Special Programs Manager II - Medicare Stars

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 of Medicare Stars, the Special Programs Manager II - Medicare Stars provides senior support in the coordination of interdepartmental system configuration and process projects focused on CMS Stars operations, regulatory compliance, and Medicare quality improvement (e.g., HEDIS, Medicare Stars, Pay for Performance, new product implementation, Quality Improvement activities, Provider risk profiles, Member and Provider surveys, data aggregation, data collection, vendor oversight, reporting, and similar items). The Special Programs Manager II - Medicare Stars is responsible for program management including initiation, planning, development, and monitoring of Special Programs implementations to ensure timely execution of deliverables and fiscal sustainability.

The Special Programs Manager II - Medicare Stars will act as a liaison between several functional departments for related activities to ensure projects and issues are tracked, updated, and reported out frequently as scheduled and will provide support to department Managers and Directors to coordinate the delivery of documents related to internal and external audits (NCQA, Medicare Readiness, CMS, compliance reviews, and similar items). The Special Programs Manager II - Medicare Stars ensures policies and procedures, requirements, change control requests, and issue management tickets are completed as necessary and available for review and provide expertise and knowledge to project management processes for release management, and interdepartmental issue response and resolution management from medium‐to-high priority / size of complexity. This position involves collaboration across technology deployments and communications of project and issue management at the Manager, Director, and Chief levels.

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
• 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

1. Provide research, analytical support, and project management to Medicare Stars leadership in the areas of issue resolution, implementation of regulatory changes, strategic projects, and configuration and processes that are in the best interest of Medicare Stars business operations
2. Manage medium‐to‐large complexity / medium‐to‐high priority projects and issues inclusive of business, regulatory, or technology deployments (inclusive of project budgets and acquiring resources with agreements from functional areas, 3rd party vendors, and consultants)
3. Coordinate, prepare, and monitor assigned Medicare Stars projects, documentation, and report outs. Capture process efficiencies developed through projects and incorporate LEAN methodologies into project practices
4. Act as a liaison between several functional departments for configuration and software‐related activities to ensure projects and issues are tracked, updated, and reported out frequently as scheduled
5. Support Medicare Stars leadership with external vendor(s) operations in areas such as planning and implementing specific initiatives, and managing the terms of the vendor service agreement
6. Collaborate with other Quality departments and the Compliance department in planning, developing, and submitting responses to audits
7. Support Medicare Stars leadership across Quality and Stars program governance Committees, ensuring all follow‐up activities or action items from the meetings are completed in a timely manner
8. Support senior and executive divisional leadership and Chief sponsors on special companywide and departmental projects and initiatives
9. Monitor ongoing work plans and initiatives to ensure that interventions are completed to mitigate risks and issues
10. Perform gap analysis and updates to Policies and Procedures (PnP) including working with SMEs to update existing content or create new documents. Ensure appropriate version control and distribution into Compliance 360, SharePoint, or other source document management areas as needed. Assist in the responses and completion of deliverables to Corrective Action Plans (CAPs)
11. Determine program resource requirements and procedure resources
12. Gather details for budgets needed and analysis for special projects or issue resolution as requested by Quality Department leadership
13. Lead the development of Request for Proposals (RFP) for external products and or services
14. Perform any other duties as required ensuring Health Plan operations are successful

Education & Requirement

• A minimum of five (5) years of relevant work experience in healthcare quality and is a strategic thinker with experience in program/project management
• Experience in developing plans and has application experience of standard Project Management practices
  • Prior experience implementing Medicare Star Measure interventions preferred
  • Experience with Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred
  • Demonstrated experience managing targeted quality improvement activities
• Bachelor’s degree in public health, health administration, or a related field from an accredited institution required
  • In lieu of the required degree, a minimum of 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
  • Master's degree in public health, health administration, or a related field from an accredited institution preferred
  • PMP, PgMP, CBAP or PMI‐PBA preferred

Key Qualifications

• Strong knowledge and understanding of:
  • Effective implementation of quality initiatives (e.g., quality management programs and similar programs)
  • Data mining and data profiling
  • Data analysis, quality monitoring and oversight, and promoting a data‐aware culture throughout the organization
  • Project management and cross‐ organization coordination
  • Understanding and sensitivity to a multi‐cultural environment and community
  • Machine learning, statistics, and informational retrieval
  • Developing plans and applying standard PM practices
• Strongly preferred strong 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
• Strong proficiency in the following areas:
  • Interpersonal skills
  • Project management and issue management skills
  • Microcomputer applications: spreadsheet, database, and word processing
  • Writing, interpersonal communication, and organizational skills
• Proven ability to:
  • Translate data into meaningful and actionable information
  • Possess a high degree of patience and attention to detail
  • Work in a changing, fast‐paced environment
  • Support a culture of collaboration
  • Be a strategic thinker
  • Manage targeted quality improvement activities
  • Work in a diverse, demanding, and evolving environment with strong conflict and problem resolution skills
  • Interact with external entities and represent IEHP in a professional manner
  • Understand the importance of and respect the confidentiality of sensitive information

Start 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.)