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SCAN Health Plan jobs in Long Beach, CA

- 82 jobs
  • Analyst II - Test Governance & Coordination

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of Vice President of Business Relationship Management and BSA Department, this position aids in the development of the quality standards, audits, Test Intake/planning process, and User Acceptance Test coordination. This position will serve as a liaison between IT and several business units to ensure Testing progress is tracked, updated, and reported out as scheduled for projects. Duties also include continuously improving processes and a variety of complex assignments that are delegated by management in terms of objectives rather than specific instructions. Provide guidance to other Analysts. 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 Hybrid schedule 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 Participate and lead the development of the quality standards, educating teams on the quality standards, and conducting governance checks. Responsible for auditing the UAT activities and ensuring User Acceptance Test delivery Plays senior role in UAT Test Coordination across several business teams on several new projects, Product upgrades, releases, and CR implementations Collaborate with PMs/ BPEs/ QE Engineers/Vendors/Business teams and various other parties as part of Test Governance Participate in Test Intake/planning and Test Estimations Contribute to the UAT test strategy/test plan (task list & owner, testing scope, test data needs, test environments, configuration needs, locations/logistics, etc.) Contribute to the UAT Kickoff (status, reporting, DevOps access/training, application training, etc.) Contribute to the daily planning and execution of UAT test scripts Perform Functional Testing activities on various applications as needed Assist in the development and implementation of metrics and maintenance of Visual Management Tools Participate in daily UAT standups and report status updates Participate in scheduled calls with extended project team members Build and manage UAT test scripts in DevOps (own structure, load test scripts, and manage test scripts) Gather Test results from various Business teams as part of UAT testing and upload test results back to Test management tools (DevOps/WF) Manage UAT defects - verify the execution of test plans, manage and report on defects Contribute to data set for UAT test script execution (define Test datasets between the various business teams for End-to-End test coverages) Assist in the development and maintenance of policies and procedures related to job functions, procedures, and technical guidelines Coordinate and prepare documentation for internal/external audits Train and provide guidance to other Analysts in the team as needed Qualifications Education & Requirements Three (3) years in IT Quality Assurance Prior experience in utilizing Test Management Tools Prior Experience in coordinating UAT testing with business teams Experience successfully managing business relationships with stakeholders required Experience Health Plan Operations and Government Programs preferred Experience in healthcare is desirable Bachelor's degree in Public or Business Administration, Health Care, Computer Science, Mathematics, or Accounting or related field from an accredited institution required Key Qualifications Knowledge of Managed Care systems and client/server applications - Preferred Understanding of SDLC life cycle and QA methodologies Knowledge of health plan business operations - Preferred Principles and methods of systems analysis for data processing - Required Principles of sound testing methodologies - Required Knowledge of Test Management and Reporting Tools- Required Knowledge in Test Planning and Estimates- Required Sound research techniques - Preferred Proficient in Microsoft Office Suite programs including Visio - Required Project management understanding and skills - Preferred Excellent written, and oral communication skills - Required Proven analytical and problem-solving capabilities - Required Ability to work independently, under pressure, balances multiple projects and deadline driven - Required Ability follow-through and track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed timely - Required Ability to grasp new ideas and concepts quickly - Required Ability to successfully present ideas in an audience-oriented manner - Required. Ability to manage multiple projects of varying complexity, priority levels and deadlines - Required Strong work ethic and highly self-motivating and directing - Required Successful working in a team-oriented, collaborative, and changing environment - Required Willingness and ability to learn - Required Must be detail-oriented with strong organizational skills - Required Demonstrate a commitment to support IEHP's strategic priorities to become a 5-Star Health Plan Demonstrate commitment to Team Member Engagement by participating in projects/tasks/activities that promote Team Member excitement and enthusiasm for their role, increased work effort, and commitment to the organization Makes necessary adjustments to work shift ensure completion of projects and to meet deadlines, e.g., system releases, critical milestones 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 $80,059.20 - USD $106,059.20 /Yr.
    $80.1k-106.1k yearly Auto-Apply 18d ago
  • Senior Claims Examiner

    Care1St. Health Plan 4.7company rating

    Monterey Park, CA job

    The Claims Analyst is responsible for analyzing and adjudicating medical claims. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or CSIM (Customer Service Inquiry Module). Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Generates and develop reports which include but not limited to root causes of PDRs and CSIMs. Collaborates with other departments and/or providers in successful resolution of claims related issues. QUALIFICATIONS: •Minimum 1-2 years financial analyses/accounting experience and 2-5 years medical claims examining experience, or a combination/equivalent of the two •2 or more years experience in managed care organization a plus •Minimum typing speed of 45 WPM and use of Ten-Key by touch •Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus •Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements a plus •Ability to write analytical reports and comprehensive summaries •Advanced proficiency in Microsoft Word and Excel; Access knowledge a plus •Must be detail oriented •Ability to effectively communicate with internal and external associates •Ability to deal with complex claim issues •Knowledge of DMHC, DHS, CMS, Title XX II CRC, Title 42, and Medi-Cal and Medicare processing guidelines a plus •Ability to work in a fast pace environment with minimal supervision •Ability to handle multiple projects and is able to prioritize workflow ESSENTIAL DUTIES AND RESPONSIBILITIES TO INCLUDE BUT NOT LIMITED TO: •Conducts claims payment analyses to identify root cause of claims issues/deficiencies. •Adjudicates medical claims according to regulatory and Care1st Health Plan processing guidelines and contractual agreements: ◦Verifies patient account, eligibility, benefits and authorizations. ◦Prioritizes assigned claims according to regulatory timelines. ◦Requests additional information for incomplete or unclean claims; follows up with provider as necessary. ◦Contacts providers on claims related issues as necessary. •Notifies Claims Management immediately when claims or other projects cannot be completed within the processing timelines. •Performs payment reviews and adjustments due to retroactive effective date of contracts and/or fee schedule changes: ◦Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes. •Responds to provider inquiries/calls related to claims payments. •Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process, CSIM (Customer Service Inquiry Module) and/or provider calls. •Generates and develop reports which include but not limited to root causes of PDRs and CSIMs •Maintains productivity and quality standards as defined by Management. •Communicates with other departments (such as Provider Data Maintenance, Provider Network Operations, and Utilization Management) to resolve provider claims related issues. •Contacts providers either telephonically or in writing for additional information to resolve or clarify submitted claims issues. •Handles misdirected claims inquiries: ◦Corresponds with IPAs/Medical Groups regarding misdirected claims. ◦Reviews Division of Financial Responsibility (DOFR) to ensure proper routing of claims. ◦Notifies Management and/or Provider Network Operations (PNO) Department of any issues related to misdirected claims routing. •Complies with company's attendance and punctuality standards. •Promotes teamwork and cooperation with other staff members and management. •Performs additional related duties as assigned by Additional Information All your information will be kept confidential according to EEO guidelines.
    $47k-68k yearly est. 60d+ ago
  • Senior Medical Director - Policy & Outcomes

