Health Plan Of San Mateo (hpsm) Jobs

The Call Center Quality Monitoring Analyst is responsible for ensuring that customer interactions meet quality standards and deliver great customer experience. This includes evaluating and monitoring calls, providing feedback and coaching to agents, and helping improve call center processes. The analyst will also track key performance metrics, such as ACD reports, to identify trends and opportunities for improvement. Prepare internal and regulatory reports. Position overview Essential Functions: Work closely with Call Center Leadership and trainers to maintain a comprehensive call quality monitoring program that ensures staff adherence to HPSM's customer service standards, as well as compliance with applicable regulations and policies. Conduct regular quality evaluations of recorded calls to assess call center agents' performance, ensuring adherence to HPSM's predefined quality standards. Participate in calibration sessions with leadership and fellow analysts to ensure consistent, fair, and accurate quality evaluations, maintaining alignment with internal standards and performance goals. Identify opportunities for process improvements and efficiencies within the team. Prepare and deliver accurate internal and regulatory reports on a daily, monthly, and year-to-date basis, highlighting key metrics such as call quality, productivity, availability, and other performance indicators. Design and create visually compelling tables, graphs, and charts to effectively communicate insights and support data-driven decision-making. Design and develop effective processes and tools to ensure consistent and accurate tracking of quality monitoring results. Leverage quality monitoring data to identify trends and root causes of recurring issues. Effectively communicate findings and insights to call center leadership and other internal stakeholders to drive continuous improvement. Provide support to the call center by assisting with problem-solving, escalating member issues across departments, serving as a backup for call center coverage, and contributing to member outreach initiatives as needed. Contribute to Member Services quality improvement projects, actively supporting initiatives aimed at enhancing service delivery and overall member satisfaction. Adhere to deadlines and maintain a high level of accountability in all tasks and responsibilities. Secondary Functions: Perform other duties as assigned. Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education and experience Bachelor's degree in related health care field preferred (e.g. Health Science, Public Health, Computer Science, Business Administration). Five (5) years of experience may be substituted for an academic degree. Minimum of two (2) years of work experience in a healthcare or managed care environment. Experience working in a call center environment is highly preferred. Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Medicare and Medi-Cal programs highly preferred. Regulatory and/or compliance processes impacting health care. Experience with database management, spreadsheets, and relationship databases. Fluency in Microsoft Excel. Best practices in customer service, especially telephone-based services. Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks. Analyze data and create reports by utilizing strong analytical skills with high attention to detail. Communicate effectively. Adapt to changes in requirements/priorities for daily and specialized tasks. Identify, analyze, and solve problems and work with teams to solve problems. Prepare concise reports and recommendations. Use initiative, work independently, and make sound judgments. Interpret government rules, regulations and guidelines. Exercise 100% objectivity in all work functions and maintain confidentiality. Work under pressure and within strict timeframes. Interact well with a variety of people and work effectively as part of a cross functional team. Work Hybrid- Report to South San Francisco, CA office 2-3 days per week. Skills: Bilingual in Spanish, Tagalog or Chinese required Salary and benefits The starting salary range is $69,302 - $89,020 per year, depending on the candidate's work experience. Excellent benefits package includes: HPSM-paid premiums for employee's medical, dental and vision coverage (employee pays 10% of each dependent's premiums) Fully paid life, AD&D and LTD insurance Retirement plan (HPSM contributes equivalent of 10% of annual compensation) 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year Tuition reimbursement plan Employee wellness program It is HPSM's policy to provide equal employment opportunities for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Salary Min Hiring Rate $69,302.00 Max Hiring Rate $89,020.00

1. Develop and implement medical policy for utilization management activities and functions, including benefit manual statement, policies and procedures, and Utilization Management Subcommittee Guidelines. Provide training and consultation for both internal staff and medical personnel of the Plan regarding policy application. 2. Provide direction and control of current medical practices ensuring that medical personnel of the Plan follow medical protocols and rules of conduct. 3. Ensure assigned patients are provided healthcare services and necessary medical attention at all locations. 4. Collaborates with Contracting Department to ensure full and appropriate primary, specialty, and ancillary care network adequacy for Members. 5. Ensures that medical decisions are rendered by qualified medical personnel, unhindered by fiscal or administrative management. Provides clinical oversight and direction over credentialing process. 6. Ensures that medical care rendered by providers meets with applicable professional standards for acceptable medical care and quality. 7. Consults on written medical protocol for Plan physicians to ensure adherence to current standards and quality of medical care. Coordinates professional interactions among practitioners and lends assistance toward correcting any deviation from medical standards. 8. Interacts regularly with inpatient hospitalist groups, PCP & specialists to ensure appropriate medical care is provided and utilization standards are met. 9. Develops and manages a formal Utilization Management Program for the Plan and its Providers. This Program includes protocol, procedures, oversight, and training in the following areas: a. Provider Selection b. Credentialing c. Peer Review Activities d. Referral Management e. Pre-admission authorization f. Prospective, concurrent, and retrospective review g. Utilization review reporting and evaluation h. Case Management i. Provider Incentive Programs j. Chairperson/ Co-Chair of the HEDIS Improvement Committee, Quality Management Committee, Quality Improvement Committee, Credentialing Committee, Grievance Trend Committee k. Participates on the Pharmacy and Therapeutics Subcommittee l. NCQA Accreditation. 10. Act as a liaison to Provider Relations as a link between IEHP and individual physician, IPAs, medical groups, and hospitals. 11. Adjudicate medically related grievances and appeals that flow through the Member grievance and appeals process. 12. Review State mandated benefits to ensure IEHP is in full compliance through its Providers. 13. Assist Compliance on sanctioned and excluded Provider management. Responsibilities include oversight of safe transitions of care for Members and communication with regulatory agencies and impacted departments (e. g. , Pharmacy, Claims, Care Management, Utilization Management, etc. ). 14. Provide physician level guidance on organizational improvement initiatives, including LEAN activities and Process Improvement Team projects.

