Vice President, Care Coordination & Care Management

Inland Empire Health Plan•Rancho Cucamonga, CA

1d•$280,842 - $393,182•Hybrid

About The Position

What you can expect! 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 Chief Medical Officer, the Vice President, Care Coordination & Care Management provides enterprise-level leadership, operational direction, and strategic advancements for core operational care coordination and care management functions. This role is accountable for ensuring IEHP members across all risk levels receive integrated, effective, efficient, and compliant care services that measurably improve health outcomes. The Vice President is responsible for operating across the continuum of care coordination and management, and is accountable for optimizing performance, regulatory compliance (including DSNP requirements), and member experience across all lines of business. This role’s scope includes, but is not limited to, the oversight of key functional areas such as care management, behavioral health, case management, transitions of care and discharge planning, Long-Term Services, and strong coordination with Enhanced Care Management requirements. This role would also be required to coordinate with key county partners as identified. The Vice President will also advance care management and coordination functions through modern, scalable techniques, including the thoughtful adoption and integration of AI tools and innovative care management technologies where applicable. This role will also drive system-wide strategic initiatives in collaboration with key business partners such as Hospital Relations, Network Management, Quality, Medical Management, Population Health & Care Initiatives, and Pharmacy. 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 twelve (12) years progressively responsible experience in managed care setting that serves the Medicaid population and/or similar populations
Eight (8) or more years of progressive healthcare leadership
Strong clinical experience in multidisciplinary team collaboration in a Medi-Cal managed care environment, as well as proficiency in care management, behavioral health, birthing pathways, complex children and all associated workflows
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 issued by the appropriate state board in one of the following areas required:1. Registered Nurse (RN) license issued by the California BRN2. Social Services related field issued by the California Board of Behavioral Sciences required. (LCSW or LMFT preferred.)3. Physician Assistant license issued by the Physician Assistant Board of California4. Physician and Surgeon license or Osteopathic Physician and Surgeon license issued by either the Medical Board of California or Osteopathic Medical Board of California
Must have a valid California Driver’s license
Comprehensive knowledge and in-depth understanding of: Care Coordination and Care Management requirements, including, but not limited to, its application to PHM, LTSS, HEDIS and CAHPs, CMS, DMHC and NCQA regulations in both the inpatient and outpatient settings
Clinical workflows and interdisciplinary team models
End-to-end understanding of member journeys, clinical pathways, and escalation mechanisms
Organizational design, workforce planning, leadership development, and building high-performing teams
Program requirements, reporting standards, audit expectations, and compliance risks for care coordination and care management
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
Ability to use analytics to guide strategy, forecast needs, and evaluate program effectiveness
Proven ability to: Lead and build high performing teams Be highly effective and an active communicator who works well with people at all levels Generate executive and granular level content independently and in teams Demonstrate a strong work ethic Show commitment to working on advancing team culture Handle multiple priorities Be highly organized Be highly collaborative, cross-functional, and systematic Work with a high degree of diplomacy, credibility, and influence to consistently cultivate effective working relationships Effectively express ideas and gain traction Be proactive, responsive, and action oriented Drive performance, close loops, and accomplish difficult tasks

Nice To Haves

Master's or Doctorate degree in a related field from an accredited institution preferred
Certification by one (1) of the American Specialty Boards preferred
Experience with implementing new innovative tools, such as AI, in relevant care settings

Responsibilities

Establish key strategic priorities across core operational care coordination and care management functions. This includes the oversight of key functional areas such as care management and case management, as well as strong coordination with enhanced care management requirements.
Ensure member care strategies are harmonized, linked, and streamlined to support key priorities, including value based and quality objectives for all lines of business. This includes accountability for improving quality metrics across key domains within the Care Management and Care Coordination functions.
Forecast care coordination, care management, and care outcome trends and needs mapped to regulatory and compliance requirements. This also includes ensuring meeting the standards of regulatory, compliance, and audit requirements
Ensure that all department functions are elastic to meet the demands of a dynamic membership population across all risk types.
Executive level accountability to ensure all regulatory and compliance requirements are executed on, across all regulators, including, but not limited to, DHCS, DMHC, CMS and Covered CA.
Influence enterprise initiatives and priorities that focus on continuous improvement for member outcomes, including the use of modern tools and techniques such as artificial intelligence where applicable.
Partner and built trust with key stakeholders, including, but not limited to, Quality, Medical Management, Population Health, Pharmacy, Hospital and Ancillary Relations, and Provider Network to ensure care is managed and coordinated appropriately across all risk categories. This also includes partnering and building trust with external stakeholders including state, regional, county and local departments, county public health, CBOS, providers, and other county partners as identified.
Serve as a lead in all regulatory audits, including representation in key state, local, and regional committees as applicable.
Develop, grow and cultivate high performing teams, while fostering a culture of accountability, collaboration, responsiveness, and performance.
Ensure enterprise alignment and integration of care coordination and care management functions across technical departments, such as IT and Informatics, and ensure medical management software is optimized to meet the needs of the team.
Identify macro and micro barriers that impact care coordination and care management across-functional departments, including leading internal and external applicable case/care conferences and ensuring appropriate utilization.
Deliver regular team member, senior leadership, executive, and board level reporting, including mitigation of strategic risks. Must ensure that all content is communicated clearly and calibrated to the appropriate audience, including translatable concrete action steps.
Create a data informed decision-making process to optimize membership needs.
Ensure transparency, consistency, integrity, and accountability within the departments caring for IEHP members.
Lead high performing departmental teams with an understanding of LEAN and AGILE methods, as well as relevant AI/Machine Learning use cases.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.