Senior Director, Product Configuration & Implementation
Company: Inland Empire Health Plans
Location: Rancho Cucamonga
Posted on: January 26, 2023
Press Tab to Move to Skip to Content Link Under the direction of
the Chief Financial Officer and in collaboration with the Director
of Strategic Decision Support, the Senior Director of Product
Configuration & Implementation is ultimately responsible for the
structure, staffing, best practices and standardization of the
Product Configuration and Implementation Department. -
- Collaborating with Director of Strategic Decision Support to
implement new governance process.
- Developing formal communication channels with impacted business
units, enable escalations, and expedite decision making.
- Establishing ownership and driving accountability to ensure IEHP
is proactively responding to new benefits and code set changes from
regulatory bodies (for all product lines). -
- Leading cross-functional implementation of new benefit and
clinical procedure code changes by gathering the right stakeholders
and thought leaders within the organization to make decisions in
planning, prioritizing, and navigating ambiguous regulatory
directives. -Major Functions (Duties and Responsibilities)1. Serve
as the primary resource to assess and operationalize new benefit
changes and additions for Medi-Cal, Medicare, and commercial
products (Covered CA) and its underlying code sets impacting claims
2. Dive and organization the structure, staffing, best practices
and standardization of the Product Configuration and Implementation
3. Work in collaboration with multiple business units including,
but not limited to: Provider Contracting, UM/Pre-authorizations,
Claims/Encounters, Benefits Configuration, Actuarial, Provider
Communication, Legal/Compliance, IT, Quality to implement
changes/additions to benefits.
4. Define metrics, drives problem solving and root-cause analysis
to systematically improve and sustain operations.
5. Analyze plan designs, coverage certificates, and regulatory
requirements and provide rigorous interpretation and translation
into coverage documentation and benefit configuration requirements
6. Lead the prioritization and manages the implementation of new
benefits as outlined by DHCS, CMS and Covered CA and holds the
"source of truth" for benefit coverage within IEHP.
7. Provide technical guidance, consultation, and recommendations
for improvement of the organization's policies, procedures, and
practices for all product lines in relation to benefit coverages
and code sets. Ensures appropriate and timely implementation of
8. Interface with regulatory agencies and governmental
9. Meet and communicate regularly with organization-wide
operations, non-operations, and clinical leaders to resolve
10. Cultivate and maintain positive working relationships at all
levels of the organization to ensure positive collaboration to
identify, assess, and prioritize impacts of the benefit changes or
additions throughout the organization.
11. Develop plan for scaling the department when new lines of
business, for example, Covered CA are introduced.
12. Stay current on regulations, industry trends, current
practices, new developments, applicable laws, and legislation.
-Major Functions (Duties and Responsibilities) ContSupervisory
Responsibilities Leader: Administers Hires, Terminations, and
Performance Reviews Experience QualificationsA minimum of ten (10)
years of experience in a leadership position within the health plan
administration function, which includes:
- A minimum of five (5) years of experience in a managed care
- Claims, coding, and configuration experience in a managed care
- Demonstrated experience with Covered CA/Medicare product
requiredPreferred ExperienceDemonstrated experience with Medi-Cal
product preferred.Education QualificationsBachelor's degree in a
related field from an accredited institution required.Preferred
EducationMaster's degree in a related field from an accredited
institution preferred. -Professional CertificationAmerican Academy
of Professional Coders (AAPC) and American Health Information
Management Association (AHIMA) certifications
preferred.Professional LicensesDrivers License Required Yes, 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 RequirementDemonstrated knowledge
- Managed care, commercial, government programs, or other product
- Healthcare, health plans and/or health plan accreditation
principles and practices, in directing operations within the
- Regulatory and compliance requirements related to commercial
products, including but not limited to, the California Knox-Keene
Healthcare Service Plan Act and Regulations. Health plan operations
in a commercial plan environment. Skills RequirementExcellent
- Interpersonal communication with a proven ability to interact
effectively at all levels of the organization.
- Verbal and written communication.
- Organization, process, and project management.
- Strong organizational skills and attention to detail.
- Analysis and synthesis.
- Communicating data requirements with actuaries and configuration
team and communicate technical requirements (from a business
perspective) with System vendors (or IT Department).Abilities
- Implement change in a consultative approach and maneuver in a
matrix reporting environment.
- Work independently and collaboratively within a team environment
and matrix management structure to deliver results.
- Manage multiple products within a health plan and multiple
projects with competing deadlines and changing priorities with
proven execution against aggressive objectives.
- Partner with external partners to execute goals and initiatives
of the organization.
- Work in a complex, rapidly evolving environment which requires
high-level initiative, and judgment necessary to bring resolution
to sensitive issues.
- Communicate effectively to a variety of audiences in small or
large group setting.Commitment to Team CultureThe IEHP Team
environment requires a Team Member to participate in the IEHP Team
Culture. A Team Member demonstrates support of the Culture by
developing professional and effective working relationships that
include elements of respect and cooperation with Team Members,
Members and associates outside of our organization.Working
ConditionsNormal business hours - Hybrid Position Hybrid Physical
Requirements Hearing: One-on-One - FREQUENTLY Near Visual Acuity -
FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY
Regular and reliable attendance - CONSTANTLY Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY Keyboarding: 10-Key -
FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding:
Traditional - FREQUENTLY Pay rate will commensurate with
experienceInland Empire Health Plan (IEHP) is the largest
not-for-profit Medi-Cal and Medicare health plan in the Inland
Empire. We are also one of the largest employers in the region.
With a provider network of more than 7,000 and a team of more than
2,500 employees, IEHP provides quality, accessible healthcare
services to more than 1.5 million members. And our Mission, Vision,
and Values help guide us in the development of innovative programs
and the creation of an award winning workplace. As the healthcare
landscape is transformed, we're ready to make a difference today
and in the years to come. Join our Team and make a difference with
us! IEHP offers a competitive salary and a benefit package with a
value estimated at 35% of the annual salary, including medical,
dental, vision, team bonus, and state pension plan.
Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles
Keywords: Inland Empire Health Plans, Rancho Cucamonga , Senior Director, Product Configuration & Implementation, Executive , Rancho Cucamonga, California
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