10 Inland Empire Health Plan jobs in Rancho Cucamonga

• Provides executive medical leadership across the Health Services Departments. This includes direct oversight and management of the Utilization Management Medical Directors as well as provision of clinical leadership and strategic direction across Health Services in partnership with various senior and executive leaders across the organization.
• Works closely with the Health Services leadership team on Utilization Management activities and complex clinical cases.
• Has a lead role in regulatory audits (DHCS, DMHC, CMS, NCQA).
• Participates in the development of potential new business lines, rising risk and high-risk member programs, integrated care models, Population Health strategies including involvement in assigned state initiatives (CalAIM), hospital relations, oversight of provider and IPA utilization and performance, strategic plan implementation, and coordination with the Quality and Grievance & Appeals Departments.
• Serves as a mentor to Medical Directors and clinical staff to foster professional growth and development.

• 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

• Required: Ten (10) years of post-residency clinical experience in a recognized medical specialty. Proven leadership experience, mentoring, and developing a team at a leadership level.
• Of the ten (10) years of experience required,
  • at least five (5) years of medical management experience in a lead role.
• The successful candidate will possess a proven track record of working with large provider groups to improve regulatory related clinical quality opportunities.
• Experience with NCQA, DMHC, and DHCS audits and regulatory agencies.
• Experience with regulatory agencies
• Experience working in a medical group, IPA, Plan, or hospital setting in a leadership role preferred
• Doctorate of Medicine or Doctorate of Osteopathic Medicine from an accredited institution required
• Certification by one (1) of the American Specialty Boards
• Possession 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 at IEHP

• 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
• Possesses strong knowledge of:
  • Medi-Cal Health Plan Regulations
  • Utilization management, evidence-based care models, population health, clinical quality, and Managed Care principles
  • CMS and Medi-Cal program
  • Administrative practices and procedures (including but not limited to utilization review, peer review, credentialing and risk management; rules regulations, policies, and standards related to managed care
  • Principles of effective supervision and organization; methods, techniques, practices, and literature in the broad field of medical sciences; and overview of the highly specialized techniques, procedures, and equipment used in the medical or surgical specialties
• Excellent oral and communication skills, including active listening
• Excellent collaboration skills for work with network providers and internal employees
• Proficient in Microsoft Office Suite, includes Microcomputer applications such as Microsoft Word, Excel, and Access helpful
• The VP will possess very strong communication and leadership skills, with an analytical mindset, the gravitas to communicate internally and externally, and a commitment to advancing quality to improve patient care
• Highly effective and active communicator who works well with people at all levels.
• High-energy, persistent, assertive, data driven, accountable, and focused.
• Demonstrated ability to:
  • Implement and lead new and improved clinical approaches to improvement of care and service quality
  • Design, lead, and implement overall regional population health and integration strategies
  • Lead multidisciplinary teams, even when Team Members are not in direct line of authority
  • Engage and develop relationships with network providers, with a high degree of patience
  • Be highly collaborative, cross-functional, and systematic
  • Work with high degree of diplomacy, credibility, and persuasiveness to consistently cultivate effective working relationship
  • Effectively express ideas and gain their acceptance
  • Be proactive and action oriented
  • Drive performance and be persistent in accomplishing difficult tasks
  • Actively seek out and support collaborative thinking and problem solving with others in the organization
  • Operate with an open leadership style.
  • An ability to influence and persuade without formal authority is critical.
• While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell
• The employee must occasionally lift or move up to 25 pounds
• Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus

REQUIRED : Three years of supervisory or administrative experience in a psychiatric or behavioral health setting which included responsibility for program management and evaluation and budget preparation and fiscal control.
License: Possession of a valid license to practice as a Licensed Clinical Social Worker, Licensed Professional Clinical Counselor, or Licensed Marriage and Family Therapist issued by the California State Board of Behavioral Science Examiners.

