Analyst II - Policy & Regulatory Operations

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the Policy & Regulatory Operations Manager’s general supervision, the Analyst II – Policy & Regulatory Operations helps ensure Health Services, Quality Systems, Provider Services, and Member Services remain in compliance with Local, State, Federal, contractual and accreditation requirements and supports these departments’ operational strategies by completing compliance assessments, regulatory reviews and audit related submissions; managing cross functional regulatory implementation, operational and system enhancement projects.

The Analyst II - Policy & Regulatory Operations is responsible for Local, State, Federal, contractual and accreditation requirements interpretation, gap analysis, project scope develop and initiation, resource planning, risk identification and project implementation, as well as timely comprehensive review and maintenance of internal and Provider policies. for the purpose of gap analysis, project scope development and initiation, resource planning, risk identification, and project implementation, as well as timely and comprehensive review of internal and Provider policies. To do these effectively, the Analyst II – Policy & Regulatory Operations must have a clear understanding of IEHP business operations and the responsibilities of various departments in Health Services, Quality Systems, Provider Services, and Member Services, and demonstrated ability to effectively and consistently manage multiple projects and priorities concurrently.

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, but we also aim to match our team members with the same energy by providing prime benefits and more.

Competitive salary

Hybrid schedule

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Life, short-term, and long-term disability options

Career advancement opportunities and professional development

Wellness programs that promote a healthy work-life balance

Flexible Spending Account – Health Care/Childcare

CalPERS retirement

457(b) option with a contribution match

Paid life insurance for employees

Pet care insurance

Key Responsibilities

Responsible for planning and managing cross functional projects, which may include, but not be limited to projects that support regulatory compliance, system enhancement, process development, and improvement within a single or multiple departments in Health Services, Quality Systems, Provider Services, and Member Services. This responsibility includes: developing and defining the project scope, goals, and deliverables; developing, monitoring, and maintaining a detailed project plan; managing changes to the scope, schedule, and deliverables; communicating potential risks; ensuring successful relationships between project stakeholders and resources to ensure timely delivery of project outcomes; reporting and escalating project status and barriers to management, as needed; and creating and maintaining comprehensive project documentation.

In collaboration with department policy owners, review, update and manage internal and Provider policies for their assigned department(s) to ensure that these are kept current, accurate and in accordance with applicable regulatory and accreditation requirements. This responsibility includes supporting the management and publication of IEHP Provider Manual of Policies and Procedures, electronic Data Interchange (EDI) Manual and internal department manuals; researching, reviewing and citing regulatory and accreditation requirements, plan policies, and other relevant sources; identifying compliance and/or operational risks as well as upstream and downstream impacts of policy changes on other department(s) and/or documents; and defining and summarizing the degree and description of change.

Facilitate the timely and comprehensive assessment or examination of current policies and standard procedures against new regulations for the purpose of identifying the health plan’s state of compliance, regulatory and process gaps, and action plan.

Responsible for identifying, gathering, developing, and bookmarking evidence and/or narratives for regulatory and/or audit related submissions.

Facilitate cross functional implementation projects that support compliance with Local, State, Federal, contractual and accreditation requirements. This responsibility includes requirements interpretation, gap analysis, project scope development and initiation, resource planning, risk identification, implementation, and ensuring the development and implementation of compliance monitoring at the department level.

At the direction of the Policy and Regulatory Operations Manager, support departments in the completion of their system enhancement and/or process development requests by facilitating the development and documentation of process flow, standard work, and business requirements, as well as testing and validating system enhancements prior to implementation.

Serve as the primary analyst reviewer and support for their assigned department(s). This responsibility includes preparing draft work output for quality assurance review by the Policy and Regulatory Operations Manager or Analyst III.

Perform a broad range of project management and research activities, using analytical and critical thinking skills.

Support departments in Health Services, Quality Systems, Provider Services, and Member Services to make Lean business decisions by identifying and communicating identified opportunities for process improvements.

Qualifications

Education & Requirements

At least three (3) years of experience providing analytical and/or project implementation support, including but not limited to regulatory review and analysis in a healthcare setting

Bachelor’s degree from an accredited institution required

Key Qualifications

Must have a valid California Driver’s license

Working knowledge of project management software such as Workfront, MS Project or equivalent

Knowledge of managed care industry practices and standards including Local, Federal, State and/or accreditation standards, is preferred

Must have strong organizational skills

Must have strong critical thinking, research, verbal, and written communication skills

Demonstrated proficiency in Microsoft Office products: Word, Excel, Visio, and Power Point, sufficient for use in all aspects of an office environment

Must have the ability to manage multiple projects with competing deadlines and changing priorities

Must have the ability to work well in a team environment and build effective relationships with Team Members at all levels

Must be detail oriented

Exceptional follow through to track all outstanding tasks and ensure these are completed timely

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and 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!

Work Model Location

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

Pay Range

USD $80,059.20 - USD $106,059.20 /Yr.

Regular Full-Time