Inland Empire Health Plan
Manager, Regional Quality Improvement
This job is now closed
Job Description
- Req#: 5521
- Competitive salary.
- Hybrid schedule.
- State of the art fitness center on-site.
- Medical Insurance with Dental and Vision.
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development.
- Wellness programs that promote a healthy work-life balance.
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
- Implement sustainable quality improvement processes that improve quality measure performance (HEDIS, CAHPS, MCAS, Stars) in the IEHP Direct Provider Network with a goal of achieving 4 Star performance across the network in partnership with external stake holders. External partnerships include and are not limited to; community-based organizations, large health systems, contracted primary care providers, school districts, healthcare delivery vendors, etc.
- Effectively measure the success/outcomes of improvement efforts using valid statistical methods and report the results of these efforts to Leadership and the Quality Improvement Committees/Workgroups. Manage a data analytics portfolio of regional level quality performance metrics, risks, root cause issues, initiatives, and work plans.
- Manage and lead a team of professionals responsible for the development, coordination, implementation, and monitoring of prioritized regional quality community model quality improvement interventions aimed at addressing root cause issues and improve quality measure performance (HEDIS, CAHPS, MCAS, Stars).
- Develop regional level sustainable strategies that facilitate the enhancement of quality improvement activities and achievement of goals, required by IEHP’s regulatory and accrediting bodies, ensuring the application of industry best practices and consistently meeting quality standards and deliverable timeframes. Structure and manage key workstreams to deliver strategic objectives and apply understanding of business challenges while aligning engagement strategies to address challenges.
- Collaborate with appropriate internal and external stakeholders to develop, prioritize, and implement high priority regional level quality improvement initiatives, activities and interventions that aim to address performance gaps and organizational strategic goals. This includes targeted quality programs such as those requiring partnership and collaboration from external entities (inclusive of project budgets and acquiring resources with agreements from functional areas, 3rd party vendors, external partners, consultants, etc.).
- Communicate and evaluate the availability of necessary resources for the execution of related projects.
- 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.
- A minimum of five (5) or more years of experience in a health plan setting within a leadership capacity engaging cross-functional multidisciplinary teams
- Strong experience with Medicaid, Medicare, and/or Commercial health coverage programs
- A minimum of five (5) years of experience working in quality improvement or process improvement in a health care setting
- Experience requires strong data analysis, reporting, and business intelligence
- Master’s Degree in Public Health, Health Administration, Public Administration, or other healthcare related focus from an accredited institution required
- In lieu of a Master's degree, a minimum of a Bachelor’s degree and four (4) 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 above
- Certified Professional in Healthcare Quality (CPHQ) or Master Certified Health Education Specialist (MCHES) certification required or acquired within one (1) year from hire date
- Advanced understanding and knowledge of: National Committee for Quality Assurance (NCQA), Centers for Medicaid and Medicare Services (CMS), and California Department of Health Care Services (DHCS) performance measure sets (i.e., HEDIS, CAHPS, MCAS, Stars, and HOS); Medicaid, Medicare, and/or Commercial health coverage programs; Healthcare quality performance and measurement sets including CMS Stars, DHCS Managed Care Accountability Set (MCAS), NCQA Quality Improvement Standards, and HEDIS; Ambulatory care practices in a managed care environment; Standard coding sets as they are used in quality measurement including ICD-10, CPT, CPT Category II, HCPCS, LOINC, NDC
- Strong analytical and critical thinking skills
- Excellent written and verbal communication and interpersonal skills
- Strong organizational skills and computer proficiency
- Possesses problem solving, leadership qualities, conflict management, and team building skills to ensure a productive work environment and achievement of quality goals
- Demonstrated skills in successfully working with and engaging diverse teams
- Proven ability to: Establish and maintain effective working relationships with others; Interact effectively and demonstrate comfort with public speaking to varied audiences; Possess a high attention to detail; Be results and outcome oriented; Work well under pressure to meet deadlines in a fast-paced environment
Overview
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 an authentic experience!
Reporting to the Director, Quality Improvement, the Manager, Regional Quality Improvement is responsible for leading quality improvement initiatives with IEHP's network providers across various regions throughout the Inland Empire with the aim of improving IEHP’s overall quality performance by strategically working with providers who can move the needle in performance. Key activities include designing, implementing, and evaluating a regional level quality improvement program that uses data-driven insights to impact overall Plan performance on key quality measures. The Manager, Regional Quality Improvement is responsible for the daily oversight of the Regional Quality Community Model team, including the management, evaluation, mentoring, and coaching of direct reports. The incumbent is responsible for coordinating, implementing, monitoring, and measuring the progress of all selected improvement plans and for measuring the performance/outcomes of such efforts on a routine basis. The Manager, Regional Quality Improvement, is responsible for bringing together multiple internal and external stakeholders to engage in the development of regional level quality improvement activities, structures and processes aimed at improving priority measure outcomes.
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.
Additional Benefits
Perks
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.
Key Responsibilities
Qualifications
Education & Requirements
Key Qualifications
Start your journey towards a thriving future with IEHP and apply TODAY!
Work Model Location
This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)
Pay Range
USD $118,601.60 - USD $157,144.00 /Yr.About the company
Notice
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