Manager, Clinical Programs – Hospital Relations

Inland Empire Health Plan

  • Rancho Cucamonga, CA
  • Permanent
  • Full-time
  • 15 days ago
Overview: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!The Manager, Clinical Programs - Hospital Relations will design and implement clinical programs, initiatives, and pilots to strategically advance IEHP strategic priorities and goals to improve quality to members, providers, and hospital partners.In this role, the Manager, Clinical Programs will provide oversight of identified initiatives, including planning, organizing, and collaborating with key internal and external stakeholders. In this role, the individual will be also ensuring the work is in line with IEHP strategic quality goals, objectives and is conducted and executed effectively. This position will provide support to all hospitals and ancillary services, ensuring the Joint Operation Meetings are running smoothly, mitigating issues, and finding resolution, managing daily operations of the work groups and activities of the team, and working with internal and external stakeholders to leverage their part of the program.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. Additional Benefits:PerksIEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
  • Competitive salary
  • Hybrid schedule
  • CalPERS retirement
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development
  • Wellness programs that promote a healthy work-life balance
  • Flexible Spending Account – Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance
Key Responsibilities: * Guide others at a strategic business level to ensure initiatives, programs or pilots are in line with IEHP strategic goals that foster clinical care transformation.
  • Develop innovative solutions and optimization of services in collaboration with internal and external stakeholders (i.e., Hospital Partners, SNFs, PCPs, etc.) that are efficient and effective that better serve Members.
  • Oversee all aspects of program operations: initiation, planning, development, and monitoring.
  • Participate in the research and selection process of vendors.
  • Track contract expectations, communication, budgets, performance metrics and timelines.
  • Prepare, oversee, and review documents that are related to assigned clinical projects.
  • Consult with all levels of senior management, make recommendations, and influence decision making that may involve the creation of new projects or programs to mitigate challenges being experienced.
  • Evaluate the availability of necessary resources for the execution of hospital-related and ancillary-related clinical projects.
  • Leverage cross functional relationships with vendors, hospital partners, external consultants, and IEHP Team Members to review and create programs and services.
  • Collaborate closely with Quality and Compliance for alignment with data reporting and project compliance.
  • Determine key business issues including resolution; take part in procedure/process improvement initiatives and mitigate enterprise risk.
  • Demonstrate thought leadership and cross functional collaboration within the IEHP environment.
  • Help in the training and development of staff, especially clinical staff, as needed.
  • Develop, review, analyze and interpret department and individual performance reports to ensure that the team is continually performing at optimum levels.
Qualifications:Education & Requirements
  • Requires at least five (5) years of prior relevant experience
  • Requires at least three (3) years of experience in health plan or hospital setting
  • Experience in Quality improvement and utilization management
  • Writing clinical procedures and other clinical documents is a plus
  • Bachelor’s degree in any Science or Health Related field from an accredited institution required
  • Master’s degree in any Science or Health related field from an accredited institution preferred
  • PMP Certification Preferred
  • Possession of an active, unrestricted, and unencumbered license issued by appropriate California state board required:
  • LVN
  • RN
  • LCSW/LMFT
  • Other active, unrestricted, and unencumbered related licenses (PT, OT, ST, etc.)
  • In lieu of a professional clinical license, five (5) additional years of hospital operations experience will be accepted (ten (10) years of experience in total including the minimum experience requirements listed above)
Key Qualifications
  • 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 of:
  • Health Plan or Hospital Federal, State and Accreditation Requirements
  • Care Coordination and Transition Management processes
  • Principles of performance improvement and program design
  • Risks and liabilities, as well as budget and performance metrics
  • Good problem-solving, organizational, and leadership skills are highly required
  • Proficient user of basic computer applications for the execution of daily project operations
  • Must possess excellent communication skills so as to be able to effectively convey messages across to both study team members and other external persons like vendors and external consultants
  • Ability to organize and motivate other members in the project team
  • Must be able to work as part of a team
  • Attention to detail at all times
  • Must be able to work within a dynamic environment, including managing multiple projects, and pivot or change direction as needed
Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location:This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range: USD $118,601.60 - USD $157,144.00 /Yr.

Inland Empire Health Plan