Quality Improvement Facilitator III – Medicare Stars

IEHP

. Serve as a Medicare Stars program expert, consulting and coaching teams across the organization on quality improvement initiatives .

Posted 10/6/2026full-timeRancho Cucamonga • California • United StatesMid-LevelSenior💰 $104,042 - $137,842 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Stars program management, quality improvement methodologies, and project management within healthcare settings. Proficient in data analysis, regulatory compliance, and team leadership to enhance organizational performance and quality ratings.

Highest-signal resume keywords

Medicare Stars Program ExpertiseProject Management Professional (PMP) CertificationAdvanced Knowledge of Healthcare Quality PerformanceExperience in Quality Improvement ProjectsStrong Verbal and Written Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Process ImprovementData AnalysisQuality Measurement SetsProject Management TechniquesContinuous Improvement ToolsQuality Improvement ConceptsCoding Sets KnowledgeRegulatory Documentation RequirementsHealthcare Quality StandardsAnalytical Skills

Soft Skills

LeadershipConflict ManagementTeam BuildingProblem SolvingFacilitation Techniques

Tools & Technologies

Microsoft ExcelMicrosoft PowerPointMicrosoft Visio

Certifications & Qualifications

Project Management Professional (PMP)Certified Professional of Healthcare Quality (CPHQ)

Industry Keywords

CMS Quality ProgramsHEDISNCQA StandardsMedicare Managed Care ManualQuality Improvement Initiatives

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Serve as a Medicare Stars program expert, consulting and coaching teams across the organization on quality improvement initiatives
Support leadership in promoting strategic goals and improving organizational performance
Participate in onboarding new quality improvement team members
Coach and mentor Quality division staff on quality improvement concepts, lean principles, and process improvement experiments
Provide quality improvement tools and training solutions to address knowledge, competency, and skill gaps
Lead complex quality improvement projects and events with minimal oversight, including planning, implementation, assessment, and follow-up
Oversee multiple quality improvement initiatives and meet quality standards and delivery timelines
Translate data into meaningful information, draw conclusions, and relate findings to industry standards
Recommend actions to stakeholders and the QI Leadership Team regarding performance gaps, program implementation, and outcomes
Guide resource prioritization and delegate assignments
Act as primary liaison with CMS and other regulatory agencies for quality improvement submissions and communications
Monitor healthcare quality improvement trends and assess organizational impact
Identify improvement opportunities and communicate findings to leadership
Partner with Compliance to monitor CMS rule changes and Medicare oversight requirements
Perform additional duties supporting Health Plan operations and department business needs

Requirements

What you’ll need

Minimum of six (6) 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 required
Master’s degree in public health, health administration, public administration, or another healthcare-related focus from an accredited institution required
Project Management Professional (PMP) Certificate, Certified Professional of Healthcare Quality (CPHQ), or another recognized quality improvement certificate required, or successful completion within one (1) year of hire
Valid California Driver’s license
Advanced knowledge of healthcare quality performance and measurement sets, including CMS quality withhold, NCQA Quality Improvement Standards, and HEDIS
Knowledge of project management techniques, continuous improvement tools, and work process redesign
Knowledge of standardized quality improvement concepts
Knowledge of coding sets used in quality measurement, including ICD-10, CPT, CPT Category II, HCPCS, LOINC, and NDC
Knowledge of CMS quality programs, Medicare Star Ratings methodology, HEDIS, CAHPS, Pharmacy Part D measures, NCQA standards, Risk Adjustment basics, and regulatory documentation requirements
Experience supporting CMS audits, data validation reviews, or compliance reporting
Knowledge of the Medicare Managed Care Manual, HPMS guidance, and CMS regulatory updates
Advanced analytical and critical-thinking skills
Advanced proficiency in Microsoft Office applications, especially Excel, PowerPoint, and Visio
Strong verbal, written, and listening communication skills, including comfort with public speaking
Ability to apply facilitation techniques to quality improvement project teams
Problem-solving, leadership, conflict-management, and team-building skills
Ability to work with and motivate diverse teams, including group process facilitation, change management, and conflict resolution
Ability to teach quality improvement concepts and principles
Ability to increase Quality Ratings through targeted quality improvement activities
Ability to read and interpret data
Results- and outcome-oriented approach
Ability to perform complex tasks, prioritize multiple projects, and work under pressure to meet deadlines
Excellent project and time management skills
High attention to detail

Benefits

Comp & perks

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
Hybrid work schedule: Monday and Friday remote; Tuesday–Thursday onsite