Location: Rancho Cucamonga, CA
Company: Inland Empire Health Plans
positions. The role is responsible for monitoring performance of the team and individual Team Members, identification of process improvement areas, developing a team approach to problem solving and developing a cohesive team. Overall, responsibilities include ensuring timely completion and response for Behavioral Health & Care Management department functions including: - Ensuring accurate completion of the authorization data entry tasks, continuity of care, and Behavioral Health authorization processes - Referrals and calls - Ensuring compliance with all regulatory and quality requirements, including but not limed to, screening, backssment, care planning, and follow-up.
Major Functions
(Duties and Responsibilities) 1. Develop effective relationships with co-workers, direct reports, and community partners, modeling excellent interpersonal skills and collaboration in working toward job duties and goals.
2. Model the importance of Member experience and engagement and engage with other leaders in BH and CM and at IEHP in developing and implementing Member and Team Member experience improvement activities. 3. Work closely with the BH and CM leadership to develop effective behavioral health care management principles, processes, and workflows as well as monitor care management services to ensure compliance with all IEHP, state and federal regulatory requirements. 4. Monitor
and provide direction to the BH and CM team to ensure implementation of timely processes and follow through of calls, task completion, care coordination and care management, including Complex Care Management responsibilities.
5. Proactively recognize problematic or risk areas and help develop effective and efficient solutions in conjunction with BH &CM Team Members. 6. Professionally represent the department at selected IEHP meetings including external events, as necessary. 7. Provide exemplary leadership and support for all assigned BH and CM Team Members ensuring Team Members are given every opportunity to succeed in their positions and are supervised in accordance with Department and Human Resources (HR) policies.
8. Discuss difficult or complex cases with Team Members, provide recommendations for further action, coach Team Members in addressing Member’s holistic needs. 9. Review and update departmental policies and procedures, as necessary. 10. Evaluate current programs for efficiency and program outcomes by analyzing specific data and providing improvement suggestions. 11. Assist in auditing services authorized by BH & CM leadership and submit statistical reports to managerial and director leadership as requested. 12. Work closely with management to coordinate daily staffing and coverage of the BH & CM Units.
13. Supervise and train BH & CM assigned Tam members including monitoring of performance standards. 14. Monitor and provide timely direction to BH & CM assigned team to ensure adherence to NCQA, CMS, DMHC and DHCS regulator standards ensuring delivery of high-quality, cost-effective services to Members. 15. Engage in direct care management activities when needed. Provide mentoring and clinical supervision of licensed and unlicensed Team Members when needed. 16. Assist in training of new staff members utilizing proficiency in all electronic medical management systems (e.
g. Med Hok, Medi Trac, Super Search and Web Portal). Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications Three (3) years of relevant progressive work experience in a healthcare setting is required. Working experience and knowledge in teams consisting of Behavioral Health, Care Management, and Team Members dedicated to addressing social determinants of health. Supervisory/lead capacity experience required. Preferred Experience Experience in a managed care organization servicing Medicaid and/or Medicare membership preferred.
Education Qualifications Bachelor’s degree in a related field from an accredited institution required. In lieu of a bachelor’s degree, one of the following applicable scenarios may be considered: 1. Candidate with an active, unrestricted, and unencumbered Registered Nurse (RN) issued by the California BRN without a bachelor’s degree will require four (4) years of additional relevant work experience. This experience is in addition to the minimum years listed in the Experience Requirements above. 2. Candidate with an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians without a bachelor’s degree will require six (6) years of additional relevant work experience.
This experience is in addition to the minimum years listed in the Experience Requirements above. Internal Candidates Only: In lieu of the required degree, a minimum of five (5) years of IEHP work experience in Health Services division is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above. Preferred Education Master’s degree from an accredited institution preferred.
Professional Licenses Possession of one (1) of the following active, unrestricted, and unencumbered clinical licenses issued by appropriate California state board required: - Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians. - Registered Nurse (RN) license issued by the California BRN. - Clinical Social Worker (LCSW) license or Marriage and Family Therapist (LMFT) license issued by the California Board of Behavioral Sciences Drivers License Required Yes, must have a valid California Driver's license and valid automobile insurance.
Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points. Knowledge Requirement Deep understanding and knowledge of: - Behavioral health and substance use conditions, including acute and chronic management. - Awareness of the impact of unmitigated bias and judgement on health with the; commitment to addressing both. - Evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies. - Understanding and sensitivity to multi-cultural community - Whole health and integrated principles and practices is preferred.
Skills Requirement Skilled in the following areas: - Problem-Solving: Identify and resolve problems, effective time management and the ability to work in a fast-paced environment. - Report Analysis: Comprehend and analyze statistical reports, aggregate data, make recommendations. - Effective engagement and skill development to support strong, cohesive, productive Teams. - Effective written and oral communication. - Informally and formally sharing expertise. Abilities Requirement Proven ability to: - Work as a member of a team, executing job duties and making skillful decisions.
- Function independently. - Be a self-starter. - Sufficiently engage Members and Providers. - Show resilience to tolerate a moderate level of change and development around new models of care and care management practices. Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
A reasonable salary expectation is between $103,708.80 and $132,225.60, based upon experience and internal equity. Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work. ” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
Management & Executive Jobs refer to positions within an organization where individuals are tasked with making strategic decisions, overseeing operations, and leading teams towards achieving business goals. These roles typically include titles such as manager, director, vice president, and CEO, and are characterized by their high level of responsibility, authority, and often, a requirement for extensive experience and leadership skills. Executives set the vision for the company, while managers implement strategies and policies to drive success. These jobs often involve complex problem-solving, strong communication abilities, and the capacity to influence and motivate others.