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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 Vice President of Health Services, the Senior Medical Director Policy & Outcomes (Sr. Medical Director - P&O) is responsible for the strategic oversight of IEHP Medical Policies and clinical leadership around member health outcomes. The Sr. Medical Director - P&O oversees the day-to-day operations as it relates to developing, executing, leading and updating guidelines, policies, clinical pathways, and communications enabling effective health outcomes, as well as effective health plan performance as per DHCS, DMHC, CMS, and CCA clinical requirements. This leader serves as the accountable medical leader for clinical activities related to key activities including quality management, grievance and appeals, delegation oversight, and population health management. The Sr. Medical Director - P&O also works in partnership with the appropriate cross functional departments to monitor the impact of policy outcomes through regular reporting, metrics, initiatives, and other improvement activities. This position is responsible for leading regulatory audits for all its relevant domains. 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 Hybrid schedule 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 Lead the development and execution of creating and/or updating medical policies and procedures to align with health plan regulatory requirements. Ensure guidelines and clinical pathways are updated with best practices, along with appropriate downstream connections to utilization management, population health, and other compliance and regulatory activities Lead, develop and implement clinical programs and medical policies to align with IEHP's strategic priorities in order to improve member safety, quality of care and outcomes Lead clinically, through strong partnerships with other departments for activities related to member outcomes, quality improvement, grievance and appeals, and network corrective action plans. Develop and increase collaborative relationships with internal departments. Assure interdepartmental collaboration and communication with key business departments, including, but not limited to, compliance, member experience, provider relations, and claims. Serve as a liaison with providers, county public health partners and oversight agencies as assigned. Monitor network performance proactively to ensure adherence to policy standards. Develop and implement appropriate internal initiatives to address any issues impacting member outcomes Co-leadership with the Sr. Medical Director of Health Servies to advance IEHP's Mission, Vision and Values. Work in partnership with the Senior Medical Director focusing on UM to coordinate daily huddles, develop work schedules, adherence to department metrics and KPIs, and training of medical staff. Manage medical directors, as well physician reviewers, working in the domains of policy, outcomes, quality management and clinical guideline development. Provide clinical direction to the Health Service team and act as a resource to all IEHP departments responsible for providing or coordinating clinical services to IEHP members. Direct, implement, and/or enhance medical policy, internal policies, and job aids as it relates to member safety and quality management activities, clinical guideline development, delegation and oversight, credentialing, peer review, and compliance related activities. Ensure medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management, with timely and appropriate use of UM criteria and guidelines. Direct clinical and workflow training for medical directors and physician reviewers within their oversight. Ensure medical personnel of the Plan and its delegates follow IEHP policies, protocols and rules of conduct consistent with the values of IEHP. Identify gaps in policies or activities relating to member outcomes and implement strategic, effective solutions. Serve as a primary point of contact for clinical, quality and performance issues for medical directors at delegated IPAs, as well as for providers in the IEHP direct network. Support other departments as needed to ensure timely completion of member grievances and appeals as required for regulatory compliance. Provide clinical leadership, support and/or guidance including, but not limited to, the following areas: Pre-admission authorization Prospective, concurrent and retrospective review Inpatient case review Inpatient claims reviews Utilization review Member case management Provider incentive programs Credentialing, Peer Review and Member Safety Subcommittees Pharmacy and Therapeutics Subcommittee NCQA Accreditation Reviews State mandated benefits to ensure IEHP is in full compliance through its providers. Perform any other duties as required to ensure Health Plan operations and department business needs are successful Qualifications Education & Requirements Seven (7) years of post-residency experience in a recognized medical specialty or practice, which must have included at least (3) years of medical administrative experience required Minimum of five (5) years of managed care or health plan leadership experience with proven track record of leading high performing physician teams Experience working with clinical practice guidelines and evidenced based criteria sets Has exposure to working with regulatory agencies Medical Director for an IPA, medical group, or CA HMO highly desirable Medical specialty/practice experience preferably in the state of California Doctorate of Medicine from an accredited institution required Certification by one (1) of the American Specialty Boards required Completion of an accredited residency program required. Possession of an active, unrestricted, and unencumbered Physician's and Surgeon's Certificate issued by the State of California required A physician certified in a state other than California may be employed prior to receipt of California certification provided that an application for a California physician and surgeon's certificate is filed in the state of California prior to date of appointment. Key Qualifications Valid California Driver's License preferred Possesses in depth comprehensive knowledge of: Managed Care principles Administrative practices and procedures (including but not limited to: credentialing and risk management, rules regulations, policies, and standards related to managed care) Principles of effective supervision and organization; methods, techniques, practices, principles, and literature in the broad field of medical sciences The principles of medical practice in a variety of settings (inpatient, outpatient, subacute, etc) Familiarity with local healthcare organizations and/or local practice experience is preferred Highly Organized, Effective Communication Skills, Microcomputer applications such as Microsoft Word, Excel, and Access. Proven execution skills Assertive communicator Demonstrate effective leadership of other physicians and clinical staff A track record of leading with accountability is required Travel within California Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Travel within California Pay Range USD $280,841.60 - USD $393,182.40 /Yr.
    $280.8k-393.2k yearly Auto-Apply 29d ago
  • Director, CAHPS Performance

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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 Director of CAHPS Performance is responsible for designing, leading, and executing strategies to improve Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance across all of IEHP's product lines (Medi-Cal, Medicare DSNP, Covered CA). This role drives measurable improvement in member experience, Star Ratings, Health Plan Ratings and quality performance by integrating voice-of-the-member insights into enterprise strategy, operations, and provider engagement. The Director serves as a change leader and subject matter expert, ensuring the organization consistently delivers exceptional member experience that meets regulatory expectations and strengthens market competitiveness. 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 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 Develop and execute an enterprise-wide CAHPS improvement strategy, aligned with CMS Star Ratings, NCQA, Medicaid, and Marketplace requirements. Integrate CAHPS performance into broader organizational member experience and growth strategies. Serve as the organization's expert on CAHPS methodology, benchmarks, and best practices. Lead cross-functional initiatives that directly improve CAHPS measures such as Getting Needed Care, Getting Care Quickly, Care Coordination, and Rating of Health Plan. Translate member survey insights into actionable operational and clinical interventions. Collaborate with IEHP's provider network leadership team to align practice transformation and clinical workflows with CAHPS improvement goals. Design and deliver training and toolkits to empower providers and staff in improving member experience. Partner with member services, care management, and quality teams to ensure member-first interactions. Direct the development of dashboards and reporting tools to track CAHPS performance in near real-time. Use data to identify trends, disparities, and opportunities for targeted interventions. Regularly report performance to executive leadership, and other key stakeholders. Build, coach, and lead a cross-functional CAHPS improvement team through influence and partnerships. Foster a culture of accountability, empathy, and member-centered care across the organization. Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements A minimum of eight (8) years of progressive leadership experience in health plan quality, member experience, or related roles required. Proven success in designing and implementing CAHPS/member experience improvement strategies required. Bachelor's degree in healthcare administration, public health, business, or related field from an accredited institution required. Master's degree in healthcare administration, public health, business, or related field from an accredited institution preferred. Key Qualifications Deep knowledge of CAHPS survey methodology, Star Ratings, and Medicaid quality requirements. Member-centered mindset, with passion for improving care experiences. Strong analytical, communication, and change management skills. Data-driven and outcomes-focused. Ability to lead cross-functional initiatives and influence at all levels of the organization. Strategic and operational balance: able to set vision while driving execution. Collaborative leader skilled at provider and stakeholder engagement. Work Model Location This position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday - Thursday onsite in Rancho Cucamonga, CA.) Pay Range USD $169,312.00 - USD $232,793.60 /Yr.
    $169.3k-232.8k yearly Auto-Apply 22d ago
  • Special Investigations Unit Medical Reviewer

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP's Compliance Special Investigations Unit (SIU). 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 * 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 * A minimum of two (2) years of experience performing medical reviews of medical records and claims in a healthcare setting * Bachelor's degree in Medical Billing/Medical Coding, Nursing, Healthcare Administration, or 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 * Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Coding Specialist (CCS) required * One of the following licenses preferred: * Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians * Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN Key Qualifications * Must have a valid California Driver's license * Strong understanding of medical coding, billing practices, and healthcare regulations * Thorough understanding of ICD, CPT, HCPCS, DRG, revenue codes, NDC's and other guidelines and general understanding of investigative processes within a healthcare environment are required * Knowledge of Medi-Cal and Medicare rules and regulations, and managed care in California is preferred * Strong verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail * Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary * Detail-oriented with strong organizational and time management abilities. Ability to articulate medical review findings clearly and thoroughly * Conduct research in support of medical reviews and make determinations on claims with a high level of accuracy * Demonstrated ability to interpret and analyze healthcare data and records * Adapt to different technology software and platforms, including anti-fraud solutions * Ability to work independently and collaboratively with a team Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $71,572.80 USD Annually - $93,038.40 USD Annually
    $71.6k-93k yearly 60d+ ago
  • Engineer III - VMware and Windows

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of the Manager, Compute and Collaboration, the Engineer III - VMware and Windows would be responsible for helping in the design, configuration, and maintenance of the VMware virtual environment. This role will also help in build, configuration, and maintenance of Windows Server infrastructure for production, test, and development environments. 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. 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 Key Responsibilities Implement, maintain, and Support VMware vSphere. Implement, maintain, and Support VMware vROps, Skyline and other related VMware infrastructure and monitoring tools. Implement, maintain, and Support DNS, DHCP, SSL Certificates and internal CA servers. Process changes to system software and hardware so that performance meets company's objectives and maintain SLAs in accordance with change management policy. Implement and maintain anti-virus on systems. Manage and apply necessary system security access. Analyze performance indicators to ensure that systems are operating efficiently. Build and maintain Windows servers and associated applications in a highly available, scalable, and secure environment. Install and configure ESX-i on physical hosts for vSphere. Perform root cause analysis for VMware and Windows related issues. Qualifications Education & Requirements Eight (8) or more years of hands-on experience working with VMware and Windows environments Five (5) years of experience in Systems Administration Experience with SCCM and patch management for monthly security updates and patches Hands on experience with installing/racking physical servers and appliances Exposure and experience with Azure as an extension of the Windows Server environment Bachelor's degree in a computer related field or similar technical field from an accredited institution required In lieu of the required degree, a minimum of four (4) years of additional Systems Administration experience and VCP/MCSE Certification is required for this position This experience is in addition to the minimum years listed in the Experience Requirements above. Key Qualifications Must have a valid California Driver's License Linux Red hat and other Linux OS experience is a plus. Experience working in the Healthcare Industry will be an added advantage VCP/MCSE preferred Strong knowledge in the areas defined but not limited to in the duties and responsibilities section Strong technical knowledge of VMware ESX / ESXi and Virtual Center, SRM, vCOPs Deep knowledge and experience with PowerShell Familiarity with datacenter concepts and best practices, high-availability systems, capacity planning, system performance evaluation, diagnostic techniques, and methodologies Understanding of cloud computing operating principles, features, and benefits Advance knowledge of Microsoft Windows Server and associated products Basic knowledge of SAN/WAN/LAN networking Ability to plan, organize and document complex system design activities and to configure systems to be consistent with operational. policies/procedures Ability to communicate technical/complex information both verbally and in writing, as well as perform multiple tasks concurrently and respond to emergency situations effectively Team player and ability to work well with others Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range USD $118,601.60 - USD $157,144.00 /Yr.
    $118.6k-157.1k yearly Auto-Apply 18d ago
  • Security Operations Engineer III-IAM

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of the Manager, Information Security Operations, the Security Operations Engineer III - IAM (Identity Access Management) is an experienced senior level cybersecurity engineering position primarily responsible for the designing, implementation and maintaining of identity and privilege access management systems and processes. This position will also be a subject matter expert in cybersecurity that will engineer, implement, support, and maintain cybersecurity solutions as needed to support the organization's cybersecurity and information security programs. Other duties include security tool monitoring, incident response, automating response activities to prevent and or limit impact of adverse security incidents, maintain documentation related to policies, standards, and procedures; mentor team members; and provide consultative services to teams and stakeholders to improve the security posture of their environments. 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; we also aim to match our Team Members with the same energy by providing prime benefits and more. * CalPERS retirement * 457(b) option with a contribution match * Generous paid time off- vacation, holidays, sick * State of the art fitness center on-site * Medical Insurance with Dental and Vision * Paid life insurance for employees with additional options * Short-term, and long-term disability options * Pet care insurance * Flexible Spending Account - Health Care/Childcare * Wellness programs that promote a healthy work-life balance * Career advancement opportunities and professional development * Competitive salary with annual merit increase * Team bonus opportunities Education & Experience * Eight plus (8+) years IT hands on technical experience with at least five (5) years in a cybersecurity role with a focus on IAM, PAM, JIT access, and cybersecurity detection, protection, and response. * Scripting experience such as PowerShell, JavaScript, or Python. Experience with the * 3rd party IAM \ PAM applications * Risk mitigation strategies * TCP/IP networking. * Defense in Depth strategies * Security Operations Tools such as SIEM, EPM, DLP, Vulnerability scanners, Firewalls, WAFs, Antivirus Solutions, Email Protection Solutions, * Identifying indicators of compromise and indicators of attack * Mitre ATT&CK and Cyber Kill Chain frameworks * Computer operating systems such as Windows, MacOS and Linux * Bachelors degree with a major in computer related field or similar technical field from an accredited institution required * In lieu of the required degree, a minimum of four (4) years of additional cybersecurity work experience is required for this position Key Qualifications * Strong planning, organization, critical thinking, decision-making and communication (verbal and written) skills * Mentoring skills Proven ability to: * Work as member in a team * Be flexible and adaptable to change in a dynamic work environment * Learn and apply new concepts Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $118,601.60 USD Annually - $157,144.00 USD Annually
    $118.6k-157.1k yearly 31d ago
  • IT Business Relationship Manager

    Inland Empire Health Plan 4.7company rating

    Rancho Cucamonga, CA job

    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! The Business Relationship Manager (BRM) is responsible for ensuring business project requests are aligned to IEHP strategic goals, initiatives, and efforts. As a liaison with IEHP business and Compliance units, the BRM is dedicated to foster productive, value-producing relationship between business and IT by aiming for customer satisfaction and understanding and relaying customer needs to the IT team. By adopting a customer-centric approach this position will assist IT Strategic Programs leadership to advance technology agenda aligning business strategy and goals. The BRM will work regulatory, statutory & strategic programs and policies in collaboration with Program Managers and IT Leadership Team. The BRM is responsible for ensuring projects, work plans, and initiatives are implemented meeting business goals and objectives, in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships. 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. 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 Key Responsibilities 1. Act as a liaison between several functional departments to ensure projects and issues are tracked, updated, and reported out to ensure business stakeholders are appraised on program planning, implementation and/or execution status. 2. Understand and advocate for business and IT units, balancing the needs of our Members, Providers, and business units against the capabilities and resources to drive the appropriate technology for business success and increased performance. 3. Establish and maintain effective, positive, and productive working relationships at all levels with business and IT to ensure positive collaboration to identify, assess, and prioritize upstream and downstream impact of initiatives throughout the organization. 4. Engage with the Strategy Management department to update, track and monitor projects submitted via the Enterprise Project intake process ensuring projects are transitioned to IT for solution development and deployment. 5. Manage multiple large, high complexity, and high-risk issues and projects inclusive of business, regulatory, or technology deployments in coordination with IT PMO and/or business Special Project Managers. 6. Lead relevant committees, project governance workgroups while actively engaging stakeholders 7. Effectively lead large and small workgroups. Act as a liaison to the various cross functional team and ensures interdependencies are coordinated and aligned. 8. Effectively communicate the status of assigned projects to Executive leadership including risks, issues, barriers and recommended solutions. 9. Assist the work with external vendor(s) if needed in planning and implementing specific initiatives, and to manage the term of the vendor service agreement. 10. Coordinate, prepare, and monitor assigned department projects, documentation, and report outs to business stakeholders and IT leadership. 11. Monitor ongoing work plans and initiatives to ensure that interventions are completed to mitigate risks, issues, or project scope creep. Lead workgroups to solve specific business issues in coordination with IT PMO and/or business Special Programs Managers. 12. Measure and evaluate IT organization's program activities and outcomes in partnership with program sponsors by managing stakeholder expectations and analyzing performance metrics to ensure stakeholder satisfaction. 13. Lead and/or engage with business partners / stakeholders in preparation of program / project materials (data, reports, and any other documentation) for presentation to key program governance groups. 14. Coordinate and prepare documentation for standing IT Strategic Programs / leadership meetings where projects are reviewed and assessed by IT leadership. 15. Provide research, reporting, analytical support, and project management in the areas of issue resolution, implementation of regulatory changes and strategic projects, and processes that are in the best interest of supported business units. Conducts data gathering and analysis to understand business strategy requirements. 16. Capture process efficiencies developed through projects and incorporate LEAN and AGILE methodologies into project practices. 17. Engage with internal and external partners to identify opportunities for collaboration and align actions and processes to maximize program impact and efficacy. 18. Foster a technology-first approach is maintained across program strategic initiatives to support business growth plans. 19. When required or requested, lead, or assist with the development of Request for Proposals (RFP) for external products and/or services supporting IT Strategic Programs leadership. 20. Gather details for budgets needed and analysis for special projects or issue resolution as requested by department leadership. Qualifications Education & Experience Minimum of seven (7) years of Information Systems experience with a strong background in program management, program development, program evaluation, strategic planning, program operations and business acumen Bachelor's degree in Computer Science, Information Management or similar technical 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 Key Qualifications Must have a valid California Driver's License. Knowledge and proven track record of: Current business practices and computing systems; IT development methodologies and operations. IEHP's business processes and functional landscape. IEHP's IT systems and operations. Working with Compliance teams to determine solutions to help comply with regulations, APLs etc. Supporting strategic, regulatory and statutory programs and initiatives. Understanding of CMS and DHCS protocols and mandates. Program and project management and planning as well as Business process mapping. Complex heterogeneous technologies and the ability to synthesize new technical information into existing structures. Healthcare Industry and appreciation of IEHP's application landscape. Strong understanding of: Managed Care programs. Ability to consume CMS APLs & other documents and translate it for the IT teams. Legacy / Core Healthcare Payer systems integration with internal digital assets and external systems. Healthcare issues, trends, and concerns. Conceptualizing business strategies while implementing information systems and technology strategic direction. New IT landscape and solutions to help align the programs to new IT landscape. Excellent communication, verbal and written skills, and collaborative approach. Strong planning, organization, critical thinking, decision-making and problem-solving skills. Group presentation, analytical and organizational skills. Build and maintain business relationships. Express action-oriented and creative approaches to IT system issues and problems. Present issues and challenges to IT and/or business leadership. Listen effectively, respond to sensitive inquiries or complaints, be flexible with an ambiguous or changing environment. Work with a team of professionals from various disciplines. Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range USD $135,200.00 - USD $179,129.60 /Yr.
    $135.2k-179.1k yearly Auto-Apply 60d+ ago
  • Quality Improvement Facilitator I

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of management, the Quality Improvement (QI) Facilitator I assists in the facilitation of quality improvement initiatives, including planning, implementation, assessment, and monitoring. The QI Facilitator I possesses knowledge of fundamental quality improvement concepts; and is able to apply the techniques of system design, project management, continuous quality improvement (e.g., brainstorming, cause and effect analysis, root cause analysis), and outcomes measurements with minimal coaching or oversight. 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 & Requirements * Minimum of two (2) 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 preferred. * Bachelor's degree from an accredited institution required, degree preferably in Public Health, Health Administration, or other health care related field from an accredited institution. * Project Management Professional (PMP) Certification, Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate preferred. Key Qualifications * Foundational knowledge of: * Project management techniques, basic tools of continuous improvement, and work process redesign * Standard coding sets as they are used in quality measurement including ICD-10, CPT, CPT Category II, HCPCS, LOINC, NDC. * Strong analytical and critical thinking skills. Proficient in all Microsoft Office applications, with an emphasis on Excel, PowerPoint, and Visio. Strong communication skills (verbal, written and listening) with ability to interact effectively. Skilled in reading and interpreting data. * Ability to: * Must exhibit high attention to detail * Perform complex tasks, prioritize multiple projects and work under pressure to meet deadlines in a fast-paced environment * Successfully contribute to quality improvement projects to achieve optimal potential. Pay Range * $80,059.20 USD Annually - $106,080.00 USD Annually
    $80.1k-106.1k yearly 21d ago
  • Director, Reporting Analytics & Informatics

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! The Reporting Analytics & Informatics Director plays a key role in setting and upholding standards for analytics and reporting. This position manages the day-to-day operations of the reporting and analytics CoE, including organizing forums, maintaining processes and documentation, and overseeing project intake and prioritization. The Director, Reporting Analytics & Informatics ensures adherence to policies, supports initiative execution, and proactively addresses issues and risks. This role requires close collaboration with business partners and stakeholders to maintain consistency and quality in analytics and reporting practices. 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 Hybrid schedule 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 Oversee day-to-day operations and execution of the Center of Excellence (CoE) program and related initiatives. Coordinate and facilitate all CoE forums and working sessions, including the CoE Council, User Group Forums, and Steering Committee. Manage the CoE backlog by overseeing intake, prioritization, and tracking of initiatives, risks, issues, and other requests. Enforce process adherence by championing and monitoring CoE-aligned practices and standards. Maintain and socialize the repository of CoE processes and policies across the organization. Identify training needs, monitor development efforts, and maintain the training catalog to ensure continuous learning. Track program success by benchmarking and monitoring KPIs and developing action plans when KPIs fall short. Lead the Reporting and Analytics team, ensuring the delivery of high-impact insights and data support. Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements Minimum of 7 years of experience in a health plan or other healthcare related organization, inclusive of data project management experience, and leadership of a small to medium team (5+ people) Experience with technical data product delivery (e.g., ETL, data modelling, reporting development) Experience with reporting and analytics governance Bachelor's degree in computer science, MIS, or information management or a related field from an accredited institution required Master's degree in computer science, MIS, or information management preferred Key Qualifications Knowledge of reporting and analytics best practices and common tools used (e.g., Power BI, SAS) Knowledge of project management, meeting facilitation, backlog management, and project prioritization Knowledge of data delivery lifecycle (i.e., development, testing, production) Knowledge of common health plan reporting and analytics use cases Apply knowledge and experience to motivate team to meet organizational goals Highly developed skills in priority setting and alignment of project priorities with Departmental strategy Highest personal and professional integrity and strong work ethics Ability to articulate vision of transformation efforts and a sense of mission Willingness to take change and provide direction Results orientation, willingness to commit to a direction and drive operations to completion Demonstrated ability to manage adversity and challenging situations Ability to manage relationships and drive collaboration and alignment across business & technical audiences Ability to develop cooperative and constructive working relationships Ability to handle complaints, settle disputes and resolve conflicts and negotiate with others Collaborative team player orientation towards work relationships, strong culture awareness Ability to break down complex problems and projects into manageable goals Ability to get to the heart of the problem and make sound and timely decisions to resolve problems Schedule may adjust based on business need which may include evenings, holidays, and weekends Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $193,003.20 - USD $265,387.20 /Yr.
    $193k-265.4k yearly Auto-Apply 18d ago
  • Analyst II - Policy & Regulatory Operations

