Medical Director – Inpatient

Morgan Consulting Resources, Inc. has been retained to conduct the search for an Inpatient 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 heal thcare 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 Inpatient 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 Inpatient 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 inpatient quality improvement efforts while helping to assure appropriate and efficient health care delivery for IEHP members, manage health plan medical costs, and support IEHP strategic goals.
  • Provide clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight, consultation, and training within the inpatient team.
  • Consult with the Inpatient UM Team for IEHP members and delegated membership and participate in concurrent review activities for members in an acute, skilled, or a long-term care facility.
  • Build relationships with Inpatient and Facility Providers to conduct peer to peer conversations addressing quality and utilization issues.
  • Manage Hospital and Facility metrics with quality team and work with providers to improve the overall quality of care.
  • Contribute to the department specific goals and manage internal metrics which include average length of stay, readmissions, bed days, Out of Network referrals, and placement of complex cases.
  • Review high risk cases and work in a multidisciplinary team to address difficult to discharge placements.
  • Assist, as appropriate, with the contracting process of hospitals, ancillary providers, and emergency and other support services, and evaluate the medical aspects of provider contracts.
  • Ensure that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management. Provide clinical oversight and direction over credentialing process.
  • Build relationships and work collaboratively with facilities on a regular basis, attend Joint Operating Meetings <x{(}>(</x{(}>JOMs), identify key issues, and communicate IEHP strategic goals to help align Member care.

Qualifications:

  • 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 Internal Medicine or Family Practice; hospitalist experience required.
  • Minimum of five years’ experience in medical practice or equivalent.
  • 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: Medical Director – Inpatient
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 Inpatient Utilization Management services. The Inpatient Medical Director will lead and collaborate with the Case Management Inpatient Team and develop cooperative relationships with community inpatient providers and physicians. They will collaborate to improve inpatient quality measures, value based care, waste reduction and facilitate care delivery.

Principal Accountabilities

  • Lead inpatient quality improvement efforts while helping to assure appropriate and efficient health care delivery for IEHP members, manage health plan medical costs, and supports IEHP strategic goals.
  • Provide clinical leadership to the interdisciplinary Medical Management team, which includes clinical/medical oversight, consultation, and training within the inpatient team.
  • Consult with the Inpatient UM Team for IEHP members and delegated membership and participate in concurrent review activities for members in an acute, skilled or a long-term care facility.
  • Build relationships with Inpatient and Facility Providers to conduct peer to peer conversations to addressing quality and utilization issues.
  • Manage Hospital and Facility metrics with quality team and work with providers to improve the overall quality of care.
  • Contribute to the department specific goals and manage internal metrics which include average length of stay, readmissions, bed days, Out of Network referrals, and placement of complex cases.
  • Review high risk cases and work in a multidisciplinary team to address difficult to discharge placements.
  • Assist, as appropriate, with the contracting process of hospitals, ancillary providers, and emergency and other support services, and evaluate the medical aspects of provider contracts.
  • Ensure that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management. Provide clinical oversight and direction over credentialing process.
  • Build relationships and work collaboratively with facilities on a regular basis, attend Joint Operating Meetings <x{(}>(</x{(}>JOMs), identify key issues, and communicate IEHP strategic goals to help align Member care.
  • Participate in the development of physician incentives, value based contracting arrangements, pay for performance and targeted network improvement programs.
  • Develop best practices and high standards of care for Inpatient management and disseminate into our provider network. Ensure internal partners are aligned with IEHP’s goals.
  • Create and maintain programs that encourage providers to achieve appropriate utilization, cost, and quality outcomes.
  • Provide clinical education to UM Nursing staff to help them make and exercise sound clinical judgment.
  • Participate in and maintain the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse incidents and quality of care concerns.
  • Provide physician level guidance on organizational improvement initiatives, including LEAN activities and Process Improvement Team projects.
  • Ensure the privacy and security of PHI <x{(}>(</x{(}>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 <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 Internal Medicine or Family Practice; hospitalist experience required.

Experience:

  • Five <x{(}>(</x{(}>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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