Possesses strong knowledge of:
- Utilization management, evidence-based care models, population health, clinical quality, and Managed Care principles.
- CMS and Medi-Cal program.
- Administrative practices and procedures (including but not limited to 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, 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.
- Excellent oral and communication skills, including active listening.
- Excellent collaboration skills for work with network providers and internal employees.
- Proficient in Microsoft Office Suite, including Microcomputer applications such as Microsoft Word, Excel, and Access helpful.
- Highly effective and active communicator who works well with people at all levels.
- High-energy, persistent, assertive, data driven, accountable, and focused.
- Demonstrated ability to:
- Implement and lead new and improved clinical approaches to improvement of care and service quality.
- Design, lead, and implement overall regional population health and integration strategies.
- Lead multidisciplinary teams, even when Team Members are not in direct line of authority.
- Engage and develop relationships with network providers, with a high degree of patience.
- Be highly collaborative, cross-functional, and systematic.
- Work with high degree of diplomacy, credibility, and persuasiveness to consistently cultivate effective working relationships.
- Effectively express ideas and gain their acceptance.
- Be proactive and action oriented.
- Drive performance and be persistent in accomplishing difficult tasks.
- Actively seek out and support collaborative thinking and problem solving with others in the organization.
- Operate with an open leadership style.
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.
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.
Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
IEHP Team Members are expected to ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures related to HIPAA compliance.
The position purpose, principal accountabilities, essential functions, minimum qualifications, and the requirements listed in this position 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.