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the Policy & Regulatory Operations Manager's general supervision, the Analyst II - Policy & Regulatory Operations helps ensure Health Services, Quality Systems, Provider Services, and Member Services remain in compliance with Local, State, Federal, contractual and accreditation requirements and supports these departments' operational strategies by completing compliance assessments, regulatory reviews and audit‐related submissions; managing cross‐functional regulatory implementation, operational and system enhancement projects. The Analyst II - Policy & Regulatory Operations is responsible for Local, State, Federal, contractual and accreditation requirements interpretation, gap analysis, project scope develop and initiation, resource planning, risk identification and project implementation, as well as timely comprehensive review and maintenance of internal and Provider policies. for the purpose of gap analysis, project scope development and initiation, resource planning, risk identification, and project implementation, as well as timely and comprehensive review of internal and Provider policies. To do these effectively, the Analyst II - Policy & Regulatory Operations must have a clear understanding of IEHP business operations and the responsibilities of various departments in Health Services, Quality Systems, Provider Services, and Member Services, and demonstrated ability to effectively and consistently manage multiple projects and priorities concurrently. 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 * 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 * At least three (3) years of experience providing 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 * Must have a valid California Driver's license * 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 preferred * Must have strong organizational skills * Must have strong critical thinking, research, verbal, and written communication skills * Demonstrated proficiency in Microsoft Office products: Word, Excel, Visio, and Power Point, sufficient for use in all aspects of an office environment * Must have the ability to manage multiple projects with competing deadlines and changing priorities * Must have the ability to work well in a team environment and build effective relationships with Team Members at all levels * Must be detail oriented * Exceptional follow‐through to track all outstanding tasks and ensure these are completed timely * While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and lift or move up to 25 pounds * Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $80,059.20 USD Annually - $106,059.20 USD Annually
    $80.1k-106.1k yearly 25d ago
  • Developer III - Application Development (Data Integration)

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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 IT Department Leadership, the Developer III - Application Development is responsible for development, modification, and implementation of Inland Empire Health Plan's internal/external applications. The Developer III - Application Development is considered a Senior Developer position and is responsible for offering guidance to junior personnel. 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 Hybrid schedule 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 Gather project requirements and document business solutions. Execute full lifecycle of software development (Agile/DevOps). Communicate efficiently/effectively with all internal/external business entities. Create well designed, testable efficient code. Assist in generating test cases for new and existing applications. Design, develop and implement software independently or within a team. Serve as a subject matter expert in key businesses projects. Conduct code reviews and provider manful feedback. Analyze software errors to define and create tools that help mitigate problems. Train Team Members in coding standards and best practices. Collaborate with team members and contribute ideas for improving development workflows. Implement automation tools and frameworks (CI/CD pipelines). Conduct systems test before releasing software. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements At least five (5) years of experience developing multi-tiered, efficient, highly responsive web applications required Candidates must possess solid work experience in client-side browser centric or middle-tier/back-end service development Hands-on experience with Microservices architecture and event-driven model utilizing Rabbit MQ and Kafka Experience with MongoDB: schema design, indexing strategies, replication, and performance optimization for large datasets Experience in configuring an IIS/NGINX/PHP web server, Docker containers, PHP, and Linux OS (Redhat/Debian/Apline) is preferred Experience integrating data across systems preferred(e.g., APIs, flat files, cloud storage, HDFS, etc.) Bachelor's degree in a science-related field of study from an accredited institution required, degree preferably in Computer Science 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 Key Qualifications Deep comprehensive knowledge in the following areas: Knowledge in the server-side development stack utilizing .Net, C# and SQL Server Ability to design and implement complex, scalable, and maintainable enterprise solutions using .NET and modern architectural patterns Acute analysis, observation, and good communication CI/CD pipelines, automated builds, and deployment processes Ability to utilize REST and SOAP webservices Preferred Knowledge: Knowledge of Healthcare domain Knowledge of EDI 834 message format Familiarity with data exchange standards (e.g., HL7, FHIR, CCDA). Knowledge of Python Data Integration & Interoperability: Expert-level SQL development and SQL Server: database design, query optimization, stored procedures, and performance tuning. T-SQL, stored procedures, data governance, performance tuning, indexing strategies SSIS (SQL Server Integration Services): advanced ETL package design, deployment, and troubleshooting Knowledge of .Net Core & .Net Frameworks (C#), including advanced concepts such as asynchronous programming, dependency injection, design patterns, Rest API development, Message Bus technologies, and more Proven ability to: Work well in a team and be a strong team player with ability to mentor junior developers, perform code reviews, and enforce coding standards Quickly learn new technologies, tools, and frameworks to stay aligned with evolving project needs Take ownership of projects and drive solutions independently Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $118,601.60 - USD $157,144.00 /Yr.
    $118.6k-157.1k yearly Auto-Apply 17d ago
  • Analyst II - Policy & Regulatory Operations

    Inland Empire Health Plan 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the Policy & Regulatory Operations Manager's general supervision, the Analyst II - Policy & Regulatory Operations helps ensure Health Services, Quality Systems, Provider Services, and Member Services remain in compliance with Local, State, Federal, contractual and accreditation requirements and supports these departments' operational strategies by completing compliance assessments, regulatory reviews and audit‐related submissions; managing cross‐functional regulatory implementation, operational and system enhancement projects. The Analyst II - Policy & Regulatory Operations is responsible for Local, State, Federal, contractual and accreditation requirements interpretation, gap analysis, project scope develop and initiation, resource planning, risk identification and project implementation, as well as timely comprehensive review and maintenance of internal and Provider policies. for the purpose of gap analysis, project scope development and initiation, resource planning, risk identification, and project implementation, as well as timely and comprehensive review of internal and Provider policies. To do these effectively, the Analyst II - Policy & Regulatory Operations must have a clear understanding of IEHP business operations and the responsibilities of various departments in Health Services, Quality Systems, Provider Services, and Member Services, and demonstrated ability to effectively and consistently manage multiple projects and priorities concurrently. 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 Hybrid schedule 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 Responsible for planning and managing 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. In collaboration with department policy owners, review, update and manage internal and Provider policies for their assigned department(s) 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 compliance and/or operational risks as well as upstream and downstream impacts of policy changes on other department(s) and/or documents; and defining and summarizing the degree and description of change. Facilitate the timely and comprehensive assessment or examination of current policies 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. Responsible for identifying, gathering, developing, and bookmarking evidence and/or narratives for regulatory and/or audit‐related submissions. Facilitate 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, implementation, and ensuring the development and implementation of compliance monitoring at the department level. At the direction of the Policy and Regulatory Operations Manager, support departments in the completion of their system enhancement and/or process development requests by facilitating the development and documentation of process flow, standard work, and business requirements, as well as testing and validating system enhancements prior to implementation. Serve as the primary analyst reviewer and support for their assigned department(s). This responsibility includes preparing draft work output for quality assurance review by the Policy and Regulatory Operations Manager or Analyst III. Perform a broad range of project management and research activities, using analytical and critical thinking skills. Support departments in Health Services, Quality Systems, Provider Services, and Member Services to make Lean business decisions by identifying and communicating identified opportunities for process improvements. Qualifications Education & Requirements At least three (3) years of experience providing 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 Must have a valid California Driver's license 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 preferred Must have strong organizational skills Must have strong critical thinking, research, verbal, and written communication skills Demonstrated proficiency in Microsoft Office products: Word, Excel, Visio, and Power Point, sufficient for use in all aspects of an office environment Must have the ability to manage multiple projects with competing deadlines and changing priorities Must have the ability to work well in a team environment and build effective relationships with Team Members at all levels Must be detail oriented Exceptional follow‐through to track all outstanding tasks and ensure these are completed timely While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and lift or move up to 25 pounds Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $80,059.20 - USD $106,059.20 /Yr.
    $80.1k-106.1k yearly Auto-Apply 60d+ ago
  • Manager, Clinical Programs

