Inland Empire Health Plan
Analyst II – Policy & Regulatory Operations
Inland Empire Health Plan, Rancho Cucamonga, California, United States, 91739
Overview
Overview:
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. Commit to IEHP’s quality program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Benefits
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, including regulatory compliance, system enhancement, process development, and improvement within Health Services, Quality Systems, Provider Services, and Member Services. This includes defining project scope, goals, deliverables; developing, monitoring, and maintaining a detailed project plan; managing changes to scope, schedule, and deliverables; communicating risks; maintaining stakeholder relationships; reporting status and barriers to management; and creating comprehensive project documentation.
In collaboration with department policy owners, review, update and manage internal and Provider policies to ensure currency and alignment with regulatory and accreditation requirements. Support the management and publication of IEHP Provider Manual of Policies and Procedures, electronic Data Interchange (EDI) Manual and internal departmental manuals; research, review and cite regulatory requirements; identify compliance and/or operational risks and impacts of policy changes; define and summarize changes.
Facilitate timely and comprehensive assessment of current policies and procedures against new regulations to identify compliance gaps and action plans.
Identify, gather, develop, and bookmark evidence and narratives for regulatory and/or audit-related submissions.
Facilitate cross-functional implementation projects that support compliance with Local, State, Federal, contractual and accreditation requirements, including interpretation, gap analysis, scope development and initiation, resource planning, risk identification, implementation, and monitoring.
At the direction of the Policy and Regulatory Operations Manager, support departments in system enhancements and process development by documenting process flow, standard work, and business requirements; assist in testing and validating system enhancements prior to implementation.
Serve as the primary analyst reviewer and support for assigned department(s), 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 opportunities for process improvements.
Qualifications
At least three (3) years of experience providing analytical and/or project implementation support, including 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
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
Physical requirements: ability to stand, walk, sit, use hands, and lift or move up to 25 pounds; vision requirements include close, distance, color, peripheral, depth perception, and ability to adjust focus
#J-18808-Ljbffr
Overview:
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. Commit to IEHP’s quality program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Benefits
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, including regulatory compliance, system enhancement, process development, and improvement within Health Services, Quality Systems, Provider Services, and Member Services. This includes defining project scope, goals, deliverables; developing, monitoring, and maintaining a detailed project plan; managing changes to scope, schedule, and deliverables; communicating risks; maintaining stakeholder relationships; reporting status and barriers to management; and creating comprehensive project documentation.
In collaboration with department policy owners, review, update and manage internal and Provider policies to ensure currency and alignment with regulatory and accreditation requirements. Support the management and publication of IEHP Provider Manual of Policies and Procedures, electronic Data Interchange (EDI) Manual and internal departmental manuals; research, review and cite regulatory requirements; identify compliance and/or operational risks and impacts of policy changes; define and summarize changes.
Facilitate timely and comprehensive assessment of current policies and procedures against new regulations to identify compliance gaps and action plans.
Identify, gather, develop, and bookmark evidence and narratives for regulatory and/or audit-related submissions.
Facilitate cross-functional implementation projects that support compliance with Local, State, Federal, contractual and accreditation requirements, including interpretation, gap analysis, scope development and initiation, resource planning, risk identification, implementation, and monitoring.
At the direction of the Policy and Regulatory Operations Manager, support departments in system enhancements and process development by documenting process flow, standard work, and business requirements; assist in testing and validating system enhancements prior to implementation.
Serve as the primary analyst reviewer and support for assigned department(s), 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 opportunities for process improvements.
Qualifications
At least three (3) years of experience providing analytical and/or project implementation support, including 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
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
Physical requirements: ability to stand, walk, sit, use hands, and lift or move up to 25 pounds; vision requirements include close, distance, color, peripheral, depth perception, and ability to adjust focus
#J-18808-Ljbffr