Quality Improvement - Outpatient, Riverside, CA.
Riverside University Health System - Behavioral Health's (RUHS-BH) Quality Improvement (QI) unit plays a vital role in ensuring the integrity, effectiveness, and efficiency of behavioral health services provided both directly by the department and through contracted community-based organizations. The QI unit supports the department's mission by conducting system-wide performance monitoring, utilization reviews, and providing actionable feedback to enhance service delivery and operational outcomes. The Quality Improvement Administrator leads and manages the daily operations of the QI unit, ensuring compliance with all applicable state and federal regulations. This role is responsible for planning both clinical and administrative reviews of county-operated and contracted provider services, coordinating state audits and reviews with the Department of Health Care Services (DHCS), and facilitating ongoing staff training on clinical best practices. The position will work a 9/80 schedule and requires occasional travel; therefore, a valid California driver's license is required.

The certification list generated from this recruitment may be used to fill other future Behavioral Health Service Supervisor vacancies within Behavioral Health that may occur in the coming weeks.

Under general direction, to plan, organize, and coordinate the delivery of services for a large, regional mental health program for adults and/or children or a comprehensive, multiple-component, mental health program for adults or children for a large regional program or with Department-wide responsibilities; to coordinate with potential contract community organizations, and public and private providers of health, mental health, and social services and other concerned parties; to represent the department on Regional Mental Health Committees and other various committees and advisory boards; and to do other work as required.

The Mental Health Services Administrator plans, organizes and manages 100 or more employees through six or more subordinate supervisors and performs 1) the full scope of administrative and operational responsibilities for a large, regional, mental health program responsible a) for adults and children within an assigned geographic area or b) for a comprehensive multiple component, mental health program for adults or children; or 2) develops, implements, administers, and maintains the standards for treatment and services of the largest, most comprehensive, mental health programs with Department-wide responsibilities. Incumbents receive program and policy direction from the Deputy Director, Mental Health Services or higher level class while clinical direction is received from the Program Chief, Mental Health Services. The Mental Health Services Manager is distinguished from the Mental Health Services Administrator in that the latter plans, organizes and manages mental health services for a specialized population or a program unit through five or less subordinate supervisors and a team of less than 100 employees. This class is distinguished from the next higher level class of Deputy Director, Mental Health Services in that the latter provides administrative and program direction to subordinate managers and assists senior management in department-wide program planning and policy formulation.

Meet the Team : Plans, organizes, and manages the delivery of services for a large, regional or county-wide mental health program for adults and children or a comprehensive, multiple-component, Mental Health Program with county-wide responsibilities.

• Provides program guidance to multi-disciplined, mental health staff; plans, organizes, assigns, directs and evaluates the work of subordinate supervisory staff; reviews and evaluates staffing patterns, coordinates interviewing, personnel selection and development, and implements disciplinary action, when required.

• Assesses the needs of the communities served to determine program and service priorities; coordinates with the Deputy Director of Mental Health Services and the regional Board of Supervisor's staff to address Mental Health issues identified by County Supervisors; evaluates the effectiveness of existing programs, and within agency guidelines recommends and/or implements new or modified programs; reviews policies, procedures and methods used for effectiveness and consistency with service goals.

• Continually evaluates and assesses operations relative to effective utilization of resources and achievement of goals and implements changes as necessary; may review and evaluate treatment standards, and therapeutic techniques of clinic staff to ensure patients are receiving correct and adequate diagnosis and treatment.

• Keeps abreast of all local, State, Federal, and other regulatory agency laws, rules, regulations, and policies and procedures applicable to assigned programs to ensure compliance; may review and recommend revisions to existing or develop new program policies, procedures, and methods used for effectiveness and consistency with service goals.

• Meets with the Deputy Director, Mental Health Services or higher, to identify staffing, equipment, material and supply needs; prepares budget estimates and justifications for assigned programs and maintains cost controls to assure compliance with budget provisions.

• May develop, administer, and monitor contractual agreements with private and public mental health service providers; may monitor program to ensure compliance with contact provisions; may recommend procedural and operational changes to maximize service delivery; may recommend remedial action to correct any noted deficiencies to ensure continuation of contracts.

• Acts as liaison and represents Riverside County Mental Health in relationships with service providers, county departments, state or other funding sources and community and business organizations; participates in a variety of internal and external meetings, committees and coalitions; interacts with various planning councils and boards; answers questions and provides training and technical assistance as required; participates in management meetings to assist in the development of department-wide policies.

• Directs and ensures the maintenance of records, preparation of reports, and the clerical and housekeeping functions necessary for program operations; prepares correspondence and reports as required.OPTION I

Education: Possession of a Doctorate degree in clinical psychology from an accredited college or university.

OR OPTION II

Education: Graduation from an accredited college or university with a Master's degree in social work, nursing, psychology, mental health or health care administration, public or business administration or a closely related field. (A Bachelor's degree from an accredited college or university in a related field and additional qualifying experience may substitute for the required Master's degree on the basis of 30 semester or 45 quarter units equaling one year of full time experience.)

AND

Experience (both options): Three years of supervisory or administrative experience in a psychiatric or mental health setting which included responsibility for program management and evaluation and budget preparation and fiscal control.

Knowledge of: The principles of public administration and personnel management as they apply to the operation of community mental health programs; the principles and techniques of budgetary analysis, preparation and control; the range of treatment services provided by comprehensive community mental health programs; the clinical principles of mental health treatment; public and private resources available to provide mental health services; the principles of community organization; the characteristics and social aspects of mental and emotional disturbances and their effect on the individual in the community; the principles, procedures, and techniques used in mental health program planning and evaluation; current trends in the field of mental health and the laws, rules, regulations and policies which affect the operation of a community mental health program; the administrative organization of and the services and operations normally provided by County government; contract development, negotiations, and administration including evaluation methods to ensure contract compliance.

Ability to: Manage a comprehensive mental health program; develop effective channels of communication to foster the confidence and cooperation of a variety of community groups; organize County and community resources and contract providers to service and community and achieve program goals; determine the need and priority of mental health services in the community; communicate effectively both orally and in writing; analyze service delivery and administrative problems, generate and evaluate alternatives, reach practical conclusions, formulate recommendations and institute effective solutions; establish and maintain effective working relationships with public and private agencies, community organizations, public officials, other staff members and individuals; prepare clear and concise reports; understand and interpret the laws, rules, and regulations applicable to community mental health programs and the detailed provisions of contractual agreement.Qualified applicants may be considered for future vacancies throughout the County.

Questions: For further information regarding this posting, contact the recruiter:
Jeremy Holforty at: or .

Youth and Family Community Services

Riverside, CA

Must have a valid license to practice as a Licensed Clinical Social Worker or Licensed Marriage and Family Therapist issued by the California State Board of Behavioral Science.

Youth & Family Community Service

The County of Riverside's Behavioral Health Department - Youth & Family Community Services has an opening for a Behavioral Health Services Supervisor in Riverside. This position will support youth social workers and community agencies in providing services to youth in the dependent system. The goal is to reduce inpatient psychiatric hospitalization and the need for higher levels of care, foster stable placement, and ensure youth receive specialty mental health services. This position will provide administrative and clinical supervision, conduct staff meetings, assign assessments and referrals, monitor productivity, ensure documentation meets standards. This position will work a 9/80 schedule and does require some driving therefore a California Drivers License is required.

We are looking for candidates who

• Are Licensed professionals (LCSW or LMFT)
• Have a minimum of two years post-licensure experience
• Have strong computer and organizational skills
• Have supervisory/lead experience

The certification list generated from this recruitment may be used to fill other future Behavioral Health Service Supervisor vacancies within Behavioral Health that may occur in the coming weeks.

Meet the Team!
RUHS-Behavioral HealthPlan, assign, direct, supervise, and coordinate the work of a multidisciplinary staff providing behavioral health treatment services, social and rehabilitation services, and consultation and education services to consumers, public and private agencies, and the community.

Evaluate overall unit activities, including methods and procedures for effectiveness and consistency with program goals and objectives,; recommending and implementing changes in program, policies, and procedures as necessary.

Evaluate performance of personnel and take or recommend appropriate course of action; interview, select, and recommend the hiring of new staff members.

Provide guidance to subordinates on departmental philosophy, goals and objectives, and policies and procedures through casework conferences, staff meetings, and work review; assist and participate in the development and coordination of in-service training and staff development programs.

Make or review decisions on difficult consumer assessment and casework matters.

Work with other public, private, and community organizations providing health and human services to mentally and emotionally disabled individuals to gain and ensure cooperation in order to achieve program goals; participate in behavioral health conferences and local area committees; may participate in regional or countywide community needs assessment and program planning development and evaluation activities.

Assist in preparing annual budget requirements and monitor expenditures to ensure unit is within funding provisions; prepare reports and correspondence regarding workload statistics, casework and unit methods, and procedures. Experience: Two years of post-license professional experience in a psychiatric or behavioral health setting providing direct client services which must have included: client assessment and evaluation, development and implementation of appropriate treatment plans, providing psychotherapy or behavioral health counseling, and providing indirect services involving information, consultation, and educational services to staff and community.

License: Possession of a valid license to practice as a Licensed Clinical Social Worker, Licensed Professional Clinical Counselor, or Licensed Marriage and Family Therapist issued by the California State Board of Behavioral Science Examiners.

Candidates recruited from out-of-state must possess an out-of-state license to practice in one of the above stated options. Individuals hired under this option shall obtain their license to practice issued by the California Board of Behavioral Sciences within three years of date of hire. During the interim three years, the incumbent shall be eligible for a Mental Health Professional Licensing Waiver Request approved by the State of California Health and Human Services Agency.

Candidates qualifying with the Licensed Professional Clinical Counselor option must have completed additional education and training as defined below:

1) Six semester units or nine quarter units specifically focused on the theory and application of marriage and family therapy, OR a named specialization or emphasis area on the qualifying degree in marriage and family therapy, marital and family therapy, marriage, family, and child counseling, or couple and family therapy;

2) No less than 500 hours of documented supervised experience working directly with couples, families, or children; and

3) A minimum of six hours of continuing education specific to marriage and family therapy, completed in each license renewal cycle.
Knowledge of: The characteristics and social aspects of behavioral and emotional disorders and their effect on the individual in the community; the principles and techniques of diagnosis, treatment and rehabilitation of individuals with behavioral or emotional disorders; the range of treatment services provided by comprehensive community behavioral health programs; the kinds of behavioral health resources normally found in the community; the principles of community organization; principles and techniques of effective supervision and training; laws, rules and regulations governing publicly funded behavioral health services in California.

Ability to: Plan, organize and direct the work of subordinate staff; organize and interpret data pertinent to community program planning and caseload management; evaluate program effectiveness; analyze problems, generate and evaluate alternatives, teach practical conclusions, and recommend and adopt effective courses of action; provide effective leadership and consultation to staff in casework treatment methods and in professional development; understand and interpret procedures, regulations and legal implications of casework or treatment services; communicate the goals and objectives of the County's behavioral health services program to staff, members of the community and other interested individuals; establish and maintain effective working relationships with staff, community groups and other public and private agencies.License: Possession of a valid California Driver's License is required.

For questions regarding this recruitment contact the recruiter, Jeremy Holforty:
/ .

Join the Physician Partnership Where You Can Increase Your Impact

Vituity's ownership model provides autonomy, local control, and a national system of support, so you can focus your attention where you want it to be - on your patients.

Join the Vituity Team. Vituity is a 100% physician-owned partnership and is led by frontline physicians that are all equitable owners. As an equal and valued partner from day one, our ownership model provides you with financial transparency, a comprehensive benefits package including profit distribution, and multiple career development opportunities. Our leadership understands what your practice needs to thrive and gives you autonomy and local control so you can provide care when, where, and how your patients need it. You are backed by a best-in-class corporate healthcare team and supported by the broad peer-level expertise of 6,000 Vituity clinicians. At Vituity we've cultivated an environment where passion thrives, and success comes through shared purpose. We were founded in a culture that values team accomplishments more than individual achievements, an approach we call "culture of brilliance." Together, we leverage our strengths and experiences to make a positive impact in our local communities. We foster this through shared goals and helping our colleagues succeed, and we also understand the importance of recognition, taking the time to show appreciation and gratitude for a job well done.

Vituity Locations: Vituity has opportunities at 475 sites across the country, serving 9 million patients a year. With Vituity, if you ever need to move, you can take your job with you.

The Opportunity

• Seeking Board Eligible/Certified Psychiatric Behavioral Health physicians.
• Current CA state license is a plus.

The Practice

Mesa Counseling Services - Rialto, California

• Vituity's physician partnership culture inspires clinician retention and engagement, and supports autonomy to make local decisions.
• Equal distribution among all practicing physicians.
• No outside investors, external stakeholders, or long-term debt.

