Director, Integrated Care Management

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!

Reporting to the Senior Director, Integrated Care Management, this position oversees the Integrated Care Management teams to ensure compliance with regulatory guidelines (DHCS, NCQA, DMHC). Implement and maintain new programs such as LTSS and develop policies and procedures that will allow the Regional/Integrated teams to identify and enroll members needing case management. Work collaboratively with  other Health Services leaders to develop integrated workflows that better address the holistic needs of our members across the continuum of care. The Director of Integrated Care Management works collaboratively with other Directors within care management and other pertinent departments ensure that IEHP is meeting program requirements and achieving quality measures to comply with regulatory bodies.

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.

Perks

IEHP 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

1. Direct and oversee the Integrated Care teams. Responsible for teams’ personal development and ensuring adherence to quality standards of care.
2. Develop, implement, and maintain a comprehensive care management program incorporating risk stratification, clinical pathways, LTSS, population health management, and CalAIM as recommended by Executive Leadership, and/or the regulators.
3. Collaborate with internal Directors within Health Services and other pertinent departments within the organization (i.e., Quality System, etc.) to design, incorporate and integrate case management program for the appropriate complex members.
4. Prepare the Regional Integrated Care Team to address subpopulations as requested by regulators (i.e. DHCS/NCQA, etc.). Engage the Regional Integrated Care Team to address core requirements of Care Management as required by the regulators (ie. CMS, DHCS, NCQA, CCA, etc.).
5. Develop and maintain the Annual Department Work Plan (i.e., BHCM Dashboard) in addition to quarterly updates that meet requirements for the annual Quality Improvement Plan for all programs and ensure all indicators are met. Create a plan of action for any gaps and deficiencies identified.
6. Support and participate in operationalizing strategic goals of the organization.
7. Embrace LEAN to promote efficiencies and implement continuous quality improvement for the department.
8. Collaborate with external partners (County Public Health, County Behavioral health, and other external partners) to integrate care management model of care and demonstrate continuum of care.
9. Collaborate with the Quality Oversight department to oversee and delegate across the various care management programs to ensure compliance with DHCS, DMHC, CMS, NCQA, and other regulatory bodies, and improve quality measures impacting the organization.
10. Oversee interdisciplinary care case conferences and other committees as assigned.
11. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Education & Requirements 

• A minimum of seven (7) years of relevant experience in a health care setting which includes a minimum of five (5) years of experience in a managed care setting with five (5) years in leadership
• Master’s degree Nursing, Social Work, or in a Healthcare related field from an accredited institution
• Possession of one of the following active, unrestricted, and unencumbered licenses required:
  • Registered Nurse (RN) license issued by the California BRN
  • Marriage and Family Therapist (LMFT) license or Clinical Social Worker (LCSW) license issued by the California Board of Behavioral Sciences

Key Qualifications

• Must have a valid California Driver's License
• Comprehensive knowledge of:
  • Health plan regulations (DHCS, CMS, DMHC and NCQA & LTSS)
  • The resources available in the Inland Empire to support Members (community resources, Behavioral Health programs, waiver, and grant programs)
  • The Behavioral Health & Care Management Programs
  • The importance of CAHPS and HEDIS Metrics and how Behavioral Health & Care Management are an integral department to improve those areas
  • Lean principles to problem solve and evaluate program effectiveness

Start your journey towards a thriving future with IEHP and apply TODAY!

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA)