Director, Eligibility Continuity (Hybrid Work Schedule)

Date: Sep 12, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7087 


Position Summary/Position


Under the direction of the Vice President of Strategy, the Director of Eligibility Continuity will be responsible for the identification, development, implementation, and monitor of all strategic eligibility initiatives to ensure IEHP Members keep their healthcare coverage. This position leads IEHP’s current and new partnership initiatives with our two counties’ DPSS/TAD offices on eligibility maintenance and enhancement. In addition, the Director of Eligibility Continuity will lead the Eligibility Team to provide direct assistance to IEHP Members to renew their Medi-Cal coverage annually. This leadership position will also collaborate with all departments across the organization to identify and execute strategies to support eligibility maintenance, including demographics update, alignment of Medi-Cal and Medicare eligibility for the Medicare product, etc.

Major Functions (Duties and Responsibilities)


1. Be an extraordinary example and a champion in living and practicing IEHP’s Mission, Vision and Values (MVV) every day, and strongly commit to advance the organization’s strategic plan.
2. Lead and motivate direct-report Team to reach their full potential to achieve the organizational and department’s performance goals and deliver exceptional customer services.
3. Identify, develop, implement, and monitor all strategic eligibility initiatives (with ROI focus) to ensure IEHP Members keep their healthcare coverage.
4. Lead and execute all current and new initiatives with counties on Medi-Cal Eligibility maintenance and enhancement.
5. Direct the in-house Eligibility Team to provide application assistance to IEHP Members during their Annual Redetermination process.
6. Direct the in-house Outreach and Enrollment Team to provide SSI and/or Medicare application assistance to eligible IEHP Members.
7. Proactively collaborate with all departments across the organization to identify and execute strategies to support eligibility maintenance for all healthcare coverage products, including demographics update, alignment of Medi-Cal and Medicare eligibility for the Medicare product (“deeming” population), etc.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications


Seven (7) years of experience with progressive responsibilities in healthcare industry. Have a demonstrated experience in working with the Medicaid or Medicare eligibility agencies such as the County Medi-Cal offices, the federal Social Services Administration offices, or health plan partners for the purpose of eligibility maintenance or enhancement, member retention, enrollment or strategic partnership. Proven experience in building high-performance teams and developing leaders.

Education Qualifications


Bachelor’s degree from an accredited institution required.

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement


Thorough knowledge about the Medicaid eligibility criteria and general Medicaid and/or Medicare-Medicaid managed care eligibility requirements. Understanding of and sensitivity to a multi-cultural environment and community.

Skills Requirement


Strong analytical abilities to identify product strengths and weaknesses and determine areas for improvement and growth. Strong project management skills to oversee the execution of initiatives. Excellent communication skills through the use of ethical decision-making processes and good judgment. Must have a strong strategic mindset and A3 problem-solving skill. Strong leadership skills in leading and motivating a diverse Team to achieve the common goal(s). High project management and communications skills. Developing new relationship opportunities with external entities and grow existing ones to advance the membership or strategic partnership goal. Excellent writing, interpersonal, and communications skills. Outstanding communication and presentation skills, both written and verbal.

Abilities Requirement


Ability to recognize and analyze problems and to guide and develop solutions. Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Ability to leading the entire range of problem-solving work from problem definition to analysis, recommendation, and the development of implementation plans. Ability to work collaboratively with key internal and external leaders, partners, and community members. Ability to anticipate and plan for transformative moves to drive growth, innovation and new business models.

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.

Working Conditions


General office or virtual office environment; using computer keyboard and screens; travel within California and other states if needed.

Work Model Location


Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

A reasonable salary expectation is between $153,670.40  - $195,936.00, based upon experience and internal equity.


Inland 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 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core 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 retirement plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles