Location: Rancho Cucamonga, CA
Company: Inland Empire Health Plans
Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation. The Medical Director of Behavioral Health oversees the inpatient/concurrent review process, care integration efforts, and all levels of behavioral health care provided to IEHP Members.
The Medical Director coordinates care with the County Mental Health Plans that are responsible for the care of the population with a Serious Mental Illness (SMI), the County Alcohol and Drug Program, as well as all IEHP community and provider partners. Major Functions (Duties and Responsibilities) 1. Provides overall
clinical leadership and develops and implements clinical policies for the IEHP Behavioral Health Program. This includes delivery of mental health services, substance use services, medication management, and coordination of behavioral health services and primary care.
2. Provides direction of current clinical practices for behavioral health services. Ensures that qualified medical/clinical personnel render clinical decisions regarding behavioral health, unhindered by fiscal or administrative management, and consistent with regulatory requirements and UM guidelines. 3. Leads Behavioral Health quality improvement efforts while helping to manage health plan medical costs, assuring an appropriate
and efficient health care delivery system for IEHP Members, and supporting IEHP strategic goals.
4. Monitors performance of behavioral health providers and leads performance improvement efforts in the network to improve the quality of services delivered to IEHP members in collaboration with IEHP leadership. 5. Leads efforts to further integrate substance use treatment into the care delivery system, including implementing integrated care models that increase access to Medication Assisted Treatment (MAT) along with substance use counseling and other evidence-based addiction interventions. 6. Develops targeted education, training, and clinical guidance to contracted primary care physicians (PCPs) treating behavior health-related concerns not requiring referral to behavior health specialists.
7. Provides medical direction and guidance to the Behavioral Health Department in the arena of inpatient, outpatient pre-service authorizations and utilization management, including the coordination of care with external agencies, consultation on complex cases, and participation in Interdisciplinary Care Teams/case conferences 8. Leads, develops, directs, and implements clinical and non-clinical activities that impact health care quality, cost, and outcomes.
9. Reviews cases and ensures appropriate adjudication of prior authorization. Directly reviews all medical necessity denials and modifications of a prior authorization requests. 10. Ensures the creation, modification, and appropriate and timely use of UM criteria for both inpatient and outpatient authorizations. 11. Identifies and develops opportunities for innovation to increase effectiveness and quality. 12. Ensures that assigned patients have access to behavioral health services coordinated with primary and specialty care throughout IEHP’s geographic coverage area. Partners with the Contracting Department to ensure a full and appropriate primary and specialty behavioral health care provider network for Members.
13. Consults on written protocol for IEHP behavioral health providers to ensure adherence to standards and quality of care. Coordinates professional interactions among practitioners and lends assistance toward correcting any deviation from standards. Develops relationships with directly contracted behavioral health providers. 14. Reviews State mandated benefits to ensure the IEHP Behavioral Health Program is in full compliance through its providers. 15. Partners with Behavioral Health leadership in curriculum development designed to promote a comprehensive, effective, and equitable behavioral health program.
16. Any other duties as required ensuring Health Plan operations are successful. Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications Five (5) years of post-residency or Licensure experience in a recognized psychiatric specialty. Preferred Experience At least three (3) years of psychiatric administrative experience preferred. Preferred experience is in a variety of clinical settings including inpatient psychiatric, outpatient practice, and community-based care settings.
Utilization Management experience with an IPA, medical group or HMO highly desirable. Experience with Medi-Cal managed care is a plus. Education Qualifications Doctorate of Medicine from an accredited institution required. Professional Certification Certification by an American Specialty Board in Psychiatry. Professional Licenses Possession of an active, unrestricted, and unencumbered Physician’s and Surgeon’s Certificate issued by the State of California Medical Board 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.
) Drivers License Required Yes, must have a valid California Driver's License. Knowledge Requirement Administrative practices and procedures including but not limited to quality backssment and improvement, utilization review, peer review, Credentialing and risk management; rules regulations, policies, and standards related to managed care; principles of effective supervision and organization; methods, techniques, practices, principles, and literature in the broad field of medical sciences; and overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties.
Skills Requirement Microcomputer applications such as Microsoft Word, Excel, and Access helpful. 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 While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
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 Hybrid Physical Requirements Keyboarding: Traditional - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY A reasonable salary expectation is between $240,676.80 and $330,928.00, 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.