    Inland Empire Health Plan 4.7company rating

    Rancho Cucamonga, CA job

    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! The Manager, Clinical Programs designs and implements clinical programs, initiatives, and pilots to strategically advance IEHP strategic priorities and goals to improve quality to members, providers, and hospital partners. In this role, the Manager, Clinical Programs provides oversight of identified initiatives, including planning, organizing, and collaborating with key internal and external stakeholders. In this role, the individual also ensures the programs are in line with IEHP strategic quality goals and objectives and are conducted and executed effectively. This position provides support to all hospitals and ancillary services, ensuring that the Joint Operation Meetings are running smoothly, mitigating issues, finding resolution, managing daily operations of the work groups and activities of the team, and working with internal and external stakeholders to leverage their part of the program. 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 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 Key Responsibilities Guide others at a strategic business level to ensure initiatives, programs, or pilots are in line with IEHP strategic goals that foster clinical care transformation. Develop innovative solutions and optimize services in collaboration with internal and external stakeholders (i.e., Hospital Partners, SNFs, PCPs, etc.) that are efficient and effective that better serve Members. Oversee all aspects of program operations: initiation, planning, development, and monitoring. Participate in the research and selection process of vendors. Track contract expectations, communication, budgets, performance metrics and timelines. Prepare, oversee, and review documents that are related to assigned clinical projects. Consult with all levels of senior management, make recommendations, and influence decision making that may involve the creation of new projects or programs to mitigate challenges being experienced. Evaluate the availability of necessary resources for the execution of hospital-related and ancillary-related clinical projects. Leverage cross functional relationships with vendors, hospital partners, external consultants, and IEHP Team Members to review and create programs and services. Collaborate closely with Quality and Compliance for alignment with data reporting and project compliance. Determine key business issues including resolution; take part in procedure/process improvement initiatives and mitigate enterprise risk. Demonstrate thought leadership and cross functional collaboration within the IEHP environment. Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements Minimum of at least five (5) years of prior relevant experience Requires at least three (3) years of experience in health plan or hospital setting Experience in Quality improvement and utilization management Writing clinical procedures and other clinical documents is preferred Bachelor's degree in any Science or Health Related field from an accredited institution required Master's degree in any Science or Health related field from an accredited institution preferred PMP Certification Preferred Possession of an active, unrestricted, and unencumbered license issued by appropriate California state board required: LVN RN LCSW/LMFT Other active, unrestricted, and unencumbered related licenses (PT, OT, ST, etc.) In lieu of a professional clinical license, five (5) additional years of hospital operations experience will be accepted (ten (10) years of experience in total including the minimum experience requirements listed above) Key Qualifications Knowledge of: Health Plan or Hospital Federal, State and Accreditation Requirements Care Coordination and Transition Management processes Principles of performance improvement and program design Risks and liabilities, as well as budget and performance metrics Good problem-solving, organizational, and leadership skills are required Proficient user of basic computer applications for the execution of daily project operations Must possess excellent communication skills so as to be able to effectively convey messages across to both study team members and other external parties like vendors and external consultants Ability to organize and motivate other members in the project team. Must be able to work as part of a team. Attention to detail at all times. Must be able to work within a dynamic environment, including managing multiple projects, and pivot or change direction as needed. Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range USD $118,601.60 - USD $157,144.00 /Yr.
    $118.6k-157.1k yearly Auto-Apply 60d+ ago
  • Nurse Informaticist

    Inland Empire Health Plan 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of Manager, Clinical Informatics and in collaboration with IT and Quality Leadership, the Nurse Informaticist leverages critical thinking, clinical workflow expertise, analytics, and change management strategies to identify and facilitate the adoption of clinical information systems and technologies that support and improve the accurate capture and reporting of data elements that ultimately improve the clinician and patient experience, quality reporting and outcomes. The Nurse Informaticist serves as the primary liaison between external clinical teams and IEHP operations, quality and information technology. The Nurse Informaticist identifies opportunities and facilitates the identification and implementation of solutions utilizing evidence-based practices, data, regulatory requirements, and quality improvement techniques. The Nurse Informaticist is responsible for enhancing the nursing and clinical teams' use of technology and analytics to improve the health of populations. 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 Hybrid schedule 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 Utilize data to drive process, workflow, and behavior change as it relates to appropriate and efficient use of electronic health records and clinical technologies. This includes standardization of templates to capture and report metrics that impact outcome and quality measures. Facilitate the development and incorporation of clinical guidelines for major reportable disease conditions and measures using established (and yet to be established) subcommittees, advisory councils and similar structures as approved by the organization. Document specifications that will translate into the development of tools, reports, and systems that support organizational priorities. Utilize industry-standard tools (e.g. spreadsheets, swim lane diagrams, etc.) to document and analyze systems to ensure comprehensive solutions that meet process improvement goals and integrate into clinical workflows. Identify, evaluate, and develop plans for introducing technology-based innovations that will increase efficiency, reduce waste, or solve problems within the organization. Maintain a working knowledge of licensing, regulatory, and compliance factors related to clinical information system usage. Collaborate in the development and ongoing review of system related policies, procedures, and competencies. Assure that technologies and workflows align where appropriate. Serve as a resource for end users for information systems and technology. Effectively communicate and educate system changes, workflow process changes, downtime procedures, and relevant information to clinical teams. Collaborate and consult with internal and external clinicians, vendors, academic programs, and healthcare organizations to share knowledge and experiences to determine the best possible technologies and solutions for the organization and improve patient care. Incorporate informatics theories, principles, and concepts to evaluate the impact of technology on clinical practice and patient outcomes and informs opportunities for optimization and improvement. Act as a change agent, driving organizational change management to ensure successful adoption and maximize value for the healthcare team and patient care. knowledge and information. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements Minimum of five (5) years or more of nursing experience inclusive of two (2) or more years of experience in informatics functions Experience in enterprise grade EMR build/maintenance, preferably Epic or Cerner preferred Bachelor's degree in Nursing from an accredited institution required Accompanying Bachelor's degree in Informatics or a related field from an accredited institution preferred Master's degree in Informatics or a related field from an accredited institution preferred Quality-based certification a plus Certification in informatics or related fields preferred Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Key Qualifications Advanced knowledge and understanding of: Informatics and Quality principles. Healthcare Data Analytics Compliance management Stakeholder management Change management Nursing principles Project management Excellent written and verbal communication and interpersonal skills Strong organizational skills Strong critical thinking skills required Strong word processing skills involving computer keyboard and screens Proven ability to: Demonstrate sound analytical reasoning. Manage multiple projects with competing deadlines and changing priorities and be detailed oriented. Work well in a team environment and build and maintain effective working relationships with Team Members and stakeholders at all levels. Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $104,041.60 - USD $137,841.60 /Yr.
    $104k-137.8k yearly Auto-Apply 60d+ ago
  • Government Affairs Manager

