Job Description

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, Medicare Stars, the Quality Improvement (QI) Facilitator III – Medicare Stars serves as a Medicare Stars regulatory and operational subject matter expert, ensuring Medicare-related quality improvement functions align with CMS regulations, CMS Star Ratings Program requirements, the Medicare Managed Care Manual, audit protocols, evolving CMS guidance, and IEHP organizational policies. This role independently leads and oversees complex Medicare Stars quality initiatives involving the prioritization of resource utilization, delegation of project deliverables, and application of quality concepts and standards to ensure improvements in organizational performance. This position translates CMS expectations into actionable workflows across operational, clinical, and provider facing teams. The QI Facilitator III facilitates Stars driven organizational improvement by applying improvement methodologies, managing cross functional project deliverables, and aligning initiatives with IEHP’s strategic goals for sustained Stars performance excellence.

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.

• Competitive salary
• 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

Key Responsibilities

Serve as a Medicare Stars program expert consulting and coaching team members throughout the organization in the development of quality improvement initiatives surrounding CMS regulations, CMS Star Ratings Program requirements, the Medicare Managed Care Manual, and audit protocols. Provide support to leadership with promoting IEHP strategic goals to achieve improvements in organizational performance

Participate in the onboarding of new quality improvement team members. Coach and mentor Quality division staff on quality improvement concepts, lean principles, and implementation of process improvement experiments. Provide quality improvement tools and training solutions for IEHP team members to address quality improvement gaps in knowledge, competency, or skills

Lead the facilitation of quality improvement projects and events of a complex nature with minimal oversight, including planning, implementation, assessment and follow up

Oversee multiple Quality Improvement initiatives and consistently meeting quality standards and deliverable timeframes

Translate data into meaningful information, draw conclusions, and relate findings to industry standards. Provide recommendations to departmental stakeholders and QI Leadership Team regarding performance gaps, program implementation, and performance outcomes in order to maintain an effective QI Program

Guide the prioritization of resources which support quality initiatives and delegates assignment appropriately

Act as primary liaison between IEHP and regulatory agencies (e.g., CMS and/or other relevant agencies) for quality improvement submissions and communications

Monitor external quality improvement trends within the healthcare industry and how they impact the organization. Identify opportunities for improvement and communicates findings to leadership. Partner with Compliance to ensure continuous monitoring of CMS rule changes and Medicare oversight requirements

Perform any other duties as required to ensure Health Plan operations and department business needs are successful

Qualifications

Education & Requirement

• A minimum of six (6) years demonstrated experience, at a professional level, in process/project management including participation in quality improvement projects or operations
• Prior experience in the health care setting required
• Prior experience designing Medicare Star Measure interventions preferred. Demonstrated experience increasing Plan Star Ratings through targeted quality improvement activities preferred
• Knowledge of Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred
• Master’s degree in public health, health administration, public administration, or other healthcare related focus from an accredited institution from an accredited institution required
• Project Management Professional (PMP) Certificate, Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or successful completion within one (1) year of hire

Key Qualifications

• Must have a valid California Driver’s license
• Advanced knowledge and in-depth understanding of:
• Healthcare quality performance and measurement sets including CMS quality withhold, NCQA Quality Improvement Standards and HEDIS
• Project management techniques, tools of continuous improvement, and work process redesign
• Standardized QI concepts
• Standard coding sets as they are used in quality measurement including ICD-10, CPT, CPT Category II, HCPCS, LOINC, NDC
• Strongly preferred advanced knowledge and understanding of:
• Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred
• CMS quality programs, Medicare Star Ratings methodology, HEDIS, CAHPS, Pharmacy Part D measures, NCQA standards, Risk Adjustment basics, and regulatory documentation requirements
• Supporting CMS audits, data validation reviews, or compliance reporting
• Medicare Managed Care Manual, HPMS guidance, and CMS regulatory updates.
• Advanced proficiency in:
• Analytical and critical thinking skills
• All Microsoft Office applications, with an emphasis on Excel, PowerPoint, and Visio
• Communication skills (verbal, written and listening) with ability to interact effectively and demonstrated comfort with public speaking to varied audiences
• Successfully applying facilitation techniques to quality improvement project teams to achieve optimal outcomes
• Problem solving, leadership qualities, conflict management, and team building skills to ensure a productive work environment and achievement of quality goals
• Successfully working with and motivating diverse teams including group process facilitation, change management and conflict resolution
• Teaching quality improvement concepts and principles
• Demonstrated ability to:
• Increase Quality Ratings through targeted quality improvement activities
• Read and interpret data
• Be results and outcome oriented
• Perform complex tasks, prioritize multiple projects and work under pressure to meet deadlines in a fast-paced environment
• Successfully apply facilitation techniques to quality improvement project teams to achieve optimal potential
• Demonstrate excellent project and time management skills
• Exhibit high attention to detai

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location

This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday – Thursday onsite in Rancho Cucamonga, CA.)

Pay Range

USD $104,041.60 - USD $137,841.60 /Yr.