Senior Medical Director - Policy & Outcomes

Job description

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 Vice President of Health Services, the Senior Medical Director Policy & Outcomes (Sr. Medical Director - P&O) is responsible for strategic oversight of IEHP Medical Policies and clinical leadership around member health outcomes. The Sr. Medical Director – P&O oversees day‑to‑day operations related to developing, executing, leading, and updating guidelines, policies, clinical pathways, and communications that enable effective health outcomes and health plan performance according to DHCS, DMHC, CMS, and CCA clinical requirements. This leader serves as the accountable medical leader for quality management, grievance and appeals, delegation oversight, and population health management, and works with cross‑functional departments to monitor policy outcomes through reporting, metrics, initiatives, and improvement activities. The position also leads regulatory audits for all relevant domains.

Key Qualifications

Valid California Driver’s License (preferred)

Comprehensive knowledge of:

Managed Care principles

Administrative practices and procedures (including but not limited to credentialing, risk management, rules and 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

Principles of medical practice in a variety of settings (inpatient, outpatient, sub‑acute, etc.)

Familiarity with local healthcare organizations and/or local practice experience (preferred)

Highly organized

Effective communication skills

Proficient with Microsoft Word, Excel, and Access

Assertive communicator

Experience demonstrating effective leadership of physicians and clinical staff

Track record of leading with accountability (required)

Travel within California (required)

Education & Requirements

Seven (7) years of post‑residency experience in a recognized medical specialty or practice, including at least three (3) years of medical administrative experience

Minimum of five (5) years of managed‑care or health‑plan leadership experience with a proven track record of leading high‑performing physician teams

Experience working with clinical practice guidelines and evidence‑based criteria sets

Exposure to working with regulatory agencies

Medical Director for an IPA, medical group, or CA HMO (highly desirable)

Medical specialty/practice experience preferably in California

Doctorate of Medicine from an accredited institution (required)

Certification by one of the American Specialty Boards (required)

Completion of an accredited residency program (required)

Active, unrestricted, and unencumbered Physician’s and Surgeon’s Certificate issued by the State of California (required)

Physician certified in a state other than California may be employed prior to receipt of California certification, provided an application is filed in the state of California before the date of appointment (required)

Benefits

Competitive salary

Hybrid schedule

State‑of‑the‑art fitness center on site

Medical insurance including dental and vision

Life, short‑term, and long‑term disability options

Career advancement opportunities and professional development

Wellness programs promoting 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

Salary

$280,841.60 USD annually – $393,182.40 USD annually

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Worksite address

rancho cucamonga, CA, 91739, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.