    Inland Empire Health Plan 4.7company rating

    Rancho Cucamonga, CA job

    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 and under the general direction of the Director of Government Affairs, the Government Affairs Manager is responsible to lead the management and oversight of the execution of the government affairs role for Medi-Cal, Medicare, and commercial lines of business. The Government Affairs Manager plays a key role in crafting and shaping federal and state legislative and regulatory policy issues for the benefit of IEHP. The Government Affairs Manager has an active and visible lead role with the state and federal advocacy associations and legislative offices. The Government Affairs Manager serves as a lead liaison for IEHP with state and federal trade associations and legislative staff, and positions IEHP as a key influencer, maintaining relationships with advocacy groups and legislative staff. This position works collaboratively with other departments within the Plan acting as a resource to provide analysis and interpretation of draft state and federal legislative and regulatory guidance, and work with Business Units to ensure advocacy issues are presented accurately and in a compelling manner. Additionally, the Government Affairs Manager works closely with the managers in the Compliance Department to ensure seamless services to Business Units and effective advocacy, as well as with other Managers within the Plan to ensure alignment, understanding and follow through of priorities. 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 Hybrid schedule 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 In collaboration with the Director of Government Affairs, lead the day-to-day operations of the Government Affairs Department in the most effective manner to meet Plan, department, and unit objectives while ensuring quality and accuracy of the work. Implement standardized processes to maximize efficiency. Train and educate Government Affairs Team Members to ensure they are equipped to provide and carry out actionable legislative and regulatory advocacy recommendations. Develop and implement a government affairs calendar of duties. Identify, direct, and maintain Government Affairs metrics for the purpose of driving process improvements and efficiencies. Assume a lead role within the organization and oversee the interpretation of complex federal and state legislative and regulatory draft and final guidance. Guide the Government Affairs TMs to serve as a resource to ensure that Business Units are provided with legislative and draft regulatory support to ensure understanding and early identification to barriers for compliance. This includes overseeing the interpretation, and distribution of draft federal regulations, All Plan Letters (APLs), Policy Letters (PLs), Covered California guidance, etc. Lead, guide, manage, and attend, as appropriate, relevant committees and work groups, make presentations, prepare reports, data, or other materials. These may include workgroups convened by trade associations, legislators, and regulatory agencies. Lead and oversee Government Affairs active participation of various trade association and regulatory agency calls. Work closely with the Director of Government Affairs to support the CEO, and Plan leadership, in fostering strong relationships with legislators and regulatory agencies. Oversee and manage the development of memos to provide analysis on key emerging issues. Serve as the primary state and federal trade association liaison by establishing collaborative working relationships with all contracted lobbyists and advocacy associations. Partner with the Compliance Department to ensure advocacy concerns are coordinated and shared directly with regulators. Oversee and facilitate resolution of high-visibility, escalated requests, and issues from elected official offices, including but not limited to Member cases, Provider cases, and Enforcement Matters. Communicate to all levels of the Plan to ensure support, awareness, and effectiveness of new and emerging issues impacting Federal and State statutes, and regulations impacting all lines of business. Cultivate an effective system for ensuring that legislative and regulatory compliance concerns are continually reviewed and creative opportunities for addressing concerns are sought. Organize and plan for visits from legislators and legislative staff, as well as state and federal trade associations. Partner with operational areas to ensure continual understanding of internal operational policies and procedures for all lines of business. Develop, centralize, and maintain policies, procedures, training materials and oversees training completion. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Qualifications Education & Requirements : Five (5) years with managed care health plan or other relevant healthcare industry experience specific to government affairs legislative and regulatory advocacy Comprehensive advocacy experience, with direct experience interacting with regulators, legislative staff and state and federal trade associations Preferred: A minimum of one (1) year experience in project management : Bachelor's degree in Public/Business Administration, Health, Political Science, Public Policy or a relevant field from an accredited institution required Preferred: Master's degree in Public/Business Administration, Health, Political Science, Public Policy or a relevant field Key Qualifications Must have a valid California Driver's license Strong knowledge and understanding in the following areas: Medicaid, Medicare, and commercial health insurance Managed care and government-sponsored health care delivery systems County, state, and federal legislative and budget processes Policy, legislative and regulatory implications to an organization and effective advocacy strategy and tactics Principles of effective project management, effective survey tools, business impact analysis and report writing Team building, strategic planning, and organizational and project management Cross-organization coordination Understanding and sensitivity to a multi-cultural environment and community. State and federal legislative and budget process Effective advocacy strategies, including effective partnerships with state and federal trade associations Federal and state regulatory requirements related to lines of business included in IEHP's business portfolio Possesses strong skillsets in the following areas: Strong leadership and excellent interpersonal skills Excellent verbal and written communication skills High level analytical skills and ability to analyze complex regulatory and legislative proposals Project management skills Issue management skills Microcomputer applications: spreadsheet, database, and word processing Ability to translate legislation and regulatory guidance into meaningful and actionable information Strong writing, interpersonal communication, organizational skills Proven ability to: Understand, incorporate, and demonstrate the mission, vision, and values of the Plan in behaviors, practices, and decisions Maintain a high level of diplomacy Be resourceful and independent in problem solving and self-direction Establish and maintain effective working relationships with internal departments and external agencies and offices of elected officials Embrace and champion change to accommodate evolving organizational and regulatory processes Work independently and collaboratively within a team environment Manage multiple projects with competing deadlines and changing priorities Possess a strong attention to detail and exceptional follow through Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $104,041.60 - USD $137,841.60 /Yr.
    $104k-137.8k yearly Auto-Apply 36d ago
  • Developer I - BI & Analytics

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of the Supervisor, BI & Analytics, the Developer I - BI & Analytics is responsible for creating, maintaining and updating IEHP enterprise reports and dashboard. The position also serves as the technical support for all reporting projects within the BI & Analytics team. The role is expected to design and develop scalable solutions using AI tools and machine-learning models; utilizes big data computation and storage tools to create prototypes and datasets. Proficient with multiple AI tools such as Python, Java, or R and machine learning frameworks like Spark, TensorFlow, or Sciket-learn. 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 Hybrid schedule 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 Model and support enterprise data warehouse, data marts and cubes in the creation of a modern, highly effective enterprise reporting platform at IEHP following industry best practices and patterns Contribute to the technical development of reporting and analytical solutions for IEHP business stakeholders that provide critical insight into business performance. Collaborate with other IEHP departments and data stewards to assess and prioritize needs, and assist with developing strategies, plans, policies and procedures related to providing effective reporting solutions. Identify, analyze and interpret trends or patterns in complex data sets, draw meaningful business insight and translate them to a self-service report Identify and communicate issues and risks to management in a timely manner Contribute towards reporting security requirements, architecture, design and implementation, including the definition of comprehensive security controls to enforce the IEHP security strategy Contribute to development and enforcement of IEHP reporting standards Gather, select, compile and analyze health plan data, with emphasis on data maintained with data warehouse Establish and maintain effective working relationships with others throughout the IEHP organization Demonstrate a commitment to support IEHP's strategic priorities to become a 5-Star Health Plan and incorporate LEAN principles into daily work. Qualifications Education & Requirements One (1) or more years in analytics, data science and business intelligence Experience in developing reporting using Business Intelligence tools (such as Tableau, Microsoft Power BI, MicroStrategy) Experience in report writing and analysis, including experience working with large data sets that have complex relational designs and with unstructured data sets Experience in database design, query development, table joins and report development and creation Data analysis experience in the areas of medical or health services is preferred Bachelor's degree in a quantitative field from an accredited institution required Key Qualifications Working knowledge of diagnosis and procedure coding, medical terminology, knowledge of managed care, claims payment processes, and insurance terminology required Knowledge of data visualization and Business Intelligence tools is required (such as Tableau, Microsoft Power BI, MicroStrategy) Strong data analysis, data presentation, spreadsheet, and database capabilities Strong expertise in the Microsoft platform for business intelligence and reporting: Microsoft SQL Server, SSAS, Power BI, SSRS, Access and Excel Strong analysis and critical thinking skills Excellent interpersonal/ communication skills Proven ability to: Multi-task while maintaining careful attention-to-detail Handle multiple projects, data input, and strong problem-solving capability Be an independent self-starter who is driven to success, takes great pride in accomplishments and works with a sense of urgency to meet deadlines and address competing priorities Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $91,249.60 - USD $120,910.40 /Yr.
    $91.2k-120.9k yearly Auto-Apply 18d ago
  • Director, CAHPS Performance