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! The Supervisor, Claims Processing - Medi-Cal provides daily oversight of claims staff, business processes and inventory management. Ensures the claims team follows state/federal regulations and standard operating procedures. Develops best practices to optimize claim processing quality. Evaluates professional skills of team members and provide appropriate work assignments. Resolve claim payment issues and quality oversight. Assist in hiring and training new team members in their job responsibilities. Monitors individual and team performance to ensure quality and performance objectives are met. Assist in employee performance evaluation, coaching and professional development activities to improve performance efficiency. Major Functions (Duties and Responsibilities) 1. Supervise day-to-day claims operations tasks in accordance with established policies and procedures, standard operating procedures, and job aids to ensure optimal performance results. 2. Monitor and track claim inventory / workflow through the entire claim life cycle to ensure timely processing of claims based on regulatory and contractual compliance requirements. 3. Oversight of all aspects of departmental monitoring tools and controls to promote operational excellence 4. Responsible for driving team results based upon established departmental quality and production performance metrics. 5. In collaboration with the Claims Quality Assurance and Training teams, review audit results to evaluate opportunities for staff development, training, and remediation needs to maximize claim outcomes. 6. Develop strategies to improve upon departmental effectiveness and efficiencies. Identifies and implements process improvement opportunities that focus on customer value. 7. Serve as a subject matter expert and liaison with internal and external customers to address claim issues in an expeditious, accurate method. 8. Assist in formulating and executing initiatives to achieve departmental goals and objectives. 9. Select and build strong, professional functional teams through training reinforcement, coaching, motivation, and performance management. Complete and track effective performance evaluations and maintain ongoing dialogue with team members regarding development opportunities. 10. Assist Claims Management in identifying, creating, and implementing policies and procedures, standard operating procedures, and desk top references. 11. Make recommendations to leadership on changes and additions to department procedures through innovative thinking with an emphasis on automation. 12. Attend regulatory audits for assigned line-of-business and actively participate as a claims SME on processes and procedures for the claims department. 13. Stay current with changes mandated by the regulatory agencies and industry standard processes. 14. Attend key strategic meetings that are necessary to maintain a viable knowledge base within IEHP. Initiate and conduct internal meetings as well as adding substance to discussions, sharing new ideas, personal perspectives, and provides relevant follow-up items. 15. Serve as a support to the Claim Operations Manager for absences, spike claim receipts, etc. 16. Any other duties as required to ensure IEHP operations are successful. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more. CalPERS retirement 457(b) option with a contribution match Generous paid time off- vacation, holidays, sick State of the art fitness center on-site Medical Insurance with Dental and Vision Paid life insurance for employees with additional options Short-term, and long-term disability options Pet care insurance Flexible Spending Account - Health Care/Childcare Wellness programs that promote a healthy work-life balance Career advancement opportunities and professional development Competitive salary with annual merit increase Team bonus opportunities Education & Experience Four (4) years medical claims processing experience, at least two (2) years of experience in a supervisory capacity leading a team. Three (3) years of experience in a managed care environment. Experienced in benefit and financial matrix interpretation. Experience preferably in an HMO or Managed Care setting. High School diploma or GED required. Bachelor's degree from an accredited institution preferred. Key Qualifications A thorough understanding of claims industry and customer service standards. Knowledge in CMS, DHMC and DHCS regulatory guidelines including AB1455. Extensive knowledge of ICD-9, ICD-10, CPT, and Revenue Codes. Solid understanding of the DHCS, DMHC and CMS rules and regulations governing claims adjudication practices and procedures desired. Principles and techniques of supervision and training. Knowledge of medical terminology and understanding of healthcare claims. Analytical skills with emphasis on time management, data base maintenance, spreadsheet manipulation, and problem solving. Strong writing, organizational, project management, and communication skills proficiency required. Excellent interpersonal/communication skills. Must have a high degree of patience and ability to lead a large team of professionals. Start your journey towards a thriving future with IEHP and apply TODAY!

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! The Analyst II, Regulatory Affairs has experience with and performs key centralized complex and difficult regulatory activities for the Compliance Department. Team Members in this position ensure plan operations, processes, procedures, policies, etc. are in compliance with regulatory agencies, including but not limited to, Covered California, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health Care (DMHC), in addition to collaboration with, inter-departments to ensure member needs are met while simultaneously building strong peer relationships. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary. Hybrid schedule. CalPERS retirement. 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 Education & Experience Two (2) years of experience with managed care or other relevant industry experience Experience in health care, health plans, Covered California, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect Experience interacting with regulatory agencies Knowledge of and experience with state and Federal regulatory and other requirements and practices related to Covered California, Medicare and Medi-Cal (Medicaid), Title 19 (USC)/Title 29 (USC and CCR), Title 22 (CCR), Title 28 (CCR), Title 42 (USC and CFR), CA Welfare and Institutions Code, and CA Health and Safety Code Bachelor's degree from an accredited institution required Key Qualifications Must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points Knowledge of Principles and practices of managed care Possess strong interpersonal and presentation skills to communicate with internal departments and external agencies Clearly and effectively convey project objectives Strong organizational skills and attention to detail Effective communication skills; verbal and written Microsoft Office programs including, but not limited to, Word, Excel, PowerPoint, Outlook, and Access Start your journey towards a thriving future with IEHP and apply TODAY!

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 leadership of the Supervisor of Finance Analytics - Commercial Finance, the Financial Analyst II - Commercial Finance will complete a variety of specialized duties related to financial reconciliation of premium invoicing and payments from various sources, monitoring of BPO vendor, collaborating with cross-departmental teams to resolve payment issues, and ad-hoc analysis as it relates to commercial products. This role will work with large data sets and develop moderate SQL queries. Key Responsibilities: 1. Monitor and respond to inquiries, both internally and externally, regarding premium invoicing. 2. Analyze over- or under-premium payments and submit findings for leadership review. 3. Perform research into member premium issues and/discrepancies and provides recommendations on solutions. 4. Program simple to moderate SQL queries to perform reconciliation of various revenue streams (i.e.: Member payments, APTC payments, state credit/subsidies) to ensure Member accounts are accurate. 5. Resolve payment disputes received from the merchant services vendor and lockbox decisioning items received from bank lockbox to ensure funds are accurately applied to member accounts in a timely manner. 6. Work with print vendor to create/update premium billing notifications and member notices as it pertains to premium payments, as required by regulatory guidelines. 7. Coordinate with BPO vendor for programming modifications and/or other business needs. 8. Perform detailed analysis of refund requests and/or overpayments and process member refunds. 9. Perform verification of internal and external broker commission payments to ensure accuracy of payments. 10. Prepare month end reports and/or journal entries for monthly financial reporting and management reporting requirements. 11. Perform accurate interpretation of regulatory requirements as it pertains to premium billing activities, member notices as it relates to member premiums, and revenue reconciliation requirements. 12. Act as a trusted resource for the organization and consistently demonstrates IEHP organizational values while building and maintaining strong internal relationships. 13. Demonstrate a commitment to incorporate LEAN principles into daily work. 14. Any other duties as required ensuring Health Plan operations are successful. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more. This is a full remote position. California residency required. CalPERS retirement 457(b) option with a contribution match Generous paid time off- vacation, holidays, sick State of the art fitness center on-site Medical Insurance with Dental and Vision Paid life insurance for employees with additional options Short-term, and long-term disability options Pet care insurance Flexible Spending Account - Health Care/Childcare Wellness programs that promote a healthy work-life balance Career advancement opportunities and professional development Competitive salary with annual merit increase Team bonus opportunities Education & Experience Minimum three (3) years of premium billing, premium and membership reconciliation, and/or premium reporting experience. Experience working with other finance teams to support monthly financial reporting. Experience working with large data sets and developing moderate SQL queries. Managed care experience related to commercial products required. Bachelor's degree in Finance, Business Administration, Economics, Health Care Administration, Accounting, or other related field from an accredited institution required. Key Qualifications Strong knowledge and practical application of premium billing practices in the healthcare industry. Working knowledge of generally accepted accounting principles (GAAP) and practical application of general accounting theory. Must have SQL Server query development and writing skills. Intermediate skills in utilizing Excel and Word. Strong communication abilities (both written and verbal) and problem-solving skills. Strong critical thinking, analytical, problem solving, and prioritizing skills. Strong initiative to meet established deadlines. High level of attention to detail is required. Be able to communicate effectively at all organizational levels both orally and written. Start your journey towards a thriving future with IEHP and apply TODAY!

