Analyst III - Policy & Regulatory Operations

What You Can You 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! 

The Analyst III – Policy & Regulatory Operations is responsible for Local, State, Federal, contractual and accreditation requirements interpretation, gap analysis, project scope development and initiation, resource planning, risk identification and mitigation, and project implementation, as well as timely comprehensive development, review and maintenance of internal and Provider policies, and other regulatory documents. To do these effectively, the Analyst III – Policy & Regulatory Operations must have a demonstrated understanding of IEHP business operations and responsibilities of various departments in Health Services, Quality Systems, Provider Services, and Member Services; subject matter expertise of these departments’ policies and procedures and the regulations that drive their business operations and demonstrated ability to effectively and consistently manage multiple projects and priorities concurrently.

Key Responsibilities:

1. Responsible for independently leading cross‐functional projects, which may include but not be limited to projects that support regulatory compliance, system enhancement, process development, and improvement within a single or multiple departments in Health Services, Quality Systems, Provider Services, and Member Services. This responsibility includes developing and defining the project scope, goals and deliverables; developing, monitoring and maintaining a detailed project plan; managing changes to the scope, schedule and deliverables; communicating potential risks; ensuring successful relationships between project stakeholders and resources to ensure timely delivery of project outcomes; reporting and escalating project status and barriers to management, as needed; and creating and maintaining comprehensive project documentation.
2. In collaboration with department policy owners, develop, review, update and manage internal and Provider policies, as well as Evidence of Coverage (EOC) to ensure that these are kept current, accurate and in accordance with applicable regulatory and accreditation requirements. This responsibility includes supporting the management and publication of IEHP Provider Manual of Policies and Procedures, Electronic Data Interchange (EDI) Manual and internal department manuals; researching, reviewing and citing regulatory and accreditation requirements, plan policies, and other relevant sources; identifying and mitigating compliance and/or operational risks as well as upstream and downstream impacts of policy changes on other department(s) and/or documents; defining and summarizing the degree and description of change; and presenting new and revised policies to committees and internal groups, as needed.
3. Independently lead the timely and comprehensive assessment or examination of current policies, systems and standard procedures against new regulations for the purpose of identifying the health plan’s state of compliance, regulatory and process gaps, and action plan. This responsibility also includes performing quality assurance review of submissions drafted by their peer.
4. Responsible for identifying, gathering, developing, and bookmarking evidence and/or narratives for regulatory and/or audit‐related submissions, as well as identifying and leading efforts to mitigate regulatory/audit risks.
5. Independently lead the planning and management of cross‐functional implementation projects that support compliance with Local, State, Federal, contractual and accreditation requirements. This responsibility includes requirements interpretation, gap analysis, project scope development and initiation, resource planning, risk identification and mitigation, implementation, and ensuring the development and implementation of compliance monitoring at the department level. As the subject matter expert for these projects, the Analyst III is expected to be able to lead the development of internal and/or external communications, training materials, and system changes to support the implementation.
6. Independently lead the completion of system enhancement projects, which entails reviewing requests for quality, completeness and accuracy; gathering and documenting complete and comprehensive business and systems requirements; analyzing requested changes for upstream and downstream effects to existing processes and system capabilities, other departments/users, other systems/databases, reporting capabilities, and regulatory compliance; partnering with technical resources to ensure system integration, as needed; testing and validating system enhancements prior to implementation; and communicating project status, risks and updates to stakeholders and management.
7. Serve as the primary analyst reviewer and support for their assigned department(s) and in addition, perform quality assurance review on work output drafted by their peer.

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.

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.
• Hybrid schedule.
• CalPERS retirement.
• 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

Education & Requirements

• Five (5) or more years of experience providing complex analytical and/or project implementation support, including but not limited to regulatory review and analysis in a healthcare setting.
• Bachelor’s degree from an accredited institution required.

Key Qualifications

• Demonstrated proficiency in Microsoft Office products: Word, Excel, Visio, and Power Point, sufficient for use in all aspects of an office environment.
• Working knowledge of project management software such as Workfront, MS Project or equivalent.
• Knowledge of managed care industry practices and standards including Local, Federal, State and/or accreditation standards is required.

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