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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 Director of CAHPS Performance is responsible for designing, leading, and executing strategies to improve Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance across all of IEHP's product lines (Medi-Cal, Medicare DSNP, Covered CA). This role drives measurable improvement in member experience, Star Ratings, Health Plan Ratings and quality performance by integrating voice-of-the-member insights into enterprise strategy, operations, and provider engagement. The Director serves as a change leader and subject matter expert, ensuring the organization consistently delivers exceptional member experience that meets regulatory expectations and strengthens market competitiveness. 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. 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 & Requirements * A minimum of eight (8) years of progressive leadership experience in health plan quality, member experience, or related roles required. * Proven success in designing and implementing CAHPS/member experience improvement strategies required. * Bachelor's degree in healthcare administration, public health, business, or related field from an accredited institution required. * Master's degree in healthcare administration, public health, business, or related field from an accredited institution preferred. Key Qualifications * Deep knowledge of CAHPS survey methodology, Star Ratings, and Medicaid quality requirements. * Member-centered mindset, with passion for improving care experiences. * Strong analytical, communication, and change management skills. * Data-driven and outcomes-focused. * Ability to lead cross-functional initiatives and influence at all levels of the organization. * Strategic and operational balance: able to set vision while driving execution. * Collaborative leader skilled at provider and stakeholder engagement. Pay Range * $169,312.00 USD Annually - $232,793.60 USD Annually
    $169.3k-232.8k yearly 21d ago
  • Engineer III - Network

    Inland Empire Health Plan 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of the Director, Technology - Infrastructure Services, the Engineer III - Network will be responsible for administration and maintenance of the IEHP's Local Area Network (LAN) and Wide Area Network (WAN) which are Cisco Network systems. The Engineer III responsibility will be to ensure the stable operation of the in-house computer and systems network(s). This includes planning, developing, installing, configuring, maintaining, supporting, and optimizing all Network Appliance Hardware and software, and all communication circuits. 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 Hybrid schedule 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 Implement and maintain all of IEHP's Cisco Platforms, including Catalysis, Nexus, ISR, ASR, ASA and Wireless Controller with AirOnet Access Point, Palo Alto Firewalls and T1, Layer 2, MPLS WAN circuits. Provide ongoing technical support to remote area networks, Internet, and VPN communications. Troubleshoot network usage, perimeter security and all network appliances. Develop and implement policies and standards to ensure security procedures are followed. Build networks and maintains external and internal web presence, administers the networks. Perform Network Systems Appliance backups on internal and external Backbone Devices. Document network infrastructure and design. Assist with space planning associated with network infrastructure needs. Research, order, configure, and administer WAN circuits. Work with vendors, clients, carriers, and technical staff on network implementation, optimization, and ongoing management. Assist in design, installation, and management of network security solutions. Provide level 3 support on client level IT issues resulting in production downtime. Qualifications Education & Requirements Minimum eight (8) years of Network Design and Administration hands on experience with Palo Alto Networks, Cisco routers, switches and security solution and Cisco recommended best practices Bachelor's degree with a major in computer related field or similar technical field from an accredited institution required Cisco Certified Network Professional (CCNP) certification preferred Key Qualifications Must have a valid California Driver's License Extensive knowledge in TCP/IP and multi-routing protocols Working knowledge of all Cisco Platforms, including Cisco-ACI, DNAC, ISE, SDA, Catalyst, Nexus, ISR, ASR, ASA and Wireless Controller with AirOnet Access Point, Palo Alto Firewalls and T1, Layer 2, MPLS WAN circuits Strong planning, organization, critical thinking, decision-making and communication (verbal and written) skills Projects involving lift server appliance weighs up to 50 lbs. and heavy eye strain with computer monitors Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.) Pay Range USD $118,601.60 - USD $157,144.00 /Yr.
    $118.6k-157.1k yearly Auto-Apply 60d+ ago
  • Security Operations Engineer III-IAM

    IEHP 4.7company rating

    Rancho Cucamonga, CA job

    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! Under the direction of the Manager, Information Security Operations, the Security Operations Engineer III - IAM (Identity Access Management) is an experienced senior level cybersecurity engineering position primarily responsible for the designing, implementation and maintaining of identity and privilege access management systems and processes. This position will also be a subject matter expert in cybersecurity that will engineer, implement, support, and maintain cybersecurity solutions as needed to support the organization's cybersecurity and information security programs. Other duties include security tool monitoring, incident response, automating response activities to prevent and or limit impact of adverse security incidents, maintain documentation related to policies, standards, and procedures; mentor team members; and provide consultative services to teams and stakeholders to improve the security posture of their environments. 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; we also aim to match our Team Members with the same energy by providing prime benefits and more. CalPERS retirement 457(b) option with a contribution match Generous paid time off- vacation, holidays, sick State of the art fitness center on-site Medical Insurance with Dental and Vision Paid life insurance for employees with additional options Short-term, and long-term disability options Pet care insurance Flexible Spending Account - Health Care/Childcare Wellness programs that promote a healthy work-life balance Career advancement opportunities and professional development Competitive salary with annual merit increase Team bonus opportunities Key Responsibilities The below responsibilities are for the purpose of maintaining IT security operations functions and ensuring data protection for IEHP's members and providers. 1. Design, implement and maintain of identity access management and privileged access management systems and processes. 2. Monitor cybersecurity detection tools and respond to incidents. 3. Design, implement, maintain, administer, and provide training on cybersecurity detection and protection platforms. 4. Manage security incident response; serve as escalation point for conducting investigations into security incidents involving advanced and sophisticated threat actors and TTPs 5. Design, test, and implement response playbooks, orchestration workflows and automations. 6. Research, recommend and test new security technologies and platforms 7. Architect cybersecurity solutions for on premises and cloud computing environments 8. Participate in and \ or leads cybersecurity engineering projects. 9. Assist with risk analysis activities. 10. Assist with designing and implementing controls to mitigate risk. 11. Document, prioritize, and formally report incidents, root cause analyses, and after-action reviews. 12. Coordinate between internal and external resources protecting enterprise systems. 13. Periodically attend and participate in change management policy discussions and meetings. 14. Motivate Team Members to maximize rigorous system security controls, focusing on reducing complexity and maturing security practices. 15. Work as a team player to consistently learn and share advanced skills and foster team excellence. 16. Any other duties as required ensuring Health Plan operations are successful. Qualifications Education & Experience Eight plus (8+) years IT hands on technical experience with at least five (5) years in a cybersecurity role with a focus on IAM, PAM, JIT access, and cybersecurity detection, protection, and response. Scripting experience such as PowerShell, JavaScript, or Python. Experience with the 3rd party IAM \ PAM applications Risk mitigation strategies TCP/IP networking. Defense in Depth strategies Security Operations Tools such as SIEM, EPM, DLP, Vulnerability scanners, Firewalls, WAFs, Antivirus Solutions, Email Protection Solutions, Identifying indicators of compromise and indicators of attack Mitre ATT&CK and Cyber Kill Chain frameworks Computer operating systems such as Windows, MacOS and Linux Bachelors degree with a major in computer related field or similar technical field from an accredited institution required In lieu of the required degree, a minimum of four (4) years of additional cybersecurity work experience is required for this position Key Qualifications Strong planning, organization, critical thinking, decision-making and communication (verbal and written) skills Mentoring skills Proven ability to: Work as member in a team Be flexible and adaptable to change in a dynamic work environment Learn and apply new concepts Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range USD $118,601.60 - USD $157,144.00 /Yr.
    $118.6k-157.1k yearly Auto-Apply 18d ago

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