ABOUT THE PRACTICE Radiology Affiliates Imaging (RAI) is a radiologist practice serving our patients, community and clients for over 50 years. RAI is one of the longest-tenured and respected radiology practices in the region and have been members of the Radiology Partners (RP) team since 2019. In the last year, RP has infused national resources to modernize practice workflow, drive physician satisfaction, improve work-life balance (NO nights, evenings, weekends, or holidays required) and just one year to partnership. Today, Radiology Affiliates Imaging (RAI) is a modernized and attractive practice: * Added state-of-the-art Artificial Intelligence tools, including reco MD, Aidoc, and RadAI Omni. * Implemented a best-in-class unified reading platform to integrate all physicians in the practice ABOUT THE POSITION * Opportunity to read 100% subspecialized breast imaging (screening and diagnostic mammography, breast MR, breast US), supporting three outpatient imaging centers located in the Princeton, NJ area. * Windsor Radiology (East Windsor, NJ) - Outpatient imaging center * RAI Lawrenceville (Lawrenceville, NJ) - Outpatient imaging center * RAI Hamilton (Hamilton, NJ) - Outpatient imaging center * Must be able to cover locations above on-site. * PACS technology is Clario/Intellirad with Powerscribe dictation * Day shift, on-site, Monday-Friday, from 8:00am to 5:00pm * Ability to read mammography is required (Screening and diagnostic mammography, breast US, breast MR). * Ability to perform breast procedures is a plus, but not required (i.e. stereotactic/MR/US-guided biopsies, Magseed/needle localization, etc) Key facts: * * $500,000 total compensation * One year to partnership * PTO 8 weeks in year 1, 9 weeks at partnership * No night, evening, weekend, or holiday requirement Extra Incentives: * $25,000 signing bonus * $25,000 retention bonus after one year * Productivity incentive- Paid per RVU after exceeding productivity goals Robust Benefits Package * Virtual Primary Care * Fertility & Family Planning * Mental Health & Wellbeing * Dental * Vision * 401(k) Retirement Savings Plan * Prudential's Financial Wellness Programs * Health Savings Accounts (HAS) * Health Reimbursement Arrangement (HRA) * Flexible Spending Accounts (FSAs) * Physician Professional Expense Program (PPE) * Disability Insurance * Life and AD+D Insurance * * ABOUT THE COMMUNITY Comfortably nestled between Philadelphia and New York, Central New Jersey is a great place to live and work. Here you will find a place with an amazing history, a vibrant arts scene, outdoor adventures, and a wide variety of delicious ethnic cuisine. Residents here enjoy excellent schools, desirable housing, and low crime rates. Being in close proximity to Philadelphia, New York, and the Jersey Shore, fantastic dining, entertainment, and family fun are just a short drive away! Dozens of top universities are located in and around the area, including: Princeton University, University of Pennsylvania, NYU, Columbia University, Carnegie Mellon, Rutgers, Lehigh, Villanova, University of Pittsburgh, Pennsylvania State, Drexel, Temple, Duquesne, and Thomas Jefferson University. With the perfect combination of city entertainment and country recreation, Central Jersey provides four seasons of family fun. As the ice thaws in Spring, this region explodes into full bloom. Breathe in the fresh air and witness nature's reemergence in parks and on trails, or hit the links on a championship-caliber golf course. As the temperatures rise, so does the excitement in Summer. You can catch some rays at the Jersey Shore, splash around at a waterpark, or enjoy an outdoor concert under the stars. As Autumn arrives, this region becomes a cornucopia of color. Visit one of many "pick your own" pumpkin patches, brave a haunted attraction for Halloween fun, or ride an ATV through mountain trails. Peak season for autumn leaf peeping is mid- to late-October. As the weather turns colder, Central Jersey is a short drive from the Pocono Mountains where you can hit the slopes, explore trails on snowmobile, or enjoy any of your favorite snow sports. Warm up by the fire with a hot beverage in this family-friendly winter destination. DESIRED PROFESSIONAL SKILLS AND EXPERIENCE * Doctor of Medicine (MD) or Osteopathy (DO) * Board Eligible or Certified, American Board of Radiology (ABR) or American Osteopathic Board of Radiology (AOBR) * Residency Trained, ACGME Accredited Radiology Program * Fellowship-trained in women's imaging * A proven track record of outstanding interpersonal and communication skills * Residents and Fellows are welcome to apply ABOUT RADIOLOGY PARTNERS Radiology Partners is the leading on-site radiology practice in the US. We are an innovative practice focused on transforming how radiologists provide consistently exceptional services to hospitals, imaging centers, referring physicians and patients. With our state-of-the art clinical technology, specialized expertise, access to capital, and retention of top physician talent, Radiology Partners reliably exceeds the expectations of our clients, patients, and partners. We serve our clients with an operational focus, and, above all, a commitment to quality patient care. Our mission is To Transform Radiology. Radiology Partners is an equal opportunity employer. We believe in creating and celebrating a culture of belonging and are committed to creating an inclusive environment for all teammates.

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 general direction of the Director, Clinical Pharmacy & Product Strategy, the Resident Pharmacist is responsible for assisting clinical pharmacists with their daily duties within each business team. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary. * Hybrid schedule. * CalPERS retirement. * 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 Education & Requirements * Completion of Pharm. D. from an accredited institution is required by the start date of residency * Possession of an active, unrestricted, and unencumbered Intern Pharmacist license issued by the California State Board of Pharmacy required Key Qualifications * General skills with MS Word, Excel, Access preferred * Excellent written communication and oral presentation skills * Effective time management and project management skills * Word processing involving computer keyboard and screens * While performing the duties of this job, the employee is occasionally required to stand; walk; sit; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl * The employee must occasionally lift or move up to 25 pounds * Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $63,897.60 USD Annually - $83,075.20 USD Annually