The Community

• Rialto, California, located in San Bernardino County, is a thriving city known for its central location and community spirit.
• Its rich history includes the iconic Wigwam Motel on Route 66, a nod to the city's historic roots.
• Rialto's proximity to the San Gabriel and San Bernardino Mountains offers residents outdoor adventures, from hiking and camping to skiing at nearby resorts.
• Within a short drive, attractions like the Auto Club Speedway and Ontario Mills Mall provide excitement and entertainment.
• Rialto enjoys a warm Mediterranean climate, with hot summers and mild winters.
• The city is a commuter's dream, with convenient access to major freeways and Metrolink stations, connecting residents to Los Angeles and beyond.
• With a growing economy, friendly neighborhoods, and a mix of urban and suburban amenities, Rialto offers a well-rounded, dynamic lifestyle making it a great place to call home.

Benefits & Beyond*

Vituity cares about the whole you. With our comprehensive compensation and benefits package, we are mindful of what matters most, and support your needs of today and your plans for the future.

• Superior Health Plan Options
• Dental, Vision, HSA, life and AD&D coverage, and more
• Partnership models allows a K-1 status pay structure, allowing high tax deductions
• Extraordinary 401K Plan with high tax reduction and faster balance growth
• Eligible to receive an Annual Profit Distribution/yearly cash bonus
• EAP, travel assistance, and identify theft included
• Student loan refinancing discounts
• Purpose-driven culture focused on improving the lives of our patients, communities, and employees

We are unified around the common purpose of transforming healthcare to improve lives and we believe everyone has a role to play in that. When we work together across sites and specialties as an integrated healthcare team, we exceed the expectations of our patients and the hospitals and clinics we work in. If you are looking to make a difference, from clinical to corporate, Vituity is the place to do it. Come grow with us.

Vituity does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Vituity is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity.

*Visa status applicants benefits vary. Please speak to a recruiter for more details.

Applicants only. No agencies please.

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

This position requires relocating to Ontario, California.

The Vice President of Health Plan Operations and Claims  is responsible for the development and execution of Claim Operations strategies, end-to-end Claim process automation, optimization and management, identifying and leveraging technology and data to improve the quality and minimize process cost of Claims for all Prime Healthcare’s self-insured Employee Health Plans. Through in-depth audit and review of Claims data, the VP will identify financial savings across all aspects of the Employee Health Plans.

The VP of Health Plan Operations and Claims will provide strategic leadership and development of the Claims Department and its employees, as well as collaborate with Network Development, Provider Affiliation and Member Relations, Contracting, and Benefits Administration to ensure data integrity and to drive financial and operational value across Employee Health Plans to maximize benefit coverage while containing cost.

The VP of Health Plan Operations and Claims will partner with local C-Suites and Hospital Administration to execute goals and plans of the Employee Health Plans. Through inter-professional collaboration, The VP will ensure that TPA and Health Plan are notified in a timely fashion of any changes in process or procedures which would impact their functions.

We're looking for someone with operations experience with self-funded health plans including designing operational improvements , performance management techniques and metrics. Someone with significant claims experience including PDR's, Disputes, Appeals and Recoveries. Sound intriguing, then you will be thrilled to know we offer very competitive compensation and amazing benefits. 

As you would expect, this role has many facets including Health Plan Operations, Health Performance Metrics, Cost Reduction, Market Forces, Quality and Delivery of Care, Regulatory Reforms, Strategy and Operating Models, Long Term Business Objectives, Healthcare Payers, Claim Operations Strategies, Claim Process Automation, Self-Funded Plans, and Employee Health Plans.

Required qualifications :

Preferred qualifications:

#LI-CC2

At Prime #Healthcare, our employees #wellness is important. We're looking for our next #healthcareleaders or #healthcareprofessionals to guide our #healthplan. This position should be a part of your #jobsearch, we're #hiring and this is a rewarding #jobs.  

Prime Healthcare Management, Inc. offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $150,000.00 to $250,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire and will be dependent on a wide range of factors, including but not limited to geographic location, skill set, experience, education, credentials, and licensure. Additionally, employees in this position may be eligible to participate in the Company’s annual discretionary bonus program. Discretionary bonuses, if any, are based on a number of factors, which include but are not limited to individual and Company performance.

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: 

Privacy Notice for California Applicants: