Senior Director, Clinical Risk Management

What you can expect! 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 anauthentic experience!Reporting to the Chief Quality Officer, the Senior Director of 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 risk management frameworks and protocols.Compliance & Regulatory Oversight - Ensuring compliance with all applicable regulations and accreditation standards.Risk Monitoring & Mitigation - Identifying emerging risks and leading proactive intervention strategies.External Relations & Reporting - Building strong stakeholder relationships and providing transparent reporting to leadership and governing bodies.Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.Competitive salaryState of the art fitness center on-siteMedical Insurance with Dental and VisionLife, short-term, and long-term disability optionsCareer advancement opportunities and professional developmentWellness programs that promote a healthy work-life balanceFlexible Spending Account - Health Care/ChildcareCalPERS retirement457(b) option with a contribution matchPaid life insurance for employeesPet care insuranceOrganizational Leadership and Culturea. 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 sitesb. 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 reportingc. Serve as Co-Chair of the Member Safety Subcommittee, along with designated Medical Director, ensuring agendas, discussions, and actions align with the charter and workpland. Coordinate incident management, including event reviews and serve as liaison between both internal and external stakeholderse. Partners with Human Resources to ensure application of Just Culture principles when evaluating behaviors related to member safety eventsRisk Management Strategy & Program Developmentf. Design and lead an enterprise-wide clinical risk management program, establishing protocols for member complaints, quality reviews, and corrective actions to enhance service deliveryg. Develop and implement risk management policies and procedures tailored to a health plan environment, ensuring compliance with all applicable regulatory requirementsh. Draft and publish annual Risk Management and Safety Plan, carry out plan activities, and report measures of successi. Lead stakeholder consensus processes to assess and develop detailed action plans for serious risks related to providers or facilitiesCompliance & Regulatory Oversightj. 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 reportingk. Monitor and evaluate program effectiveness, implementing performance improvement initiatives as neededl. Conduct regular risk assessments and audits to identify potential areas for improvementm. Lead Skilled Nursing Facility Quality Assurance and Performance Improvement (SNF QAPI) audit programs to maintain regulatory compliance and quality standardsRisk Monitoring & Mitigationn. Track and analyze key risk indicators to identify emerging issues and lead proactive mitigation strategieso. 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 initiativesExternal Relations & Reportingp. Develop and maintain relationships with external stakeholders, including other health plans and regulatory agencies, to stay current with industry trends and requirementsq. Prepare and present risk management reports and updates to executive leadership and Board committees as neededHire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelinesPerform any other duties as required to ensure Health Plan operations and department business needs are successfulEducation & RequirementRequired: A minimum of ten (10) years of progressive experience in clinical risk management within a health plan or healthcare settingA minimum of three (3) years of proven leadership experience managing enterprise risk programsRequired: Bachelor's degree in nursing and/or related field from an accredited institutionIn lieu of the required degree, a minimum of eight (8) years of additional relevant work experience is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements aboveA master’s degree in nursing or related field from an accredited institution is preferredCertified Professional in Patient Safety (CPPS) or other relevant certification preferredPossession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issues by the California Board of Registered Nursing requiredKey Qualifications Must have a valid California Driver’s licenseAdvanced knowledge of risk management principles, practices and techniquesKnowledge of healthcare/health plan operations, regulations, and compliance requirementsDemonstrated knowledge of healthcare laws and regulations, safety science, and patient safety best practicesKnowledge of healthcare risk financing and health insurance principlesKnowledge of health plan accreditation standards, such as NCQAKnowledge of healthcare quality improvement methodologies, such as Lean or Six SigmaStrong knowledge of healthcare laws and regulations, such as HIPAA and HITECHStrong problem-solving skills to address complex challengesStrong communication and interpersonal skills, with the ability to interact with all levels of the organizationMindset of innovation to continuously improve operations and processes while mitigating risksAbility to assess and mitigate risks for the organizationAbility to effectively communicate risk management concepts to non-technical stakeholdersAbility to build and maintain positive relationships with internal and external stakeholdersAbility to analyze data to identify trends, make recommendations and drive decision-makingAbility to adapt to changing priorities, requirements, business environments and organizational needsStart your journey towards a thriving future with IEHP and apply TODAY!This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday - Thursday onsite in Rancho Cucamonga, CA.)Schedule may adjust based on business need which may include evenings, holidays, and weekendsUSD $220,043.20 - USD $302,536.00 /Yr.

Created: 2026-01-23