Job description

People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliate, Imperial Insurance Companies, Imperial also offers Medicare Advantage plans in Texas, New Mexico, Utah, and Arizona.

Our Mission: To deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.

Our Vision: To deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome.

THIS IS IN-OFFICE - NO REMOTE IS AVAILABLE

JOB SUMMARY: Supervise the daily activities in the accounting department, analyze, records, track, and audit financial information, and manage accounting staff members.

ESSENTIAL JOB FUNCTIONS:

1. Lead Quality initiatives relating to improving HEDIS, CAHPS Accreditation and STAR measures working closely with clinical teams, CHO, and Quality department to improve STAR measures.

2. Collaborate with Clinical Data Manager to improve risk adjustment/STARS and develop ongoing monitoring for QI Program Initiatives.

3. Lead medical records review NCQA, HEDIS, CMS and state performance measures including data extraction, processing, medical record review, survey, audit, and report submission to regulatory/ accreditation bodies.

4. Develop and execute training for delegated IPA’s and risk adjustment on quality measures and clinical gaps in care.

5. Partnering with clinical teams to assist with the completion of health risk assessments, wellness visits, interdisciplinary team meetings, and individual care plans.

6. Researching and developing quality improvement programs to provide services that lead to better healthcare outcomes. (i.e, best practice strategies to blueprint at Imperial).

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

· Bachelor's degree, RN, CPHQ, CCS, CCS-P, RHIT, RHIA, CDEO, CPMA, CPC, CRC, CHCA or similar credential

· Seven (7) or more years of experience in health care quality focused roles that included medical record audits and/or performance metric i.e., HEDIS, Stars, or similar

· Significant experience in quality measurement, HEDIS, interpretation of claims data, medical record review

· Successful experience managing complex projects beginning to end with accountability for outcomes, demonstrated organizational and project management skills to manage complex projects through effective planning, tracking, and resource allocation to meet business objectives and timelines

SKILLS/KNOWLEDGE/ABILITY:

· Quality Program Manager supports the Clinical Quality teams for quality improvement programs design and development by leadership.

· Lead medical records reviews NCQA, HEDIS, CMS and state performance measures including roadmaps, data extraction, processing, medical record review, survey, audit, and report submission to regulatory/accreditation bodies).

· Strong analytic skills/ability to translate complicated data into useable information, including analysis of practice variation

Job Type: Full-time

Pay: $68,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Vision insurance

Experience level:

• 7 years

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• Pasadena, CA: Reliably commute or planning to relocate before starting work (Required)

Work Location: One location

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