Management & Executive Jobs refer to positions at the higher levels of an organization's hierarchy, involving significant responsibility over strategic planning, decision-making, and leadership. Executives set visions, goals, policies, and they often participate in high-level negotiations. Managers oversee the implementation of these directives, leading teams, managing resources, and ensuring operational efficiency. These roles demand strong leadership, communication, and analytical skills, as well as extensive experience in their respective fields. Typical titles include CEOs, CFOs, directors, and various department heads, each with a critical influence on the company's success and direction.
Management and Executive Jobs refer to positions at the higher levels of organizational hierarchy that involve overseeing operations, strategic planning, and decision-making. These roles typically include titles such as CEO, CFO, COO, department managers, and directors. Key characteristics of these jobs include leadership responsibilities, the ability to direct teams, craft strategic initiatives, and a focus on achieving company objectives through effective resource management. They generally require a combination of advanced education, extensive experience, and skills in communication, problem-solving, and critical thinking.
but are not limited to, health education and health management classes, workshops, and health screenings, as well as information regarding access to care. The Supervisor will be responsible for assisting to establish measurable goals and outcomes for the Center in collaboration with the Community Resource Center Manager.
Assist in the outreach of partnerships related to Center events and offerings to increase awareness in the surrounding community. Serve as the liaison/ambassador to internal and external clients/community partnerships. Responsible for the Center's activities calendar and ensuring appropriate and efficient utilization is maintained and lead in building and implementation
of Quality Assurance Program, instructor evaluation, curriculum design and metrics. Responsible for supervising all activities ensuring information flow to and from the Center and IEHP headquarter office.
Reviews and submits requests for payments, invoices, and other expenses for approval to the Community Resource Center Manager. NOTE: This position includes an Addendum to PART D: POSITION MAJOR FUNCTIONS which will oversee the Fitness Coach, Nutrition Coach and CRC programs. Major Functions (Duties and Responsibilities) 1. Meet or exceed daily/weekly/monthly goals for the Community Resource Center. 2. Responsible for all aspects of staff supervision to include creating a motivating and
energized work environment through strong leadership, communication, and organizational skills.
3. Responsible for maintaining and collecting quantitative and qualitative information and evaluative tracking data on Center activities. 4. Contributes to the development of the Center's operational and capital budgets and monitors for compliance and participates in the negotiation of and monitoring of contracts and subcontracts related to the Center and related activities. 5. Assist in the coordination of ongoing team meetings in addition to staff meetings with internal IEHP departments. 6. Recommends changes to policies and procedures based on Community Resource Center needs.
7. Assist Community Resource Manager in collaborating with management from Care Management, Member Services, Health Education, Health Navigator, or other departments when resolving Member issues or working on Program projects. 8. Ensure the standards for Member rights and responsibilities, such as confidentiality is maintained by staff. 9. Assist the Community Resource Manager in coordinating special projects. Ensure special projects are completed in a timely manner. 10. Nurture relationships with community-based organization partners who provide resources to families in the communities we serve.
11. Assist in the coordination of education/discussion forums surrounding various preventive health, or healthcare access topics in center territories. 12. Coordinate high volume projects/requests from multiple facets of the Community Resource Center. ADDENDUM – For Fitness Coach, Nutrition Coach and CRC Programs 1. Coordinate daily operational tasks in accordance with established Community Resource Center (CRC) policies and procedures, standard operating procedures, and job aids to ensure optimal performance results. 2. Supervise Team Members with planning, scheduling, and reviewing their scope of work while adhering to quality standards aligned with community resource center member experience.
3. Responsible for the hiring practices, training and developing, conducting performance reviews, communicate and implement the LEAN model to meet the standards, processes, and training to support growth and development. 4. Coordinate the curriculum design and oversight for the CRC’s programs, which includes MCAS/HEDIS related activities to support organizational goals, a quality assurance program and evaluation model to ensure effective services to Members and general community and provide a monthly completion of programming with calendar duties, in collaboration with the Marketing department for translation, print requests, and promotion on websites and social media.
5. Assist in reviewing usage of CRC facilities requests from external partners. 6. Facilitate and work with external partners to promote education, outreach of services and the importance of connections to the Community Resource Centers. Major Functions (Duties and Responsibilities) Cont Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications Two (2) years experience in the following: • Supervision/Lead Capacity • Managed Care/IPA/Clinic Setting • Community Outreach • Experience working with State Health Programs (Medi-Cal and Healthy Families Program) Preferred Experience Experience with Community Centers is a plus.
Education Qualifications Bachelor's degree, preferably in relevant health, social, or behavioral discipline, from an accredited institution required. Preferred Education Professional Certification Professional Licenses Drivers License Required Yes, must have a valid California Driver's license and valid automobile insurance.
Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points. Knowledge Requirement Understanding of and sensitive to multi-cultural communities. Knowledge of Medi-Cal/managed care environment preferred. Knowledge of community resources available in Riverside and San Bernardino Counties. Skills Requirement Bilingual (English/Spanish) written and verbal skills preferred. Must be fluent conversationally. Testing will be required to determine bi-lingual language level. Excellent computer skills with an emphasis on MS Office software.
Strong verbal, communication skill, and computer skills. Excellent time management, organization, and interpersonal skills. Strong verbal and written communication skills. Abilities Requirement High degree of patience. Ability to make clear presentations. Strong sound judgement and decision making. Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
Working Conditions Word processing and data involving computer keyboard, viewing monitor. Setting up and cleaning up for classes. Must be able to lift 40 lbs. High amount of field work with 25% driving travel required. Flexibility to work evenings and some weekends. Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.
Work Model Location Onsite Physical Requirements Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY Keyboarding: 10-Key - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY A reasonable salary expectation is between $79,809.60 and $101,774.40, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work. ” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
