Quality Systems Analyst II – Medicare Stars

IEHP

. Serve as Lead Analyst in data collection, analysis, interpretation, reasonability checks, issue reconciliation, and presentation of findings .

Posted 10/6/2026full-timeRancho Cucamonga • California • United StatesMid-LevelSenior💰 $91,250 - $120,910 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in data analysis, quality improvement methodologies, and healthcare compliance standards, with a strong focus on Medicare Star Ratings and NCQA accreditation processes. Proficient in project management and collaboration across teams to drive quality initiatives and enhance healthcare operations.

Highest-signal resume keywords

Data AnalysisMedicare Star RatingsQuality ImprovementProject Management Professional (PMP) CertificateNCQA Accreditation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data CollectionData InterpretationStatistical AnalysisRisk Adjustment CalculationsHealthcare Quality PerformanceProject Management TechniquesStandardized Quality Improvement ConceptsMedical TerminologyRegulatory DocumentationData Visualization

Soft Skills

Effective CommunicationProblem SolvingLeadershipTeam BuildingConflict Resolution

Tools & Technologies

Microsoft ExcelMicrosoft PowerPointMicrosoft VisioData Analysis ToolsQuality Improvement Tools

Certifications & Qualifications

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

Industry Keywords

Healthcare Quality ImprovementMedicare AdvantageHEDISCMS Quality ProgramsNCQA StandardsManaged Care ClaimsHealth EquityPerson-Centered CareContinuous ImprovementAccreditation Requirements

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Serve as Lead Analyst in data collection, analysis, interpretation, reasonability checks, issue reconciliation, and presentation of findings
Understand and interpret data results from program designs and organize cohesive summaries for internal and external committees, the Governing Board, meetings, and Member and Provider communications
Perform initial data discovery, analysis, and modeling to inform project strategy and operations
Generate and manage updated case studies of experiments and outcomes for reporting and continuous learning
Coordinate among departmental teams and collaborate across staff levels to solve analytical issues, documenting results and methodologies
Manage assigned projects and communicate between the Quality Department and other business units to ensure accuracy, validity, and reliability of root cause analytics insights
Develop studies and reports supporting NCQA Accreditation and other quality compliance standards
Maintain knowledge of IEHP business operations for Quality Improvement studies, action plans, and quality programs
Incorporate LEAN principles into daily work
Lead gathering and presentation of audit deliverables and requests for Medicare Stars regulatory requests and audits
Maintain Medicare Stars department policies through annual reviews and updates
Interpret NCQA communications and changes and support NCQA audit activities, data gathering, and process support
Perform other duties required to support Health Plan operations and department business needs

Requirements

What you’ll need

A minimum of four (4) years of experience in study development, writing and analysis in a healthcare setting (e.g., quality improvement, patient/provider services, healthcare finance, care management or related fields)
Demonstrated experience working with complex data systems and large data sets
Experience performing online research and working in a team setting
Prior experience analyzing Medicare Star Measure data and intervention impact preferred
Demonstrated experience in increasing Plan Star Ratings through targeted quality improvement activities
Knowledge of Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred
Bachelor’s degree in biological sciences, public health, health administration, public administration, mathematics, statistics, computer science, or other healthcare related focus from an accredited institution required
Master’s degree in biological sciences, public health, health administration, public administration, mathematics, statistics, computer science, or other healthcare related focus from an accredited institution preferred
Project Management Professional (PMP) Certificate, Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or successful completion within one (1) year of hire
Advanced knowledge of healthcare quality performance and measurement sets, including CMS quality withhold, NCQA Quality Improvement Standards, HEDIS, Medicare Stars, and similar sets
Knowledge of project management techniques, continuous improvement tools, and work process redesign
Knowledge of standardized Quality Improvement concepts
Knowledge of standard coding sets and medical terminology, including ICD-10, CPT, CPT Category II, HCPCS, LOINC, and NDC
Knowledge of health plan or federal, state, and accreditation requirements
Knowledge of provider workflows, care coordination, and transition management processes
Knowledge of SDOH, health equity, community resources, person-centered care, and alternative care models
Knowledge of managed care claims, payment processes, and insurance terminology
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 Medicare Managed Care Manual, HPMS guidance, and CMS regulatory updates
Advanced proficiency in reviewing and interpreting regulatory information, research, data gathering, data analysis, and visualization tools
Advanced proficiency in Microsoft Office applications, especially Excel, PowerPoint, and Visio
Ability to communicate effectively and speak publicly to varied audiences
Ability to apply facilitation techniques to quality improvement project teams
Problem solving, leadership, conflict management, team building, group process facilitation, change management, and conflict resolution skills
Ability to teach quality improvement concepts and principles
Ability to work as part of a cross-functional team and motivate project team members
Commitment to supporting the organization’s efforts to become a 5-Star Health Plan and incorporating LEAN principles into daily work
Ability to manage complex tasks, prioritize multiple projects, work under pressure, meet deadlines, and adapt in a fast-paced, dynamic environment
Excellent project management, time management, organizational capabilities, and attention to detail
Valid California Driver’s License preferred

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