

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.
  • Experience with Quality Improvement, Project Management, and Team Management.
  • Microcomputer applications such as Microsoft Office, Word, Excel, and Access helpful.

Essential Functions

Physical Activities:
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

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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