Job Details Corporate Headquarters - Chula Vista, CA Full Time Graduate Degree $130,639.58 - $160,033.48 Salary ManagementDescription Under the direction of the Director of Corporate Quality, manages the day-to-day operations of the Corporate Quality Department including the areas of grievances and appeals (G&A), the identification, resolution, and tracking of potential quality issues (PQIs), facility and medical record reviews, Health Effectiveness Data and Information Set (HEDIS) file review and clinical oversight, and the quality reporting. Serving in a clinical and operational role, supports the provision and access to quality health care and member advocacy. RESPONSIBILITIES Upholds Community Health Group's (CHG's) quality improvement and health equity program according to standards and requirements promulgated by the Department of Managed Health Care (DMHC), the Department of Health Care Services (DHCS), the National Committee for Quality Assurance (NCQA), the Centers for Medicare and Medicaid (CMS), and based on evidence-based standards of practice. Supervises the Corporate Quality Nurses, the Grievances and Appeals Supervisor, and the Corporate Quality Specialist in the performance of their role and position description. Oversees and provides guidance and assistance to the clinical and non-clinical staff to meet individual and departmental performance goals, metrics, and regulatory requirements. Maintains and develops departmental policies, procedures, desk references, job aids, and guidelines under the direction of the Corporate Quality Director. Develops, produces, validates, and submits regulatory and management reports directly or in collaboration with staff. Oversees CHG's facility and medical record review process in accordance with DHCS along with CHG's DHCS-certified Master Trainers. Oversees CHG's grievance and appeal process in accordance with regulatory and accreditation standards and advocates on behalf of members and to appropriately identify and address potential quality issues in accordance to established policies, procedures, and standards. Oversees the complete and timely investigation and resolution of potential quality issues and the implementation and follow-up of corrective action when indicated. Provides analytical support to clinical programs; performs clinical assessments and clinical audits and file review as necessary to support the Corporate Quality Department responsibilities including HEDIS-related activities. Assists the Director of Corporate Quality in producing internal and/or external management and regulatory reports. Trains staff and providers Ensures company compliance with regulatory guidelines by participating in the preparation process required for regulatory and accreditation audits; assisting with the implementation of corrective action plans. Is able to do the work of direct reports if necessary due to absences or during spikes in volume. Responsible for the operations of the department in the absence of the director. And all other duties assigned by the department director. Qualifications EDUCATION Current, unrestricted RN license in California MSN or equivalent. EXPERIENCE/ SKILLS 5 years of professional work experience in healthcare 2 or more years or equivalent in supervision Quality management experience preferred Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas and the ability to present confidently in group settings. Organizational skills with the ability to handle multiple tasks and/or projects at one time Customer service skills with the ability to interact professionally and effectively with providers, physicians, and staff from all departments within and outside the Company Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements Problem solving skills with the ability to look for root causes and implementable, workable solutions Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs Track record of producing work that is highly accurate and demonstrates attention to detail. This position requires occasional travel within the San Diego County area. PHYSICAL REQUIREMENTS Prolonged sitting Occasional travel within the county if San Diego Must be able to lift and/or move up to 10 pounds and have close vision May be required to work evenings and weekends Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, and training. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

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 direction of the Medication Management Pharmacy Operations Supervisor, the Pharmacy Medication Management Specialist is responsible for the preparation of member medication reconciliations, comprehensive medication reviews (CMRs), targeted medication reviews (TMRs) and their respective written notifications to the provider/member for clinical review. The Pharmacy Medication Management Specialist must be able to utilize all policies and resources to answer questions and direct Providers/Members appropriately in order to resolve their concerns, accept and make phone calls concerning all facets of medication management and schedule appointments appropriately. The Pharmacy Medication Management Specialist will need to demonstrate the ability to listen to Provider/Member concerns and questions and be able to accurately document medication/allergy history, as well as communicate health plan processes in a clear and knowledgeable manner. The Pharmacy Medication Management Specialist will also be responsible for the technical review of the prescription drug prior authorization and notifying the provider of the clinical decision. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more. * CalPERS retirement * 457(b) option with a contribution match * Generous paid time off- vacation, holidays, sick * State of the art fitness center on-site * Medical Insurance with Dental and Vision * Paid life insurance for employees with additional options * Short-term, and long-term disability options * Pet care insurance * Flexible Spending Account - Health Care/Childcare * Wellness programs that promote a healthy work-life balance * Career advancement opportunities and professional development * Competitive salary with annual merit increase * Team bonus opportunities Education & Experience * One (1) or more years of experience as a pharmacy technician in a pharmacy required * Possession of an active, unrestricted, and unencumbered Pharmacy Technician license issued by the California State Board of Pharmacy required * High School Diploma or GED required * Associate's degree or Bachelor's degree from accredited institution preferred. Key Qualifications * Microsoft Office (Microsoft Excel skills preferred) * Excellent organizational, written, and verbal communication required * Project management skills preferred * Good interpersonal skills * Excellent critical thinking skills * Typing speed of 40 corrected words per minute (CWPM) required Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $27.43 USD Hourly - $35.66 USD Hourly

Join HPSM as a Care Management Specialist II and play a key role in supporting our members' health journeys! In this role, you'll work closely with a multidisciplinary team to coordinate care, assist with health assessments, and create tailored care plans to ensure our members receive the best possible care. You'll be a vital part of the team, helping to connect members with resources, specialists, and community support while promoting a collaborative approach to care. We're looking for someone with a passion for care coordination, experience in managed care, and strong communication skills. If you're ready to be a positive force for change and provide person-centered care, this is the perfect opportunity for you! Key Responsibilities Independently manage care coordination requests, assess member needs, and facilitate appropriate interventions and follow-ups. Administer Health Risk Assessments and prepare care plans for interdisciplinary team meetings. Assist members with scheduling appointments, accessing specialists, educational resources, and transportation. Collaborate with healthcare providers to coordinate and share treatment plans. Maintain medical data, track census reports, and support Care Coordination staff with appointments, equipment, and social services. Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education & Experience: High school diploma or GED required; college-level courses in healthcare a plus. Minimum 3 years of managed care experience, preferably in Care Coordination, with at least 1 year of direct Care Coordination experience. Experience as a Medical Assistant or Licensed Vocational Nurse is a plus. Knowledge: Proficiency in Microsoft Office Suite (Outlook, Word, Excel, Access, PowerPoint). Familiarity with care management, Medi-Cal, Medicare, and community resources, especially for elderly and disabled populations. Skills & Abilities: Strong communication skills (verbal and written), team collaboration, and adaptability to changing priorities. Bilingual skills (Spanish, Tagalog, or Chinese) preferred. Outstanding Benefits Package Includes: 100% HPSM-paid medical, dental, and vision coverage for employees (dependents' premiums are 90% covered by HPSM). Fully funded life insurance, AD&D, and long-term disability (LTD) coverage. Generous retirement plan with HPSM contributing an equivalent to 10% of your annual salary. Ample paid time off: 12 holidays, 12 sick days, and vacation starting at 16 days per year. Tuition reimbursement to support your professional growth. A robust employee wellness program to promote your well-being. It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Hourly Min Hiring Rate $30.29 Max Hiring Rate $38.31

