IEHP-posted 3 months ago
$280,841 - $393,182/Yr
Full-time • Senior
Rancho Cucamonga, CA
Religious, Grantmaking, Civic, Professional, and Similar Organizations

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! Reporting to the Vice President of Health Services, the Senior Medical Director Policy & Outcomes (Sr. Medical Director - P&O) is responsible for the strategic oversight of IEHP Medical Policies and clinical leadership around member health outcomes. The Sr. Medical Director - P&O oversees the day-to-day operations as it relates to developing, executing, leading and updating guidelines, policies, clinical pathways, and communications enabling effective health outcomes, as well as effective health plan performance as per DHCS, DMHC, CMS, and CCA clinical requirements. This leader serves as the accountable medical leader for clinical activities related to key activities including quality management, grievance and appeals, delegation oversight, and population health management. The Sr. Medical Director - P&O also works in partnership with the appropriate cross functional departments to monitor the impact of policy outcomes through regular reporting, metrics, initiatives, and other improvement activities. This position is responsible for leading regulatory audits for all its relevant domains.

  • Oversee the strategic oversight of IEHP Medical Policies and clinical leadership around member health outcomes.
  • Develop, execute, lead, and update guidelines, policies, clinical pathways, and communications.
  • Ensure effective health outcomes and health plan performance as per regulatory requirements.
  • Serve as the accountable medical leader for clinical activities including quality management, grievance and appeals, delegation oversight, and population health management.
  • Monitor the impact of policy outcomes through regular reporting, metrics, initiatives, and improvement activities.
  • Lead regulatory audits for relevant domains.
  • Seven (7) years of post-residency experience in a recognized medical specialty or practice, including at least (3) years of medical administrative experience.
  • Minimum of five (5) years of managed care or health plan leadership experience with a proven track record of leading high performing physician teams.
  • Experience working with clinical practice guidelines and evidence-based criteria sets.
  • Exposure to working with regulatory agencies.
  • Medical Director for an IPA, medical group, or CA HMO highly desirable.
  • Medical specialty/practice experience preferably in the state of California.
  • Doctorate of Medicine from an accredited institution required.
  • Certification by one (1) of the American Specialty Boards required.
  • Completion of an accredited residency program required.
  • Possession of an active, unrestricted, and unencumbered Physician's and Surgeon's Certificate issued by the State of California required.
  • Valid California Driver's License preferred.
  • Familiarity with local healthcare organizations and/or local practice experience is preferred.
  • Competitive salary
  • Hybrid schedule
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development
  • Wellness programs that promote a healthy work-life balance
  • Flexible Spending Account - Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance
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