Morgan Consulting Resources, Inc. has been retained to conduct the search for the Sr. Director, Clinical Risk Management for Inland Empire Health Plan. The role is based in Rancho Cucamonga, CA. A hybrid schedule is available allowing for three days in the office and two days working remotely.

About the Organization:

With a mission to heal and inspire the human spirit, Inland Empire Health Plan (IEHP) is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. In its 29th year, IEHP supports nearly 1.6 million members who are enrolled in Medicaid and has a growing network of over 8,000 providers and nearly 4,000 Team Members (Employees). Through dynamic partnerships, award-winning service, and a tradition of quality care, IEHP is fully committed to its Mission, Vision, and Values.

IEHP has consistently achieved outstanding employee engagement scores from their 4,000+ Team Members and was most recently recognized and awarded the designation of ‘Great Place to Work’ for a third year in a row! For details regarding IEHP, please visit: iehp.org.

About the Position:

Reporting to the Chief Quality Officer, the Senior Director of Clinical Risk Management provides strategic leadership and oversight for the development and implementation of the health plan’s clinical risk management program and plan. This role is accountable for identifying, assessing, and mitigating risks that could impact organizational performance, regulatory compliance, and member safety. The Senior Director collaborates with executive leadership, operational teams, and regulatory agencies to ensure member safety, adherence to state and federal requirements, accreditation standards, and industry best practices.

Key areas of responsibility include:

• Organizational Leadership & Culture – Driving a culture of member safety and accountability across the organization.
• Strategy & Program Development – Designing and implementing enterprise-wide clinical risk management frameworks and protocols.
• Compliance & Regulatory Oversight – Ensuring compliance with all applicable regulations and accreditation standards.
• Risk Monitoring & Mitigation – Identifying emerging clinical risks and leading proactive intervention strategies.
• External Relations & Reporting – Building strong stakeholder relationships and providing transparent reporting to leadership and governing bodies.

Direct Reports: Quality Management Director, Grievance and Appeals Director

Total Staff Number: 140

Experience Requirements:

• A minimum of ten (10) years of progressive experience in clinical risk management within a health plan or healthcare setting.
• A minimum of three (3) years of proven leadership experience managing enterprise risk programs.

Educational Requirements:

• Bachelor's degree in nursing and/or related field from an accredited institution is required.
• In lieu of the required degree, a minimum of an associate’s degree in nursing and/or related field from an accredited institution plus two (2) years of additional relevant work experience are required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above.
• Preferred: A Master’s degree in nursing or related field from an accredited institution is preferred.

Salary range: A reasonable starting salary expectation is between $232,793.60 and $302,536.00, based upon related/relevant experience and internal equity.

Meaningful Interest Points About Rancho Cucamonga:

Rancho Cucamonga has all the amenities and qualities that make for a family-friendly city. The public schools in the city are performing slightly above the national average. In fact, the average test score here is 2% higher than the national average and the student-teacher ratio is 23:1. And in 2018, this city was part of the happiest towns to live in the United States. This is a result of its wellbeing, community and environment, and income and employment. The city continues to excel over the years. For example, in 2020, the national civic league named it one of the Ten All-America cities due to its efforts and improvements in healthcare and wellbeing.

The centralized location of the town is one of the best perks, no matter where you are heading out to! From Rancho Cucamonga, you can get to San Diego in less than two hours, Palms Springs in just slightly above an hour, and Los Angeles in only 45 minutes by car. The town isn’t only close to major cities, but you can easily access beaches and mountains from here.

If you or someone you know has the qualifications for this role, I would love to set up a time to talk. Thank you so much for your time.

Rosie Saenz, Principal
Morgan Consulting Resources, Inc.
rosie@morganconsulting.com

ADDITIONAL POSITION DESCRIPTION

Duties and Responsibilities

Organizational Leadership and Culture:

• Foster a culture of member safety by promoting reporting of events, adherence to safety standards, and implementation of best practices to enhance safety across the organization and at provider sites.
• Provide strategic leadership and direction to the risk management team including Quality Management and Grievance & Appeals by overseeing staff development, training, and performance to ensure operational excellence and psychological safety in reporting.
• Serve as Co-Chair of the Member Safety Subcommittee, along with designated Medical Director, ensuring agendas, discussions, and actions align with the charter and workplan.
• Coordinate incident management, including event reviews and serve as liaison between both internal and external stakeholders.
• Partners with Human Resources to ensure application of Just Culture principles when evaluating behaviors related to member safety events.

Risk Management Strategy & Program Development:

• Design and lead an enterprise-wide clinical risk management program, establishing protocols for member complaints, quality reviews, and corrective actions to enhance service delivery.
• Develop and implement risk management policies and procedures tailored to a health plan environment, ensuring compliance with all applicable regulatory requirements.
• Draft and publish annual Risk Management and Safety Plan, carry out plan activities, and report measures of success.
• Lead stakeholder consensus processes to assess and develop detailed action plans for serious risks related to providers or facilities.

Compliance & Regulatory Oversight:

• Ensure compliance of Potential Quality Incidents (PQI), Potentially Preventable Conditions (PPC), Facility Site Reviews (FSR), Medical Record Reviews (MRR), Grievances, and Appeals processes with DHCS, DMHC, CMS, and NCQA requirements, including workflows, communication protocols, monitoring, and reporting.
• Monitor and evaluate program effectiveness, implementing performance improvement initiatives as needed.
• Conduct regular risk assessments and audits to identify potential areas for improvement.
• Lead Skilled Nursing Facility Quality Assurance and Performance Improvement (SNF QAPI) audit programs to maintain regulatory compliance and quality standards.

Risk Monitoring & Mitigation:

• Track and analyze key risk indicators to identify emerging issues and lead proactive mitigation strategies.
• Lead the efforts to collaborate with Legal, Quality, Member Services, Provider Services, Hospital and Ancillary Relations, and Health Services teams in the development and oversight of member safety initiatives.

External Relations & Reporting

• Develop and maintain relationships with external stakeholders, including other health plans and regulatory agencies, to stay current with industry trends and requirements.
• Prepare and present risk management reports and updates to executive leadership and Board committees as needed.
• Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Professional Certification: Certified Professional in Patient Safety (CPPS) or other relevant certification preferred.

Professional Licenses: Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issues by the California Board of Registered Nursing required.

Knowledge:

• Advanced knowledge of risk management principles, practices and techniques.
• Knowledge of healthcare/health plan operations, regulations, and compliance requirements.
• Demonstrated knowledge of healthcare laws and regulations, safety science, and patient safety best practices.
• Knowledge of healthcare risk financing and health insurance principles.
• Knowledge of health plan accreditation standards, such as NCQA.
• Knowledge of healthcare quality improvement methodologies, such as Lean or Six Sigma.
• Strong knowledge of healthcare laws and regulations, such as HIPAA and HITECH.

Skills:

• Strong problem-solving skills to address complex challenges.
• Strong communication and interpersonal skills, with the ability to interact with all levels of the organization.
• Mindset of innovation to continuously improve operations and processes while mitigating risks.

Proven ability to:

• Assess and mitigate risks for the organization.
• Effectively communicate risk management concepts to non-technical stakeholders.
• Build and maintain positive relationships with internal and external stakeholders.
• Analyze data to identify trends, make recommendations and drive decision-making.
• Adapt to changing priorities, requirements, business environments and organizational needs.

Commitment to Team Culture: The 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.

Details