Vice President, Care Coordination & Care Management

About the role

Reporting to the Chief Medical Officer, the Vice President, Care Coordination & Care Management provides enterprise-level leadership, operational direction, and advancement strategies for core operational care coordination and care management functions. This role is accountable for ensuring IEHP members across all risk levels receive integrated, effective, efficient, and compliant care services that measurably improve health outcomes.

The Vice President is responsible for operating across the continuum of care coordination and management, and is accountable for optimizing performance, regulatory compliance (including DSNP requirements), and member experience across all lines of business. This role’s scope includes, but is not limited to, the oversight of key functional areas such as care management, behavioral health, case management, transitions of care and discharge planning, Long-Term Services, and strong coordination with Enhanced Care Management requirements. This role also requires coordination with key county partners as identified.

The Vice President will advance care management and coordination functions through modern, scalable techniques, including the thoughtful adoption and integration of AI tools and innovative care management technologies where applicable. This role will also drive system-wide strategic initiatives in collaboration with key business partners such as Hospital Relations, Network Management, Quality, Medical Management, Population Health & Care Initiatives, and Pharmacy.

The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Responsibilities

• Provide enterprise-level leadership and operational direction for care coordination and care management functions.
• Ensure integrated, effective, efficient, and compliant care services for IEHP members to improve health outcomes.
• Oversee key functional areas including care management, behavioral health, case management, transitions of care, discharge planning, and Long-Term Services.
• Coordinate with Enhanced Care Management requirements and key county partners.
• Advance care management functions through modern techniques, including AI tools and innovative technologies.
• Drive system-wide strategic initiatives in collaboration with business partners such as Hospital Relations, Network Management, Quality, Medical Management, Population Health & Care Initiatives, and Pharmacy.
• Ensure regulatory compliance, including DSNP requirements, and optimize member experience across all lines of business.

Requirements

• Minimum of twelve (12) years progressively responsible experience in a managed care setting that serves the Medicaid population and/or similar populations.
• Eight (8) or more years of progressive healthcare leadership, mentoring, and developing a team at a leadership level.
• Strong experience in multidisciplinary team collaboration in a Medi-Cal managed care environment, as well as proficiency in care management, behavioral health, birthing pathways, complex children, and all associated workflows.
• Bachelor's degree in a related field from an accredited institution required.
• Master's or Doctorate degree in a related field from an accredited institution strongly preferred.
• Certification by one of the American Specialty Boards preferred if in possession of an MD license.
• Possession of an active, unrestricted, and unencumbered license issued by the appropriate state board in one of the following areas strongly preferred:
  • Registered Nurse (RN) license issued by the California BRN
  • Social Services related field issued by the California Board of Behavioral Sciences (e.g., LCSW, LMFT)
  • Physician Assistant license issued by the Physician Assistant Board of California
  • Physician and Surgeon license or Osteopathic Physician and Surgeon license issued by either the Medical Board of California or Osteopathic Medical Board of California
• Must have a valid California Driver’s license.

Qualifications

• Comprehensive knowledge and in-depth understanding of:
  • Care Coordination and Care Management requirements, including its application to PHM, LTSS, HEDIS, CAHPs, CMS, DMHC, and NCQA regulations in both inpatient and outpatient settings.
  • Experience with implementing new innovative tools, such as AI, in relevant care settings.
  • Clinical workflows and interdisciplinary team models.
  • End-to-end understanding of member journeys, clinical pathways, and escalation mechanisms.
  • Organizational design, workforce planning, leadership development, and building high-performing teams.
  • Program requirements, reporting standards, audit expectations, and compliance risks for care coordination and care management.
• Excellent oral and written communication skills.
• Excellent interpersonal skills, diplomacy, coaching, and change management skills.
• Good Microsoft applications skills (Word, Excel, and PowerPoint).
• Demonstrated problem-solving and decision-making skills with the ability to exercise initiative.
• Demonstrated ability to lead teams and achieve successful outcomes while fostering a climate of engagement and employee satisfaction.
• Ability to use analytics to guide strategy, forecast needs, and evaluate program effectiveness.
• Proven ability to:
  • Lead and build high-performing teams.
  • Be highly effective and an active communicator who works well with people at all levels.
  • Generate executive and granular level content independently and in teams.
  • Demonstrate a strong work ethic.
  • Show commitment to working on advancing team culture.
  • Handle multiple priorities.
  • Be highly organized.
  • Be highly collaborative, cross-functional, and systematic.
  • Work with a high degree of diplomacy, credibility, and influence to cultivate effective working relationships.
  • Effectively express ideas and gain traction.
  • Be proactive, responsive, and action-oriented.
  • Drive performance, close loops, and accomplish difficult tasks.

Benefits

• Competitive salary.
• 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.

Pay

Pay Range: $246,355.20 USD Annually - $344,905.60 USD Annually