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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in project management and healthcare quality, with a strong focus on Medicare Stars initiatives, quality improvement activities, and compliance with regulatory standards. Proficient in data analysis and the application of LEAN methodologies to enhance operational efficiencies.
Highest-signal resume keywords
Project ManagementHealthcare QualityMedicare Star Ratings MethodologyRisk Adjustment CalculationsPMP Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisQuality MonitoringProcess ImprovementBudget ManagementGap AnalysisLEAN MethodologiesProject DocumentationAudit SupportFinancial AnalysisRequest for Proposals Development
Soft Skills
Interpersonal CommunicationOrganizational SkillsProblem-SolvingConflict ResolutionStrategic Thinking
Tools & Technologies
Spreadsheet ApplicationsDatabase ApplicationsWord Processing Applications
Certifications & Qualifications
PMPPgMPCBAPPMI-PBA
Industry Keywords
Medicare AdvantageHEDISCAHPSNCQA StandardsCMS Quality ProgramsRegulatory DocumentationHealth Plan OperationsQuality InitiativesData MiningInformational Retrieval
Tech Stack
Tools & technologiesPMP
About the role
Key responsibilities & impact- Provide research, analytical support, and project management to Medicare Stars leadership
- Manage medium-to-large complexity and medium-to-high priority business, regulatory, and technology deployment projects and issues
- Manage project budgets and acquire resources from functional areas, third-party vendors, and consultants
- Coordinate, prepare, and monitor Medicare Stars projects, documentation, and report-outs
- Capture process efficiencies and incorporate LEAN methodologies into project practices
- Liaise between functional departments for configuration and software-related activities
- Support external vendor operations, initiative planning, implementation, and vendor service agreements
- Collaborate with Quality and Compliance departments on audit responses
- Support Quality and Stars program governance committees and track follow-up actions
- Support senior, executive, and Chief sponsors on companywide and departmental projects
- Monitor work plans and initiatives to mitigate risks and issues
- Perform gap analysis and update policies and procedures, including version control and document distribution
- Assist with Corrective Action Plan deliverables
- Determine program resource requirements and gather budget details
- Lead development of Requests for Proposals for external products and services
- Perform other duties required to ensure successful Health Plan operations
Requirements
What you’ll need- A minimum of five (5) years of relevant work experience in healthcare quality
- Experience in program/project management
- Experience in developing plans and application of standard Project Management practices
- Prior experience implementing Medicare Star Measure interventions preferred
- Experience with Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred
- Demonstrated experience managing targeted quality improvement activities
- Bachelor’s degree in public health, health administration, or a related field from an accredited institution required, or a minimum of four (4) years of additional relevant work experience in lieu of the degree
- Master’s degree in public health, health administration, or a related field preferred
- PMP, PgMP, CBAP or PMI‐PBA preferred
- Strong knowledge of quality initiatives, data mining, data profiling, data analysis, quality monitoring and oversight, project management, and cross-organization coordination
- Knowledge of machine learning, statistics, informational retrieval, CMS quality programs, Medicare Star Ratings methodology, HEDIS, CAHPS, Pharmacy Part D measures, NCQA standards, Risk Adjustment basics, regulatory documentation requirements, Medicare Managed Care Manual, HPMS guidance, and CMS regulatory updates
- Experience supporting CMS audits, data validation reviews, or compliance reporting
- Strong proficiency in spreadsheet, database, and word processing applications
- Strong writing, interpersonal communication, organizational, conflict resolution, and problem-solving skills
- Ability to translate data into meaningful and actionable information
- Ability to work in a changing, fast-paced, diverse, demanding, and evolving environment
- Ability to support a culture of collaboration and act as a strategic thinker
- Ability to interact with external entities and represent IEHP professionally
- Ability to understand and respect confidentiality of sensitive information
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