VP, Medical Management​/Deputy CMO

Morgan Consulting Resources, Inc. has been retained to conduct the search for the Vice President, Medical Management/Deputy CMO for Inland Empire Health Plan. The role is based in Rancho Cucamonga, CA. A hybrid schedule is available allowing for three days in the office twijfled and two days working remotely.

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not‑for‑profit Medicare‑Medicaid plan in the country. In its 26th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing 涓network of over 7,800 providers and nearly 4,000 Team Members (Employees).

Through dynamic partnerships, award‑winning service, and a tradition of quality 至 care, IEHP is fully committed to its Mission, Vision, and Values.

IEHP has consistently achieved outstanding employee engagement scores from their 3,000+ Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row!

For details regarding IEHP, please visit iehp.org.

Reporting to the Chief Medical Officer (CMO), the Vice President, Medical Management (Deputy CMO):

• Acts as the Deputy Chief Medical Officer and represents the CMO internally and externally and serves as a spokesperson on medical issues in the absence of the CMO.
• Provides executive medical leadership across the Health Services Departments. This includes direct oversight and management of the Utilization Management (UM) Medical Directors as well as provision of clinical leadership and strategic direction across Health Services in partnership with various senior and executive leaders across the organization.
• Serves as the clinical technical expert for койclinically related federal and state requirements as it pertains to medical management, and operational expert in implementing changes to the UM process.
• Works closely with the Health Services leadership team on Utilization Management activities and complex clinical (medical and pharmacy) cases.
• Has a lead role in regulatory audits (DHCS, DMHC, CMS, NCQA).
• Participates in the development of potential new business lines, rising risk and high‑risk member programs, integrated care models, Population Health strategies including involvement in assigned state initiatives (CalAIM), hospital relations, oversight of provider and IPA utilization and performance, strategic plan implementation, and coordination with the Quality and Grievance & Appeals Departments.
• Serves as a mentor to Medical Directors and clinical staff to foster professional growth and development.
ungkan a accountable leader for escalated member related issues.

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Responsibilities
• Direct and support Medical Management activities and overall clinical operations along with the potential for oversight of other business units based on organization chart restructuring. This includes ongoing operational process improvement across the utilization management continuum.
• Provide clinical expertise and strategic direction to the Utilization Management Department, and partners with key leaders in the development and implementation of UM polices/procedures, clinical(medical and pharmacy) and non-clinical programs, interventions, and monitoring across all business lines (Medi-Cal, Dual, and Covered California) and the full spectrum of healthy, rising risk, and high-risk members’ utilization of services in all settings (out­patient, inpatient, concurrent review, and transitions of care).
• Take a leading role in ensuring compliance with regulatory requirements, audit response, and ensuring audit readiness (DHCS, DMHC, CMS, NCQA) related to medical management and quality oversight.
• Serve as a Subject Matter Expert (SME) point of contact for clinical, quality (NCQA and Medicare Stars) and performance issues in the IEHP network, and establishes ongoing relationships with network physicians, medical groups, hospitals, and County Health Systems.
• Serve as coach and mentor to support the professional growth of Medical directors, Physician Reviewers, as well as any additional direct/…