Medical Director, Quality Transformation

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).

Mission: We Heal and Inspire the Human Spirit.
Vision: We will not rest until our communities enjoy optimal care and vibrant health.
Values: We do the right thing by:

  • Placing our Members at the center of our universe.
  • Unleashing our creativity and courage to improve health & well-being.
  • Bringing focus and accountability to our work.
  • Never wavering in our commitment to our Members, Providers, Partners, and each other.

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

About the Position:

Reporting to the Vice President of Quality, the Medical Director, Quality Transformation is responsible for advancing IEHP’s current approach to Quality by leveraging sustainable innovation, new tools and partnerships, and new business models all in service to improving quality ratings, healthcare delivery, data & analytics, and experience. The Medical Director, Quality Transformation will: lead the design, development, and execution of initiatives and programs; help develop strategy so that quality-based activities are both present forward and future back in line with IEHP’s strategic plan; define and manage new quality-based initiatives and liaise with internal and external stakeholders; and enhance provider workflows to improve quality at the PCP, IPA, and Hospital level. The Medical Director, Quality Transformation will also participate cross-functionally in business planning efforts to support IEHP’s Mission, Vision, and Values and will be responsible for navigating quality regulatory requirements in the Medi-Cal space.

This is a newly created position, and the successful candidate will get to build a team focused on innovation and transformation in an incremental and sustainable manner. A competitive candidate will be familiar with the latest trends in quality and how they tie into healthcare operations. The successful candidate will possess very strong communication and leadership skills, with an analytical mindset, gravitas to communicate internally and externally, and a commitment to advancing quality to improve patient care.

Responsibilities:

  • Influence change management within a large organization.
  • Develop strategic alignment between payment models and transformative initiatives rooted in quality.
  • Implement initiatives that account for provider workflows resulting in improvement in quality.
  • Facilitate design thinking workshops with different internal business units and stakeholders.
  • Liaise with external vendor partners to successfully align and scope work that align IEHP’s strategic plan.
  • Make enterprise recommendations to achieve a health plan 5-star rating.
  • Connect strategic initiatives to incentive pay for performance programs, including evaluation and monitoring of relevant quality metrics.
  • Prioritize, rationalize, and modernize current quality improvement initiatives.
  • Drive improved quality outcomes at the provider level.

Education:

  • MD or DO required; MA, MPH, or MBA preferred.

Experience, Knowledge, Skills & Abilities:

  • 12+ years of experience in a relevant healthcare related setting.
  • Experience in care coordination and care/disease management in an ACO or FQHC environment.
  • Strong product and program management experience, product delivery, product environments, and management consulting.
  • Strong understanding of clinical regulatory environments, including DHCS, NCQA, and CMS.
  • Strong understanding of current trends in healthcare and clinical operations.
  • Familiarity with Tableau or Power BI.
  • Excellent Word, Excel, and PowerPoint Skills.
  • Superb communication skills, including oral and written presentation.
  • Communicate difficult concepts in concise, elegant, and effective ways to key stakeholders, including providers, to reach consensus.
  • Team player with an ability to build trust with internal and external stakeholders.

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.

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