Senior Director, Integrated Care Management

Inland Empire Health Plan•Rancho Cucamonga, CA

1d•Hybrid

About The Position

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! The Senior Director, Integrated Care Management has a primary responsibility to plan, develop and implement an integrated care management program that focuses on a person-centered model of care which takes in to account the member’s medical, behavioral, and social needs. The Integrated Care Management program will provide services to all members in the continuum of care. In addition, this position will partner in the development of interventions in the communities in which our population resides to address the social determinants of health that impact the quality of our members lives. The Senior Director, Integrated Care Management ensure all private and government program regulations and requirements are met. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

Minimum of ten (10) years progressively responsible experience in managed care setting that serves the Medicaid population and/or similar populations.
Seven (7) or more years of progressive healthcare leadership.
Strong clinical experience in multidisciplinary team collaboration.
Proven leadership experience, mentoring, and developing a team at a leadership level.
Bachelor's degree in a related field from an accredited institution required.
Possession of an active, unrestricted, and unencumbered license in one of the following areas required:
Registered Nurse (RN) license issued by the California BRN
Licensed Clinical Social Work or Licensed Marriage Family Therapy issued by the California Board of Behavioral Sciences
Thorough knowledge of CalAim, PHM, ECM, Community Supports, LTSS, HEDIS and CAHPs, CMS, DMHC and NCQA regulations.
Excellent oral and written communication skills.
Excellent interpersonal skills, diplomacy, coaching and change management skills.
Good Microsoft applications skills (Word, Excel, and PowerPoint).
Demonstrated problem solving and decision-making skills with ability to exercise initiative.
Demonstrated ability to lead teams and achieve successful outcomes and results while fostering a climate of engagement and employee satisfaction.
Proven ability to:
Work independently
Present to large audiences
Work with multicultural communities in a culturally competent manner
Possess a transparent leadership style
Possess a strong work ethic
Show commitment to working with vulnerable populations and Team Culture
Handle multiple priorities
Be highly organized

Responsibilities

Direct oversight of the Integrated Care Management teams.
Lead health plan strategy that supports the integration of care management for all members on the continuum.
Develop and implement a comprehensive care management program incorporating risk stratification, LTSS, population health management, and CalAim.
Build strong rapport with executive teams from all clinical and non-clinical areas to execute business plans impacting the quality performance metrics and benchmarks of IEHP’s strategic goals.
Collaborate with internal teams to design and implement the comprehensive and integrated care management model.
Collaborate with external partners (County public health, County Behavioral Health, County care management programs such as MSSP, TCM, community-based organizations, hospitals, IPAs, ECM Providers) to develop a robust comprehensive and integrated care management model.
Oversee the ECM model 1 program to ensure compliance in all DHCS ECM required regulations.
Facilitate integration of care coordination, long term care, and behavioral health programs to ensure comprehensive care management.
Lead/and or participate in work groups that will implement the new care management model for Medi-cal. These include but are not limited to in community supports, enhanced care management, long term support services, CCA, Dual Special Needs Plans, and population health.
Collaborate with the quality oversight department across the various care management programs to oversight the department and delegates to ensure compliance with DHCS, DMHC, CMS, and NCQA.
Develop Directors and Managers as leaders to ensure they have the tools and skill sets to execute their operational plans and act as role model for professional and clinical staff.
Supervise and evaluate the Directors on an ongoing basis and provide support/feedback as needed.
Actively participate in County, and/ or community work groups that are developing processes to integrate their model of care.
Partner with community-based organizations to develop a broad network of services for our members and their communities that address social determinants of health.
Participate in both counties homeless action planning, and behavioral health to develop programs to address the homeless crisis.
Partner with both counties public health departments to develop strategies to address public health issues.
Supervise work of others, including planning, assigning, scheduling, and reviewing work, ensuring quality standards. Is responsible for hiring, terminating, training, and developing, reviewing performance, and administering corrective action for staff. Plans organizational structure and job content.
Ensure that the programs and processes align to support the strategic goals of the organization and the care teams including external partners understand their roles and how they support organizational priorities.
Develop the Annual Department Work Plan and quarterly updates that meet requirements for the annual QI Plan for all programs and ensure all indicators are met.
Guide all Clinical/Operational processes, policies and procedures, and care management programs and utilize LEAN methodologies to promote efficiency.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.