IEHP

Nonprofit public health plan for the Inland Empire

Quality Improvement Facilitator 3 - Medicare Stars

Program ManagementConfirmed live in the last 24 hours

Full-timeRancho Cucamonga, CA, USA$104k - $137.8k /yr

About the Job

Requirements

A minimum of six years of professional-level process or project management experience, including participation in quality improvement projects or operations.
Prior experience in a healthcare setting is required.
A master's degree in public health, health administration, public administration, or another healthcare-related focus from an accredited institution is required.
A Project Management Professional certificate, Certified Professional of Healthcare Quality certificate, or another recognized quality improvement certificate is required, or must be completed within one year of hire.
A valid California driver's license is required.
Advanced knowledge and in-depth understanding of healthcare quality performance and measurement sets, including CMS quality withhold, NCQA Quality Improvement Standards, and HEDIS is required.
Advanced knowledge and in-depth understanding of project management techniques, continuous improvement tools, and work process redesign is required.
Advanced knowledge and in-depth understanding of standardized quality improvement concepts is required.
Advanced knowledge and in-depth understanding of standard coding sets used in quality measurement, including ICD-10, CPT, CPT Category II, HCPCS, LOINC, and NDC, is required.
Advanced proficiency with Microsoft Office applications, especially Excel, PowerPoint, and Visio, is required.
Advanced proficiency in analytical and critical thinking is required.
Advanced communication skills, including verbal, written, listening, effective interaction, and public speaking to varied audiences, are required.
Advanced proficiency in applying facilitation techniques to quality improvement project teams is required.
Advanced proficiency in problem solving, leadership, conflict management, and team building is required.
Advanced proficiency in working with and motivating diverse teams, including group process facilitation, change management, and conflict resolution, is required.
Advanced proficiency in teaching quality improvement concepts and principles is required.
The ability to increase Quality Ratings through targeted quality improvement activities is required.
The ability to read and interpret data is required.
The ability to perform complex tasks, prioritize multiple projects, and work under pressure to meet deadlines in a fast-paced environment is required.
The ability to apply facilitation techniques to quality improvement project teams is required.
Excellent project and time management skills and high attention to detail are required.

Responsibilities

Serve as a Medicare Stars program expert, consulting and coaching team members on developing quality improvement initiatives related to CMS regulations, CMS Star Ratings Program requirements, the Medicare Managed Care Manual, and audit protocols, and support leadership in promoting strategic goals and improving organizational performance.
Participate in onboarding new quality improvement team members.
Coach and mentor Quality division staff on quality improvement concepts, lean principles, and process improvement experiments.
Provide quality improvement tools and training solutions to address gaps in team members’ knowledge, competency, or skills.
Lead complex quality improvement projects and events with minimal oversight, including planning, implementation, assessment, and follow-up.
Oversee multiple quality improvement initiatives and ensure quality standards and deliverable timeframes are met.
Translate data into meaningful information, draw conclusions, relate findings to industry standards, and recommend actions to departmental stakeholders and the Quality Improvement Leadership Team regarding performance gaps, program implementation, and outcomes.
Guide resource prioritization for quality initiatives and delegate assignments appropriately.
Act as the primary liaison between IEHP and regulatory agencies, including CMS, for quality improvement submissions and communications.
Monitor external healthcare quality improvement trends and their impact on the organization, identify improvement opportunities, and communicate findings to leadership.
Partner with Compliance to continuously monitor CMS rule changes and Medicare oversight requirements.
Perform other duties as required to support Health Plan operations and departmental business needs.

Desired Qualifications

Experience designing Medicare Star Measure interventions is preferred.
Experience increasing Plan Star Ratings through targeted quality improvement activities is preferred.
Advanced knowledge of Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations is preferred.
Advanced knowledge and understanding of CMS quality programs, Medicare Star Ratings methodology, HEDIS, CAHPS, Pharmacy Part D measures, NCQA standards, Risk Adjustment basics, and regulatory documentation requirements is strongly preferred.
Experience supporting CMS audits, data validation reviews, or compliance reporting is strongly preferred.
Knowledge of the Medicare Managed Care Manual, HPMS guidance, and CMS regulatory updates is strongly preferred.

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.

Compensation: 104041.6 to N/A (USD)

About the Company

IEHP

Nonprofit public health plan for the Inland Empire

IEHP is a nonprofit public health plan that connects residents of California's Riverside and San Bernardino counties with health coverage and care. It administers Medi-Cal coverage for eligible low-income residents, IEHP DualChoice for people with both Medicare and Medi-Cal, and IEHP Covered plans through Covered California. Members receive care through a network of doctors and other providers, with dedicated care teams for those who need extra support. Its community wellness centers run free fitness classes and health workshops, and it connects residents with food and housing resources. IEHP began operating in 1996 and is headquartered in Rancho Cucamonga, California.

Company size: 1,001-5,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Rancho Cucamonga, CA
Founded: 1996

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