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 Pay Range $91,249.60 USD Annually - $120,910.40 USD Annually #J-18808-Ljbffr IEHP