Medical Director - Hospital & Ancillary Relations

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Excitingly lead as the Medical Director of Hospital & Ancillary Relations, Steering clinical leadership towards operational and quality improvement. Drive strategic initiative with a dynamic approach, fostering collaboration with health plan and provider leaders. From identifying clinical opportunities to promoting best practices, you'll enhance care delivery, educate clinicians, and influence legislative impact.In addition to, collaboration with inter-departments to ensure member needs are met while simultaneously building strong peer relationships.Be at the forefront of quality improvement, ensuring optimal care goals and innovative approaches.
Key Responsibilities: 1. Identify clinical practice opportunities within business unit projects and activities and apply clinical and administrative skills to guide the department in implementing strategic, organizational and departmental improvements.
2. Provide clinical leadership to implement, manage and achieve hospital and ancillary optimal care goals utilizing existing channels (i.e., Joint Operations Meetings, Inland Empire Alliance meetings, throughput and quality workgroups, etc.), and via development of new avenues for implementation of novel approaches to identified challenges and highlighting best practices.
3. Develop relationships with internal and external clinical leadership teams and focuses on mutual goals to improve the quality of medical and ancillary services to advance optimal care (i.e., pediatric strategy, quality network implementation for hospitalist, hospice, post-acute services) and promote appropriate utilization of resources.
4. Inform and educate hospital and ancillary clinicians about relevant changes in clinical best practices, regulatory mandates, and other relevant information to support the health plan's strategies (i.e., palliative care initiatives, peer review program expectations).
5. Maintain an updated and expanded knowledge base on factors that affect hospital and ancillary services, and ensures that relevant information about social, medical, and fiscal issues are incorporated into IEHP policies, procedures, and strategies (i.e., All-Plan Letters, state and federal regulations).
6. Organize, coordinate, monitor, and promote the activities of the contracted medical providers to help ensure that the quality and appropriateness of services meets community standards. This may include collaboration with departmental leadership to educate and train clinicians in standards of care (i.e., specialty-specific care, evidenced-based practices, infection control practices, etc.)
7. Provide recommendations for research and development activities in strengthening quality improvement efforts for the medical providers in hospital and ancillary areas. (i.e., Hospitalist Pay for Performance program)
8. Articulate the importance and mission of the work surrounding hospice and post-acute services (i.e., SNF, long-term care, home health) to the community; specifically, how these impact hospital care quality and throughput, and Member/patient experience.
9. Participate in the development and delivery of educational programs geared towards improving the practice of clinicians including, but not limited to, physicians, mid-level providers, etc. in various settings.
10. Leverage knowledge of clinical, regulatory, social, political, and economic factors to provide feedback, as appropriate, to legislators and public policy makers about existing and proposed laws and regulations impacting hospital and ancillary care services. (i.e., payment practices).
What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Excitingly lead as the Medical Director of Hospital & Ancillary Relations, Steering clinical leadership towards operational and quality improvement. Drive strategic initiative with a dynamic approach, fostering collaboration with health plan and provider leaders. From identifying clinical opportunities to promoting best practices, you'll enhance care delivery, educate clinicians, and influence legislative impact.In addition to, collaboration with inter-departments to ensure member needs are met while simultaneously building strong peer relationships.Be at the forefront of quality improvement, ensuring optimal care goals and innovative approaches.
Key Responsibilities: 1. Identify clinical practice opportunities within business unit projects and activities and apply clinical and administrative skills to guide the department in implementing strategic, organizational and departmental improvements.
2. Provide clinical leadership to implement, manage and achieve hospital and ancillary optimal care goals utilizing existing channels (i.e., Joint Operations Meetings, Inland Empire Alliance meetings, throughput and quality workgroups, etc.), and via development of new avenues for implementation of novel approaches to identified challenges and highlighting best practices.
3. Develop relationships with internal and external clinical leadership teams and focuses on mutual goals to improve the quality of medical and ancillary services to advance optimal care (i.e., pediatric strategy, quality network implementation for hospitalist, hospice, post-acute services) and promote appropriate utilization of resources.
4. Inform and educate hospital and ancillary clinicians about relevant changes in clinical best practices, regulatory mandates, and other relevant information to support the health plan's strategies (i.e., palliative care initiatives, peer review program expectations).
5. Maintain an updated and expanded knowledge base on factors that affect hospital and ancillary services, and ensures that relevant information about social, medical, and fiscal issues are incorporated into IEHP policies, procedures, and strategies (i.e., All-Plan Letters, state and federal regulations).
6. Organize, coordinate, monitor, and promote the activities of the contracted medical providers to help ensure that the quality and appropriateness of services meets community standards. This may include collaboration with departmental leadership to educate and train clinicians in standards of care (i.e., specialty-specific care, evidenced-based practices, infection control practices, etc.)
7. Provide recommendations for research and development activities in strengthening quality improvement efforts for the medical providers in hospital and ancillary areas. (i.e., Hospitalist Pay for Performance program)
8. Articulate the importance and mission of the work surrounding hospice and post-acute services (i.e., SNF, long-term care, home health) to the community; specifically, how these impact hospital care quality and throughput, and Member/patient experience.
9. Participate in the development and delivery of educational programs geared towards improving the practice of clinicians including, but not limited to, physicians, mid-level providers, etc. in various settings.
10. Leverage knowledge of clinical, regulatory, social, political, and economic factors to provide feedback, as appropriate, to legislators and public policy makers about existing and proposed laws and regulations impacting hospital and ancillary care services. (i.e., payment practices).
Education & Requirements Medical Degree in a clinically related field (e.g., MD, DO) from an accredited institution requiredPossession 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.)Five (5) years of post-residency or Licensure experience in a recognized specialty that includes but is not limited to Family Medicine, Internal Medicine, Pediatrics, and Emergency MedicineExperience in quality, care coordination, utilization management in an inpatient, ACO or FQHC environmentStrong product and program management experience, product delivery, product environments, and management consultingKey Qualifications Medical practice and understanding of clinical operations in the hospital and ancillary settingVarious regulatory bodies and setting-specific requirements, including DHCS, NCQA, CMS, TJC/DNVCurrent trends in health care and clinical operationsAdministrative practices and procedures including but not limited to quality assessment and improvement, care coordination, utilization review, peer review, credentialing and risk managementEducation & Requirements Medical Degree in a clinically related field (e.g., MD, DO) from an accredited institution requiredPossession 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.)Five (5) years of post-residency or Licensure experience in a recognized specialty that includes but is not limited to Family Medicine, Internal Medicine, Pediatrics, and Emergency MedicineExperience in quality, care coordination, utilization management in an inpatient, ACO or FQHC environmentStrong product and program management experience, product delivery, product environments, and management consultingKey Qualifications Medical practice and understanding of clinical operations in the hospital and ancillary settingVarious regulatory bodies and setting-specific requirements, including DHCS, NCQA, CMS, TJC/DNVCurrent trends in health care and clinical operationsAdministrative practices and procedures including but not limited to quality assessment and improvement, care coordination, utilization review, peer review, credentialing and risk management
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