Act as the primary point of contact for members of CareAdvantage D-SNP and assist members with all aspects of plan benefits. Provide customer service to CareAdvantage members primarily on the phone. Answer member questions about CareAdvantage health and prescription drug benefits, eligibility, and provider network. Make New Member Welcome Calls. Resolve problems that members have accessing CareAdvantage-covered services, including but not limited to health care services and prescription medications. Ensure that assigned members retain CareAdvantage enrollment by investigating and contacting members and partnering agencies. Clearly document any member's complaints, including grievances and appeals. Follow through with proactive solutions to resolve member issues. Prepare and submit requests for services made directly by a member to HPSM Health Services. Prepare and submit member requests for continuity of care with non-contracted providers to the Provider Services Department. Refer members to appropriate community partner agencies depending on specific circumstances including but not limited to: Behavioral Health and Recovery Services, Aging and Adult Services, Legal Aid and/or HICAP when appropriate. Relay pertinent health information to HPSM clinical staff to facilitate care coordination and/or receipt of medical services including prescriptions. Participate in and professionally represent HPSM at health fairs, community partnerships, meetings, committees, and coalitions as requested by the Manager or Supervisor. Secondary Functions: Perform other duties as assigned. Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education and experience Equivalent to a high school diploma or GED required. Two (2) to three (3) years' experience performing customer service preferably in a health plan environment. Previous experience working with seniors or people with disabilities and/ in a medically related field such as medical assisting. Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint. Health Insurance programs preferred. Customer service principles and practices. Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks. Demonstrate excellent oral and written communication skills with various audiences and individuals of diverse backgrounds. Perform problem research, use analytical skills, and effectively influence positive outcomes. Develop and maintain strong professional relationships with a diverse range of people. Utilize a personal computer, including the range of Microsoft Office products (Word, Excel, PowerPoint, Access, and Outlook). Work Hybrid- Report onsite 3 days per week (Wednesday, Thursday, Friday) to our office in South San Francisco, CA. Skills: Bilingual in Spanish/English required. Salary and benefits The starting salary range is $25.03 - $31.66per hour, depending on the candidate's work experience. Excellent benefits package includes: HPSM-paid premiums for employees' medical, dental and vision coverage (employee pays 10% of each dependent's premiums) Fully paid life, AD&D and LTD insurance Retirement plan (HPSM contributes the equivalent of 10% annual compensation) 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year Tuition reimbursement plan. Employee wellness program It is HPSM's policy to provide equal employment opportunities for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Hourly

Ready to make an impact at the heart of healthcare operations? Join HPSM as an Executive Assistant and provide high-level administrative support to our Chief Medical Officer and other senior management staff. You'll play a key role in streamlining operations, ensuring smooth communication, and supporting strategic initiatives that shape our organization's success. As an Executive Assistant, you will handle a variety of administrative tasks, including managing calendars, preparing documents, and scheduling meetings. This role requires strong organizational skills, attention to detail, and the ability to manage multiple priorities effectively. Join us in providing essential support to our leadership team and making a real difference in our mission to serve our community. Position overview Prepare, edit, and manage correspondence, communications, presentations, and documents for the Chief Medical Officer and senior management. Maintain and manage calendars, schedule meetings, and arrange travel as needed. Organize and coordinate meetings, ensuring all logistics (room reservations, catering, etc.) are in place. Screen phone calls, manage mail, direct inquiries to the appropriate team members, and ensure timely follow-up. Take minutes at assigned meetings and track the completion of action items. Record and transcribe minutes, coordinate meetings, and ensure the accurate distribution of meeting materials. Maintain organized file systems for HPSM and/or other assigned committees. Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education and experience Five (5) years of office administrative or secretarial experience supporting senior executives. Associate's degree or business school training in Health Care, Public Administration, or a related field preferred. Knowledge of: Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint, Access). Business correspondence styles and formats. Modern office practices, procedures, and equipment. Record-keeping systems and techniques for organizing data. Basic math and telephone procedures. Skills & Abilities: Excellent verbal and written communication skills. Strong organizational and multitasking abilities with attention to detail. Ability to work independently and exercise initiative in a fast-paced environment. Ability to adapt to changes in priorities and task requirements. High level of professionalism and discretion, particularly when handling confidential information. Ability to work cooperatively with team members and establish effective relationships with internal and external stakeholders. Proficiency in multiple computer applications, such as word processing, electronic mail, spreadsheet software, and proprietary systems. High-speed, accurate, and efficient keyboarding skills. Benefits Excellent benefits package includes: HPSM-paid premiums for employee's medical, dental and vision coverage (employee pays 10% of each dependent's premiums) Fully paid life, AD&D and LTD insurance Retirement plan (HPSM contributes equivalent of 10% of annual compensation) 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year Tuition reimbursement plan Employee wellness program It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Salary Min Hiring Rate $69,302.00 Max Hiring Rate $89,020.00

Are you detail-oriented, highly organized, and thrive in a fast-paced environment? Do you enjoy hands-on work and ensuring seamless operations behind the scenes? If so, we have the perfect opportunity for you! We are seeking a Production Support Assistant I to join our team in South San Francisco. This is a fully onsite position, providing critical mail, document processing, and printing services that keep our organization running smoothly. Why Join Us? Be part of a dynamic team that plays a vital role in daily operations. Work in a collaborative, supportive environment where your contributions make a real impact. Gain hands-on experience with industry-leading mail and production printing equipment. What You'll Do: Primary Responsibilities: Mail & Document Processing: Open, sort, process, and distribute incoming and outgoing mail, including scanning, entering, and updating documents across multiple departments. Printing & Assembly: Operate high-volume digital production printers, bind, and prepare materials for distribution, including member handbooks and essential correspondence. Equipment Operation & Maintenance: Keep mail and print equipment running efficiently by clearing jams, refilling toner, and reporting equipment issues. Inventory Management: Track and replenish printing and mailing supplies such as paper, toner, postage, shipping materials, and more. Service Requests & Reporting: Monitor and respond to department service tickets and generate monthly reports as needed. Additional Responsibilities: Assist with conference room equipment setup and removal. Support the issuance of employee and vendor ID badges. Provide assistance to the Facilities team as required. Perform other duties as assigned. What You Bring: Education & Experience: High school diploma, GED, or equivalent required. 3-5 years of experience in a mailroom, printing, or copy/print environment preferred. Experience operating Production Digital Printing Devices a plus. Skills & Abilities: Strong attention to detail with the ability to multitask and meet daily deadlines. Excellent time management and problem-solving skills. Ability to work independently while contributing to a team-oriented environment. Strong verbal and written communication skills. Proficiency in Microsoft Office Suite. Additional Perks: Competitive pay and benefits package. Opportunities for growth and skill development. A collaborative and supportive workplace culture. Ready to take the next step? Apply today and be part of a team that keeps everything running smoothly! Note: This position is 100% onsite in our South San Francisco office. Remote or hybrid work is not available. Other details Pay Type Hourly Min Hiring Rate $18.81 Max Hiring Rate $23.79

