Senior Director, Commercial Products (Hybrid Work Schedule)

Date: May 13, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7294 

 

Position Summary/Position

 

Under the direction of the Vice President of Operations, the Senior Director of Commercial Products is responsible for the quality, compliance, and operational performance of IEHP’s commercial products, including but not limited to the California Health Benefit Exchange. Responsible for ensuring products and services brought to the market are competitive and sustainable. As a visionary leader and internal consultant for IEHP Executives and Departments, the position drives IEHP’s growth strategy and ensures the commercial product initiatives are aligned with IEHP’s Mission, Core Values and Strategic Priorities and delivers best-in-class performance.  

Major Functions (Duties and Responsibilities)

 

1. Serves as the primary resource for the Executive Leadership Team to ensure the organization maximizes the commercial product benefit coverage while containing cost. Ensures risk adjustment transfers are minimized for the respective commercial products.
2. In collaboration with the Vice President of Strategy, determines the overall organizational goals of the commercial products visions, strategies, and roadmaps.
3. Defines metrics, drives problem solving and root-cause analysis to systematically improve and sustain operations.  Drives for continuous process and product performance improvements to meet changing market, consumer, and provider demands. Ensures rigor and discipline of product lifecycle is applied to the annual re-certification process and development of benefit design.
4. Provides exemplary healthcare industry expertise, successfully integrates new growth opportunities into the organization and its operations, identifies key areas of risks in commercial product initiatives, builds mitigation plans, and drives results in the marketplace. When required, drives end-to-end product life cycle for new products, program, and services offerings across lines of business.
5. Stays current on regulations, industry trends, current practices, new developments, applicable laws, and legislation.  Provides technical guidance, consultation, and recommendations for improvement of the organization’s policies, procedures, and practices for commercial products. Ensures appropriate and timely implementation of requirements.
6. Interfaces and serves as the organization’s liaison with regulatory agencies and governmental agencies for the organization’s commercial products.
7. Provides regular feedback of the status of the commercial product initiatives and impacts to Executives, Leadership and Team Members.  Responsible for facilitating quarterly meetings with Executives and Leadership to ensure adequate understanding of accomplishments, risks, and barriers of current and newly identified initiatives.  Utilizes the quarterly meeting to ensure the scope of IEHP’s commercial products are tailored to meet the needs of the organization.
8. Meets and communicates regularly with organization-wide operations, non-operations, and clinical leaders to resolve issues and manage negative trends with particular emphasis on Marketing, Sales, Enrollment, Member Services, Care Management, Provider Services, and Claims.
9. Provides direct leadership, oversight, and accountability for the operational effectiveness of the commercial products through the development of an annual workplan that aligns with the organizational priorities which includes key infrastructure projects, training & development plans, and actions focused on continuous improvement of the team’s culture and engagement.
10. Cultivates and maintains positive working relationships at all levels of the organization to ensure positive collaboration to identify, assess, and prioritize upstream and downstream impacts of the commercial product initiatives throughout the organization.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

A minimum of ten (10) years of experience in a leadership position within the health plan administration function, includes:
- A minimum of five (5) years of experience in a progressive leadership role in commercial markets/business development in a managed care setting.
Demonstrated experience with:
- ACA and marketplace health plan operations;
- Covered CA or similar health benefit exchange, both implementation and sustainment;
- In taking a commercial product from design concept to operations;
- Contracting, implementing, and managing Third Party Administrator, including developing and managing service level agreement; and
- Working with Brokers to achieve Membership, margin, and market-share targets.

Education Qualifications

 

Bachelor’s degree from an accredited institution required.

Preferred Education

 

Master’s degree from an accredited institution preferred.

Drivers License Required

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

Knowledge Requirement

 

Knowledge of:
- Managed care, government programs, or other product lines.    
- Healthcare, health plans and/or health plan accreditation principles and practices, in directing operations within the organization. 
- Regulatory and compliance requirements related to commercial products, including but not limited to the California Knox-Keene Healthcare Service Plan Act and Regulations. 
- Demonstrated knowledge of health plan operations in a commercial plan environment.   
Deep understanding of competitive landscape to develop market strategies.

Skills Requirement

 

- Excellent interpersonal skills with a proven ability to interact effectively at all levels of the organization.
- Excellent communication skills; verbal and written.
- Excellent organization, process, and project management skills.
- Strong organizational skills and attention to detail.
- Excellent analytical skills with emphasis on utilization data to drive operational performance and financial performance.

Abilities Requirement

 

Ability to:
- 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 commercial 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 settings; and
- Quantify impact and ROI of initiatives, preferred.

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.

Work Model Location

Hybrid

Physical Requirements

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

 

Starting Salary: $219,086.40  - $290,284.80  

Pay rate will commensurate with experience

 

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 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