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

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 !