Senior Medical Director - Policy & Outcomes

IEHP

Rancho Cucamonga (CA)

Hybrid

USD 280,841 - 393,182

Full time

14 days+

Application generator

Get a reply from this employer — a resume and cover letter tailored to exactly what they’re hiring for.

Get past ATS filters

Benefits offered by this job

Competitive salary

Hybrid schedule

State-of-the-art fitness center

Medical insurance including dental and vision

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

Career advancement opportunities

Wellness programs

Flexible Spending Account

CalPERS retirement

457(b) option with contribution match

Paid life insurance

Pet care insurance

Job summary

A healthcare organization in Rancho Cucamonga seeks a Senior Medical Director Policy & Outcomes to provide strategic oversight for medical policies and member health outcomes. The role involves leading cross-functional teams, handling regulatory audits, and ensuring quality management within the medical department. Ideal candidates have extensive experience in managed care, strong leadership skills, and a Doctorate of Medicine. This position offers a competitive salary and a hybrid work schedule with comprehensive benefits.

Qualifications

Seven years of post-residency experience in a recognized medical specialty
Minimum of five years in managed-care or health-plan leadership
Experience with clinical practice guidelines and evidence-based criteria

Responsibilities

Oversee strategic guidelines and medical policies for health outcomes
Lead regulatory audits across relevant domains
Monitor policy outcomes through reporting and metrics

Skills

Managed Care principles

Effective communication skills

Leadership of physicians and clinical staff

Organization

Microsoft Word

Microsoft Excel

Microsoft Access

Education

Doctorate of Medicine

Certification by American Specialty Boards

Completion of an accredited residency program

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)