IEHP

Medical Director – Hospital & Ancillary Relations

IEHP

full-time

Posted on:

Location Type: Hybrid

Location: Rancho Cucamonga • California • United States

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Salary

💰 $246,355 - $344,905 per year

Job Level

Lead

About the role

  • Identify clinical practice opportunities within business unit projects and activities and apply clinical and administrative skills to guide the department in implementing strategic, organizational and departmental improvements.
  • Provide clinical leadership to implement, manage and achieve hospital and ancillary optimal care goals utilizing existing channels (i.e., Joint Operations Meetings, Inland Empire Alliance meetings, throughput and quality workgroups, etc.), and via development of new avenues for implementation of novel approaches to identified challenges and highlighting best practices.
  • Develop relationships with internal and external clinical leadership teams and focuses on mutual goals to improve the quality of medical and ancillary services to advance optimal care (i.e., pediatric strategy, quality network implementation for hospitalist, hospice, post-acute services) and promote appropriate utilization of resources.
  • Inform and educate hospital and ancillary clinicians about relevant changes in clinical best practices, regulatory mandates, and other relevant information to support the health plan’s strategies (i.e., palliative care initiatives, peer review program expectations).
  • Maintain an updated and expanded knowledge base on factors that affect hospital and ancillary services, and ensures that relevant information about social, medical, and fiscal issues are incorporated into IEHP policies, procedures, and strategies (i.e., All-Plan Letters, state and federal regulations).
  • Organize, coordinate, monitor, and promote the activities of the contracted medical providers to help ensure that the quality and appropriateness of services meets community standards. This may include collaboration with departmental leadership to educate and train clinicians in standards of care (i.e., specialty-specific care, evidenced-based practices, infection control practices, etc.).
  • Provide recommendations for research and development activities in strengthening quality improvement efforts for the medical providers in hospital and ancillary areas. (i.e., Hospitalist Pay for Performance program).
  • Articulate the importance and mission of the work surrounding hospice and post-acute services (i.e., SNF, long-term care, home health) to the community; specifically, how these impact hospital care quality and throughput, and Member/patient experience.
  • Participate in the development and delivery of educational programs geared towards improving the practice of clinicians including, but not limited to, physicians, mid-level providers, etc. in various settings.
  • Leverage knowledge of clinical, regulatory, social, political, and economic factors to provide feedback, as appropriate, to legislators and public policy makers about existing and proposed laws and regulations impacting hospital and ancillary care services. (i.e., payment practices).
  • Monitor and improve quality of care delivered by medical providers rendering care to IEHP Members via a quality assessment and performance improvement program that encourages self-evaluation, anticipates, and plans for change, and meets regulatory requirements.
  • Utilize results of quality assessment and performance improvement program findings to: a. Update and improve contracts, the medical provider evaluation process, financial incentives (i.e., pay for performance or value-based care integration), policies, procedures, and practices. b. Suggest, seek approval for and operationalize performance improvement activities aimed at closing gaps related to network adequacy, adequate utilization of available services (i.e., palliative care) and/or elevation of care delivery via innovative approaches. c. Identify solutions to problems that utilize a collaborative approach, including integration efforts with hospital, ancillary and community resources and services.
  • Ensure, with other Medical Directors as appropriate, that Hospital and Ancillary Service Medical Staff and Contracted Medical Providers are providing appropriate care for IEHP Members including but not limited to availability of qualified medical consultative staff and oversight of their medical staff quality performance.
  • Collaborate with Health Services to hold practitioners accountable for their utilization management activities (admissions, and transfers, including related orders and contracted facility case mix), engagement in interdisciplinary teams, performance, and practice, including corrective actions and adequate documentation of patient care as needed.
  • Review recovery audit denials and appeals inclusive of second level appeal letter, second level medical necessity review, and peer to peer reviews.
  • Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Requirements

  • Five (5) years of post-residency or licensure experience in a recognized specialty that includes but is not limited to Family Medicine, Internal Medicine, Pediatrics, and Emergency Medicine
  • Experience in quality, care coordination, utilization management in an inpatient, ACO or FQHC environment
  • Strong product and program management experience, product delivery, product environments, and management consulting
  • Preferred: At least three (3) years of administrative experience.
  • Experience is in a variety of clinical settings including inpatient, outpatient practice, and community-based care settings
  • Medical Degree in a clinically related field (e.g., MD, DO) from an accredited institution required
  • Preferred: Additional Master’s Degree (e.g., MS, MPH, MBA) from an accredited institution
  • Possession of an active, unrestricted, and unencumbered Physician’s and Surgeon’s Certificate issued by the State of California Medical Board required (A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California physician and surgeon’s certificate is filed in the state of California prior to date of appointment.)
  • Valid California Driver’s License preferred
  • Strong knowledge and understanding of: Medical practice and understanding of clinical operations in the hospital and ancillary setting, Various regulatory bodies and setting-specific requirements, including DHCS, NCQA, CMS, TJC/DNV. Current trends in health care and clinical operations, Administrative practices and procedures including but not limited to quality assessment and improvement, care coordination, 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, Overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties
  • Excellent Word, Excel, and PowerPoint skills.
Benefits
  • CalPERS retirement 457(b) option with a contribution match
  • Generous paid time off- vacation, holidays, sick
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Paid life insurance for employees with additional options
  • Short-term, and long-term disability options
  • Pet care insurance
  • Flexible Spending Account – Health Care/Childcare
  • Wellness programs that promote a healthy work-life balance
  • Career advancement opportunities and professional development
  • Competitive salary with annual merit increase
  • Team bonus opportunities

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
quality assessmentperformance improvementcare coordinationutilization managementclinical operationsadministrative practicescredentialingrisk managementevidence-based practicespalliative care
Soft skills
clinical leadershiprelationship buildingcommunicationcollaborationorganizational skillseducational program developmentstrategic thinkingproblem-solvinginterpersonal skillsaccountability
Certifications
Physician’s and Surgeon’s CertificateMDDOMaster’s DegreeCalifornia Driver’s License