Contractual Regulatory Operations Jobs (NOW HIRING)

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 auditrelated submissions; managing crossfunctional 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.

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
  • 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

1. Responsible for planning and managing crossfunctional 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.
2. 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.
3. 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.
4. Responsible for identifying, gathering, developing, and bookmarking evidence and/or narratives for regulatory and/or auditrelated submissions.
5. Facilitate crossfunctional 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.
6. 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.
7. 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.
8. Perform a broad range of project management and research activities, using analytical and critical thinking skills.
9. 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.

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

• 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 followthrough to track all outstanding tasks and ensure these are completed timely.

Start your journey towards a thriving future with IEHP and apply TODAY!

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