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! The Engineer - Cybersecurity GRC Specialist is a mid-level position in Cybersecurity governance, risk, and compliance functions. This position is responsible for routine operation activities to assure that IEHP security program can demonstrate compliance with regulatory requirements and manage cyber risk properly to safeguard the company's digital footprint. This position oversees security assessments, control testing, and regulatory compliance. Responsibilities include coordinating assessment functions, updating control matrices, recommending improvements, ensuring adherence to information security policies, and collaborating with auditors to safeguard protected data. Leadership in implementing the enterprise information security program through expertise in security analysis, risk assessments, awareness initiatives, and policy development is required. Key Responsibilities: 1. Implement security controls, risk assessment framework, and compliance program aligning with regulatory requirements to advance business objectives. 2. Evaluate risks and develop security policies, procedures, and controls to manage risks and improve security positioning compliance with NIST cybersecurity framework, HIPAA, and PCI-DSS. 3. Implement processes to automate monitoring of security controls, risks, testing, and develop reporting metrics and dashboards. 4. Define and document control ownership, schedule assessments, test control effectiveness, and create risk profile reports. 5. Engage and support stakeholders to implement privacy enhanced technologies to safeguard PII/PHI and other confidential information. 6. Participate and support ongoing GRC workstreams such as internal and external audits, risk assessments, incident response, exposure management, penetration testing, and social engineering tests. 7. Document control failures, provide remediation guidance, and prepare management reports tracking remediation activities. 8. Partner in governance, management, and oversight of all core security program functions. 9. Provide security communications and awareness training and guide other department or projects on security risk identification and remediation. 10. Remain current on best practices and act as technical resource for regulatory compliance. 11. Perform any other duties as required to ensure Health Plan operations and department business needs are successful. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more CalPERS retirement 457(b) option with a contribution match Generous paid time off- vacation, holidays, sick State of the art fitness center on-site Medical Insurance with Dental and Vision Paid life insurance for employees with additional options Short-term, and long-term disability options Pet care insurance Flexible Spending Account - Health Care/Childcare Wellness programs that promote a healthy work-life balance Career advancement opportunities and professional development Competitive salary with annual merit increase Team bonus opportunities Qualifications Education & Experience Bachelor's degree in information systems security, a computer related field, or similar technical field, from an accredited institution required. Four (4) or more years of experience as a Cybersecurity Engineer with a focus on cybersecurity governance, compliance, and risk management required. Key Qualifications One (1) or more of the following security certifications preferred: Certified Information Systems Security Professional (CISSP), Certified Information Systems Auditor (CISA), Certified in Risk and Information Systems Control (CRISC), Certified in Governance of Enterprise IT (CGEIT), Certified in Risk and Information Systems Control (CRISC), GIAC Security Essentials Certification (GSEC), CompTIA Security+. In depth understanding and comprehensive knowledge in the following areas: Information security management, governance, and compliance principles, practices, laws, rules, and regulations. Information technology systems and processes, network infrastructure, application architecture, data processes, and protocols. Expertise in cyber and cloud security standard frameworks, architecture, design, operations, controls, technology, solutions, and service orchestration. Information systems auditing, monitoring, controlling, and assessment processes. - Incident response management methodologies and procedures. Risk assessment and management methodologies. Expertise in developing and implementing enterprise governance, risk, and compliance strategies and solutions. Researching and locating information related to internal and external organizations using online and other sources. Strong project management and planning skills in the security domain. - Skilled in troubleshooting and operating computer systems and various software packages effectively. Adept at defining problems, collecting, and analyzing data, establishing facts, and drawing valid conclusions. Excellent communication skills to effectively convey technical information to diverse audiences, both in writing and verbally. Proficiency in evaluating, updating, and revising program materials. Strong interpersonal skills to interact positively with staff, the Board, the public, and regulatory agencies, promoting quality service and effectiveness. Proven ability to: Apply a risk-based approach to planning, executing, and reporting on audit engagements and auditing processes. Possess a quick learning capability to apply knowledge to new situations. - Show aptitude for handling sensitive and confidential matters, situations, and data with utmost discretion. Possess a capacity to understand and follow broad and complex instructions. - Comprehend technical language and confer, analyze, and write in an objective and lucid manner. Work independently, prioritize multiple tasks, and adapt to needed changes. Composure to remain calm under high-pressure and difficult situations. Maintain confidentiality and handle sensitive information with utmost discretion. Use sound judgment and ingenuity in maintaining objectives and technical standards. Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range USD $104,041.60 - USD $137,841.60 /Yr.

This position is open to candidates based anywhere in California, with the understanding that occasional in-office meetings may be required. Plan and evaluate activities through the design and development of data/reports and the analysis and interpretation of data. This includes the development of database tools and analysis to produce data support for various company-wide programs and activities. Position overview Essential Functions: Analyze health management programs including data collection, validation and outcome measurement. Strong ability to analyze Provider, Member, Pharmacy, Claims, and healthcare data Internal data cleansing and data reconciliation analysis Trend analysis in various functional areas of health care management. Create and generate reports through MS-Excel, MS-Access, MS-Power Platform and SQL using Business Objects interface and direct links to core databases Navigate complex data structures in SQL Server to retrieve data Produce reports for and interface with senior management and internal and external stakeholders. Gather and interpret business requirements and monitor data trends to proactively identify issues Execute data changes and update core systems as needed Handle multiple projects and timelines effectively and communicate risks and issues to manager regularly Assist with training Associate Data Analyst. Responsible for analytical data needs. Handle complex data requests, reports, and predictive data modeling. Perform data cleaning, loading, extraction, processing, storage and manipulation. Build and maintain program source code written by self and others. Maintain detailed documentation of programming and analyses. Communicate project results to managers and various users. Design and develop relational databases for collecting data and create data collection screens. Participate in decisions regarding study design, data collection, and data analysis. Secondary Functions: Backup EDI analyst in job duties Perform other duties as assigned. Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education and experience Bachelor's degree in computer science, statistics, mathematics, economics or similar field. Four (4) years' work experience in DB reporting data analysis and programming. Solid experience with SQL and DB design and maintenance with Microsoft SQL is a must. Experience in interpreting and reporting results of analysis, data processing and management, HIPAA EDI, and the use of health data codes. Knowledge of: Basic statistical concepts, models, and procedures. Medi-Cal and/or Medicare programs highly preferred. Personal computers and proficiency in Microsoft Power Platform include Power BI, Power Apps, and Power Automate. API Endpoints management and development. Ability to: Analyze data and create reports/data extractions. Organize work, manage time, and meet deadlines. Work under deadlines; manage multiple job requests simultaneously. Communicate effectively and provide a high standard of customer service. Thoroughly document work adapts to changes in requirements/priorities for daily and specialized tasks. Translate users need to program functional specifications. Communicate and work with users having a wide range of computer skill levels. Problem-solve and consider the entire solution. Work independently as well as part of a team; support team decisions. Effectively interact with internal and external contacts. Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks Skills: Microsoft .NET, C#, Visual Studio, Azure, Power Platform Microsoft SQL Server, Data Warehousing, Database Administration, Business Intelligence Salary and benefits The starting salary range is $92,240 - $118,485 per year, depending on the candidate's work experience. Excellent benefits package includes: HPSM-paid premiums for employee's medical, dental and vision coverage (employee pays 10% of each dependent's premiums) Fully paid life, AD&D and LTD insurance Retirement plan (HPSM contributes equivalent of 10% of annual compensation) 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year Tuition reimbursement plan Employee wellness program It is HPSM's policy to provide equal employment opportunities for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Salary Min Hiring Rate $92,240.00 Max Hiring Rate $118,485.00

