Senior Medical Director - Rancho Cucamonga - IEHP

    IEHP
    IEHP Rancho Cucamonga

    1 week ago

    Healthcare
    Description

    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.

    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.

    Education & Requirements

    • Seven (7) years of post-residency experience in a recognized medical specialty or practice, which must have included at least (3) years of medical administrative experience required
    • Minimum of five (5) years of managed care or health plan leadership experience with proven track record of leading high performing physician teams
    • Experience working with clinical practice guidelines and evidenced based criteria sets
    • Has 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
    • A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California physician and surgeon's certificate is filed in the state of California prior to date of appointment.

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