Analyst I

2 weeks ago

Rancho Cucamonga, United States Inland Empire Health Plan Full time

Overview:
**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 Grievance & Appeals Director. The Grievance & Appeals Analyst I is responsible for supporting the Grievance & Appeals department in the development, implementation, and monitoring if quality initiatives and special projects. Effectively communicate within various levels and departments to define scope, resources and provide documentation, tracking, and coordination and follow-up. Responsible for supporting the Grievance & Appeals Department in the development, implementation, and monitoring of care management processes, reporting projects, regulatory audits and reviews, special projects, management of data submissions and other time sensitive projects.

**Key Responsibilities**:
1. Collaborate with Grievance & Appeals Management and external departments in developing and maintaining written project plans, projected timelines, milestones and deliverables.
2. Assist in the development and monitoring of projects in collaboration with the Grievance & Appeals Management to ensure compliance with regulations (NCQA, CMS, DMHC and DHCS).
3. Assist Director of Grievance & Appeals as lead resource acting as a liaison between Grievance & Appeals department and internal and external entities (such as IPA’s), including analyzing Corrective Action Plans (CAPs), as appropriate, when issues of non-compliance are identified. Ensure submitted CAP response addresses the identified issue(s) and monitor for accuracy and timely closure.
4. Assists in drafting Board Status report items, obtaining Professional Service Agreements (PSAs) and Amendments as needed, coordinating with Purchasing department.
5. Monitors contracts with vendors. Processes invoices and manages contract budgets, including the maintenance of updated cost projections.
6. Act as a primary liaison between IEHP Grievance & Appeals stakeholders/vendors for large Grievance & Appeals projects.
7. Provide oversight and monitoring of GARC related activities.
8. Responsible for analyzing report requests to determine the needs and objectives of the Grievance & Appeals team. Collaborate with IEHP internal departments to correctly identify criteria to meet reporting requests and ensure delivery of report is accurate, timely, and formatted appropriately.
9. Track, trend, develop, and analyze department specific data into operational reports.
10. Analyze trends and collaborates with the Grievance & Appeals Department Team to recommend process and/or operational improvements
11. Assist in the development and analysis of meaningful clinical and operational dashboards for the IEHP Executive Director of Health Services and Director of Grievance & Appeals
12. Develop and participate in the implementation of department workflows utilizing process improvement tools and techniques.
13. Coordinate comprehensive work plans for multiple units.
14. Participate in inter-departmental process improvement activities.

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 from an accredited institution required.
- One (1) year of experience in managing complex projects and or programs utilizing data, work plans and project management (preferred).

**Key Qualifications**
- Knowledge of managed care principles and experience in related organization.
- Possess strong planning and organizational skills. Excellent analytic, documentation and project management skills. Must have excellent written and verbal communication skill.
- Able to lead teams to success process to accomplish intended goals. Exceptional critical thinker. Ability to establish and maintain effective working relationships. Ability to build trust with internal and external partners and strong rapport.

Pay Range: USD $30.72 - USD $39.94 /Hr.

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