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 direction of the Community Wellness Center (CWC) Leadership team, the Community Wellness Center (CWC) Nutrition Coach will lead a variety of nutrition classes consisting of food demonstrations, nutrition education and other nutrition resources, for IEHP members and surrounding community. The Community Wellness Center (CWC) Nutrition Coach will provide one-on-one training for CWC participants by providing personalized support, accountability, encouragement, and celebration on wellness journey to a diverse community and lifestyles. The Community Wellness Center (CWC) Nutrition Coach will coordinate group activities and will teach preset curriculum, implement teaching strategies, monitor, and evaluate student progress and keep accurate student records. The Community Wellness Center (CWC) Nutrition Coach will be responsible to report any required maintenance or repairs to CWC leadership while adhering to safety policies and if needed, will provide certified CPR/First Aid. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary. * CalPERS retirement. * 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 Education & Requirements * Minimum of three (3) years of experience as a nutrition coach or instructor directly related to the duties and responsibilities specified * Specific experience teaching nutrition and developing nutritious meal plans in a group setting * High School Diploma or GED required * Active Food Handlers Card (Riverside and San Bernardino Counties) required * Active CPR/First Aid Certification required * Possession of an active, unrestricted, NASM Certified Nutrition (CNC), Certified Nutrition Specialist (CNS), or equivalent certification or license required * In lieu of the NASM Certified Nutrition (CNC), Certified Nutrition Specialist (CNS), or equivalent certification or license required, a Bachelor's degree in Nutrition or related field from an accredited institution is required Key Qualifications * Must have a valid California Driver's License * Knowledge of: * The chemical makeup of macronutrients (protein, fats, and carbohydrates) and the role they play in the body * Vitamins, minerals, phytonutrients, micronutrients, and zoo nutrients. * Calorie, metabolism, and energy balance * Digestion * Water electrolyte balance and proper hydration * Energy transfer, fat storage, and muscle gain * Kitchen safety and techniques * Healthy meal planning for diverse groups * Skill in the use of first aid procedures * Strong interpersonal and communication skills with the ability to work effectively with people of all ages, skill levels and cultures * Ability to: * Prepare routine administrative paperwork * Read, understand, follow, and enforce safety procedures * Conduct safe and effective classes * Be professional with and motivate peers as class participants * Cooperate and work well with other Team Members both as class participants and as facility partners * Position includes extensive physical activity and requires strenuous physical work. Position requires a high degree of energy and endurance to complete the workouts. Position must remain flexible to ensure the hours meet the needs of customers (other IEHP Team Members seeking services). * This position will require to commute to locations designated by Community Resource Center (CRC) leadership to provide nutrition classes. Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $27.43 USD Hourly - $35.66 USD Hourly

The Provider Contract Supervisor is responsible for overseeing the negotiation, analysis, and implementation of hospital, provider, and ancillary provider agreements as well as single case agreements across all lines of business. This role entails supervising a team of contract specialists, providing guidance and performance evaluations, ensuring compliance with regulatory requirements, and enhancing contract management to ensure department goals are met. This role will require strong leadership skills, a detail-oriented and precise approach to contract language review, cross collaboration with other teams and providers, and a process-driven approach to contract management. Position overview Essential Functions: Supervise and lead provider contracting within Provider Services and across departments, including recruitment of new providers, re-negotiating existing agreements, and timely implementation of new contracts. Oversee the maintenance of all Provider Contract templates. Review new regulatory requirements and APLs; work with the Compliance Department as needed to modify contract templates to ensure compliance with all contractual and regulatory requirements. Keep internal policies, procedures and workflows related to provider contracting up to date, including through the analysis of new or updated regulations and by implementing appropriate changes as needed. Lead efforts to increase the knowledge of other HPSM departments about contract requirements that apply to HPSM and its provider network. Serve as department lead on maintenance and configuration of the provider contract database and related processes; oversee efforts to identify and implement improvements to the contract pipeline processes. Function as a liaison between HPSM and select providers as assigned; this may include managing relationships with hospitals, health systems, and ancillary providers, assisting in resolving complex payment issues, and identifying and implementing process improvements. Support HPSM network adequacy compliance, implementing corrective action as needed throughout the year to improve network performance and support regulatory submissions. Participate in internal and external stakeholder meetings as needed related to provider contract language, provider payment, and other regulatory requirements. In coordination with the Finance and Claims Department, support the development of financial impact analysis/modeling on new and revised payment arrangements. Ensure reimbursement and payment agreements are configured appropriately in claims system, in collaboration with the Claims and IT Configuration department. Support audit activities and regulatory reports for NCQA, DMHC, DHCS, and CMS as needed. Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner. Secondary Functions: Collaborate with other departments on projects requiring provider contracting expertise as needed. Perform other duties as assigned. Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education and experience are equivalent to: A Bachelor's degree or equivalent education in a related field; and an advanced degree is a plus. Minimum of five (5) years managed care provider contracting experience, including three (3) or more years in a lead capacity. Knowledge of: Medicare and Medicaid markets include regulations and requirements. Includes strong knowledge of Managed Medicare and Managed Medicaid. Health plan contracting norms and contract writing. Health plan payment methodologies, as well as provider billing and payment processes. Medicaid and Medicare reimbursement methodologies Fee schedule development, utilizing financial models and analysis in developing provider payment rates and risk-sharing arrangements. Knowledge of project management and process improvement methodologies. Quantitative reasoning and analytic tools. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint, and content management tools. Ability to: Establish and maintain cooperative working relationships across departments and with external providers. Communicate effectively, verbally and in writing. Handle complex issues with diplomacy. Works cross-functionally to execute network quality goals. Maintain accountability for regulatory compliance, often on short timeframes. Work cross-functionally to execute network quality goals. Influence others both with and without authority. Salary and benefits The starting salary range is $92,240 - $118,485 annually, depending on the candidate's work experience. Excellent benefits package includes: HPSM-paid premiums for employee's medical, dental and vision coverage (employee pays 10% of each dependent's premiums) Fully paid life, AD&D and LTD insurance Retirement plan (HPSM contributes equivalent of 10% of annual compensation) 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year Tuition reimbursement plan Employee wellness program It is HPSM's policy to provide equal employment opportunities for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Salary Min Hiring Rate $92,240.00 Max Hiring Rate $118,485.00 Job Start Date Wednesday, February 12, 2025

