Vice President, Health Services Clinical Integration & Operations

What you can expect

• Plan, organize, direct, and coordinate the IEHP approach to an integrated and person-centered care model within the plan, including direct oversight and integration of multiple departments (utilization management, care management, behavioral health, integrated transitional care, regulatory oversight, and pharmacy).
• Partner with key stakeholders to design a strategy that ensures the right care to the right patient at the right time and determine the highest yield plan strategies to identify disparities and improve overall population health.
• Work closely with key stakeholders and partners to move forward state-wide and regional initiatives related to care integration, health equity, population health, and behavioral health.
• Directly supervise the Utilization Management, Behavioral Health/Care Management, integrated transitional care, regulatory oversight, and Pharmacy Departments.
• Collaborate with senior management teams at IEHP and partner agencies, both locally and at the State/Nation level, to ensure the strategic priorities of the organization are met, with a focus on care integration, improving population health, reducing gaps in care, and promoting health equity in the Inland Empire.
• Lead assigned strategies and tactics in the IEHP strategic plan.
• Coordinate activities with IEHP Directors and external partners, and other work as required
• Ensure that the Health Services Departments are meeting all regulatory and contractual requirements under Medi-Cal, Covered California, and Medicare. (Other business lines may be explored and added in the future.)
• Be motivated to work in a setting with a social mission.

Key Responsibilities

• Lead IEHP activities to identify and implement clinical integration at the plan level, resulting in a whole person model of service at IEHP.
• Oversee the Utilization Management, Behavioral Health and Care Management, Integrated Transitional Care, Regulatory Oversight, and Pharmacy Departments., including operations, personnel management, budgets, and compliance
• Work collaboratively with the executive leadership to identify key human resource gaps and expertise needed to further build, integrate, and develop these teams and departments.
• Partner with the Senior Directors, Medical Directors, and the Inland Empire healthcare systems such as the counties to develop, implement, direct, and oversee clinical integration and other transformation initiatives such as the California Department of Health Care Services’ CalAIM initiative.
• Identify health disparities and system gaps in care, as well as ensuring that the health delivery system is focusing on evidence-based interventions for the various segments of the population, ensuring the right care for the right patient at the right time.
• Identify opportunities to realign processes and resources inside the health plan that are focused on managing utilization patterns of providers/IPAs and Members and meeting current regulatory oversight and accountability requirements. Work with key stakeholders to support efforts to partner with providers, IPAs, patients, and the community, to further transform the health system of the Inland Empire.
• Collaborate with other IEHP internal departments such as Quality and Grievance & Appeals to develop quality metrics, reporting, process improvements, and intervention activities to improve IEHP provider quality of care, enhance Member experience, and reduce gaps in care.
• Lead and participate in the development and implementation of IEHP’s Strategic Plan.
• Serve as a representative and spokesperson for IEHP in support of integration and population health activities in the Inland Empire with key county partners as well as State and National organizations and conferences.
• Participate in State and industry work groups such as DHCS, DMHC, CHCF, NCQA, ACAP and CAHP to expand IEHP’s influence on benefit design, regulations, and policy direction.
• Perform other duties and projects as assigned.
• Train, supervise and evaluate employees’ performance on an ongoing basis and take appropriate corrective action if needed.
• Ensure adherence to department and organizational standards, policies, and procedures.

Experience Requirements

• Eight (8) years or more of system level implementation work on utilization management, behavioral health, care integration, and complex care management strategies. Experience with population health management approaches, strategy, and intervention design.
• Experience leading complex enterprise-wide projects and experience in facilitating large multi-stakeholder collaborations is a plus.

Education Requirements

• Master’s degree from an accredited institution required.
  • In lieu of a Master's degree, a minimum of a Bachelor’s degree and four (4) years of additional relevant work experience is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above.
• Doctoral degree in a Health-related field, Clinical Psychology degree or Doctorate of Medicine or DO in related field from an accredited institution preferred.

Other Knowledge, Skills, and Abilities

• Utilization management, behavioral health, population health management, complex case management, care integration, and pharmacy.
• Outpatient clinical operations and quality improvement.
• People management and leadership skills.
• Understanding of and sensitivity to a multi-cultural environment and community.
• Understanding of clinical and wellness programs to address the needs of high-risk members.