Under the direct supervision of the Quality Improvement Clinical Manager, the Quality Improvement Nurse monitors member health outcomes through internal and external data collection to determine effectiveness in maintaining safe care environments that meet regulatory requirements and to ensure members are receiving care that meets evidence-based standards. QI Nurse is responsible for collecting quality related data and reviewing medical records for HEDIS abstraction and overreads, Potential Quality of Care issues (PQIs) determination, regulatory compliance, Facility Site Review (FSR) and Medical Record Review (MRR) evaluations, Physical Accessibility Reviews (PARs), quality improvement (QI) activities development, data tracking and trending, and outcomes reporting. The Quality Review Nurse must be able to keep accurate records, manage and analyze data, as well as respond appropriately and timely, both verbally and in writing to internal audiences, external professional staff and regulatory agencies. Position overview Perform Facility Site Review and Physical Accessibility Reviews Uses state approved tools and conducts FSRs, MRRs, and PARs, using clinical knowledge and judgement to determine FSR and medical record compliance with regulatory requirements, documenting, reporting and communicating findings and results as required Issue Corrective Action Plans (CAP) as warranted, monitoring and document closing CAPs as appropriate Conduct pre-contractual reviews with potential contracted providers Assess and document compliance with Physical Accessibility standards Maintain thorough knowledge of the DHCS site review requirements and processes Assists with Healthcare Effectiveness Data and Information Set (HEDIS) Medical Record Review Ensures accurate collection, abstraction, over reading and reporting of HEDIS medical record data Ensures medical record reviews are within compliance of the National Committee for Quality Insurance (NCQA) HEDIS Specifications Ensures accurate translation of these medical record data elements to appropriate software or database system Conducts Quality Improvement Medical Record Review Investigate, determine and follow-up on Potential Quality Issues Develop, implement, and follow up with corrective action plans, giving technical assistance to provider as appropriate Educate providers and office staff about quality improvement activities, processes and corrective action interventions to facilitate their compliance with HPSM, federal, state, and NCQA regulations and standards Analyze, develop and implement improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions Meet productivity, work quality and work product goals as set by management Perform computer-based statistical analysis of data related to the QI program and collect data from one or more sources including outpatient lab, claims and other data sources Create processes documentation for QI and/or HEDIS activities and collaborates with practices to integrate their electronic medical record data into HPSM systems Develop, implement, and follow up with corrective action plans, giving technical assistance to provider as appropriate Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education and experience: Associate degree in Nursing. Bachelor's degree in nursing or a related health services field is a plus. Two (2+) plus years of relevant nursing experience in a managed care/quality improvement type of setting. License and Certification: A valid California Registered Nurse license. DHCS Facility Site Reviewer Certification, Trainer or Master Trainer certification highly preferred. Knowledge of: Knowledge of HEDIS reporting The concepts of managed health care Medicare and Medi-Cal and regulatory programs Quality improvement study design methods and appropriate quality improvement tools and applications is preferred Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint Ability to: Works cooperatively with others Work as part of a team and support team decisions Communicate effectively, both verbally and in writing Adapt to changes in requirements/priorities for daily and specialized tasks Evaluate medical records and other health care data Plan, organize and lead data collection activities Resolve simple and/or complex analytical problems Present statistical and technical data in a clear and understandable manner utilizing appropriate visual aids Interact professionally and effectively with providers, physicians, and staff from all departments within and outside the Plan Establish and maintain effective and cooperative working relationship with HPSM staff and others contacted in the course of the work Maintain accurate records and confidentiality of sensitive medical information Assume responsibility and exercise good judgment in making decisions within the scope of authority of the position Accurately complete tasks within established times and to effectively prioritize multiple tasks and deadlines Other: Must have own vehicle and valid driver's license with proof of insurance in conformity with state law minimums and be willing to travel (primarily) in San Mateo County Benefits Excellent benefits package includes: HPSM-paid premiums for employee's medical, dental and vision coverage (employee pays 10% of each dependent's premiums) Fully paid life, AD&D and LTD insurance Retirement plan (HPSM contributes equivalent of 10% of annual compensation) 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year Tuition reimbursement plan Employee wellness program It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Hourly Min Hiring Rate $44.36 Max Hiring Rate $56.96

The HRIS Analyst oversees daily HR Information Systems operations, ensuring data integrity, security, and optimal functionality. The role includes implementing, configuring, and maintaining HRIS modules, collaborating on system integration, troubleshooting issues, and customizing the platform to align with HR processes. The Analyst develops analytics tools and dashboards, provides actionable insights, ensures compliance with data privacy laws, and supports audits. Additionally, the role involves training staff, managing vendor relationships, and identifying process improvements to enhance system efficiency and user experience. Position overview System Management Oversee the day-to-day operations of the HR Information Systems (HRIS), ensuring data integrity, system security, maintenance administration, and optimal functionality. Lead the implementation, configuration, and maintenance of HRIS modules, including but not limited to payroll, benefits, performance management, and talent acquisition. Configure and customize the HRIS platform to align with the organization's HR processes, policies, and workflows, and communicate system and process changes of all HR systems across the organization. Manage relationships with HR system vendors, ensuring service level agreements are met and addressing any issues that arise. Serve as the SME for employees and management by answering questions, developing training documentation, job aid, and programming documents. Data Analytics and Reporting Develop and manage HR analytics tools and dashboards to provide actionable insights on workforce trends, employee engagement, turnover, diversity, and other key HR metrics. Analyze complex data sets and present findings to HR leadership to inform strategic HR decisions and initiatives. Ensure accurate and timely reporting of HR data to internal stakeholders and external regulatory bodies as required. Manage data analysis and reporting needs for the HR department and create custom ad hoc reports and queries and maintain a library of reports in the HRIS system. Design, analyze, and provide statistical reports for the HR/Organizational metrics dashboard; this includes collecting, analyzing, and presenting data. Process Improvement Identify and implement process improvements to enhance HR Information System efficiency and user experience and utilization. Provide training and support to HR staff and other end-users to maximize system utilization and effectiveness. Create tools, automations, workflows and reports to assist other HR functional areas to execute their respective functions. Document system configurations, processes, and procedures and create and manage the HR process and job aid library. Compliance and Security Ensure HRIS compliance with all relevant legal and regulatory requirements, including data privacy laws. Monitor system access and permissions to maintain data security and confidentiality. Support department audits to ensure completion and submission. Requirements These are the qualifications typically needed to succeed in this position. However, you don't need to meet every requirement to apply. Education and experience Bachelor's degree in human resources, Business Administration, or a related field. Five (5) to seven (7) years of experience in Human Resources, HRIS management, compensation management, and/or payroll. Or an equivalent combination of education and years of experience. Skills: Advanced Microsoft Excel skills (e.g., Macros, VLOOKUP, Pivot tables, etc.). Extensive experience using Microsoft Power Platform (Power BI, Power Automate). Extensive experience in HRIS configuration, upgrades, and implementation. Extensive database management and reporting skills. Intermediate DAX and/or Power Query writing skills. Intermediate Microsoft Visio skills and experience documenting HR processes. Advanced analytical skills with the ability to interpret and present complex data. Advanced proactive problem-solving skills. Intermediate project management skills and experience working with cross functional teams. Knowledge of: Working knowledge of HR processes and best practices. Working knowledge of data management, data privacy, and security regulations. Ability to: Ability to work collaboratively with cross-functional teams. Ability to manage multiple tasks and projects simultaneously. Ability to work independently and collaboratively within a team. Ability to handle sensitive information with integrity and discretion. Ability to pay close attention to detail and ensure data accuracy. Benefits HPSM-paid premiums for employee's medical, dental and vision coverage (employee pays 10% of each dependent's premiums) Fully paid life, AD&D and LTD insurance Retirement plan (HPSM contributes equivalent of 10% of annual compensation) 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year Tuition reimbursement plan Employee wellness program It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics. Other details Pay Type Salary Min Hiring Rate $83,854.91 Max Hiring Rate $107,000.00