Clinical Operations and Health Information Manager

Community Health Plan of Imperial Valley; Imperial (CA); On-site; USD 100,000 - 130,000; Full time

Benefits offered by this job

Health insurance premium covered

Paid time off

Life and disability insurance

401(k) retirement plan with 4% match

Job summary

Community Health Plan of Imperial Valley seeks a Clinical Operations and Health Information Manager to bridge our plan with the provider network and drive quality improvement, risk adjustment, and incentive programs. Your guidance will influence member outcomes, provider performance, and program success.

You will lead data-driven improvements, provider education on coding and documentation, EHR optimization, and incentive design, collaborating with Quality, Compliance, and Finance to achieve

Qualifications

• 5+ years of experience in clinical operations, quality improvement, or risk adjustment.
• Knowledge of HEDIS, STAR, CAHPS, and risk adjustment methodologies.
• Experience designing provider incentive programs that drive measurable improvements.
• Experience advising providers on EHR optimization for quality reporting and coding accuracy.
• Excellent communication and relationship-building with providers and multidisciplinary teams.

Responsibilities

• Lead implementation of initiatives to streamline operations and data exchange with contracted provider offices, focusing on referrals, authorizations and STARS performance.
• Drive risk adjustment initiatives, including provider education on compliant coding for Medicare and Medi-Cal populations.
• Design, launch, and manage provider incentive programs and software solutions that reward performance in quality, risk adjustment, and member experience metrics.
• Analyze performance data to identify trends, gaps, and opportunities for improvement; translate insights into actionable strategies for providers.
• Advise provider offices on EHR optimization to support quality reporting, coding accuracy, and care gap closure.
• Collaborate with Quality, Compliance, Provider Relations, Data Analytics, Finance to align initiatives and track incentive program performance.
• Conduct on-site and virtual visits to deliver training, share performance dashboards, and support workflow optimization.
• Monitor and report on initiative outcomes, adjusting strategies to maximize impact and meet plan goals.
• Serve as SME on CMS, DHCS, NCQA quality standards, risk adjustment guidelines, and value-based care models.

Skills

Quality improvement

Risk adjustment

Provider training

Data analytics

EHR optimization

Education

Bachelor's degree in Nursing/Healthcare Admin/Public Health

Job description

As the Clinical Operations and Health Information Manager at CHPIV you will be the bridge between our health plan and the provider community, ensuring that quality improvement, risk adjustment, and incentive programs are implemented effectively and sustainably. Your work will directly influence member health outcomes, provider performance, and the plan’s ability to deliver on its promise of exceptional care and service. By guiding providers through data-driven strategies, compliance requirements, EHR optimization, and incentive program participation, you will help close care gaps, improve HEDIS and STAR ratings, ensure accurate risk adjustment coding, and motivate providers to achieve shared goals—ultimately shaping the health of our community.

What You'll Do

• Lead the implementation of initiatives to streamline operations and data exchange with contracted provider offices, focusing on referrals, authorizations and STARS performance
• Drive risk adjustment initiatives, including provider education on accurate and compliant coding for Medicare and Medi-Cal populations.
• Design, launch, and manage provider incentive programs and software solutions that reward performance in quality, risk adjustment, and member experience metrics.
• Analyze performance data to identify trends, gaps, and opportunities for improvement; translate insights into actionable strategies for providers.
• Advise provider offices on EHR optimization to support quality and risk adjustment goals—such as improving documentation workflows, integrating clinical decision support tools, and leveraging reporting functions to track care gaps.
• Collaborate with internal teams (Quality, Compliance, Provider Relations, Data Analytics, Finance) to align initiatives, ensure regulatory adherence, and track incentive program performance.
• Conduct on-site and virtual provider visits to deliver training, share performance dashboards, and support workflow optimization.
• Monitor and report on initiative outcomes, adjusting strategies to maximize impact and meet plan goals.
• Serve as a subject matter expert on CMS, DHCS, and NCQA quality standards, risk adjustment guidelines, and value-based care models.

What You'll Bring

• Bachelor’s degree in Nursing, Healthcare Administration, Public Health, or related field (Master’s preferred).
• 5+ years of experience in clinical operations, quality improvement, or risk adjustment within a health plan or provider network.
• Strong knowledge of HEDIS, STAR, CAHPS, and risk adjustment methodologies for Medicare and Medi-Cal.
• Proven ability to design and implement provider incentive programs that drive measurable performance improvement.
• Hands-on experience advising providers on EHR optimization for quality reporting, coding accuracy, and care gap closure.
• Exceptional communication and relationship-building skills, with the ability to influence providers and multidisciplinary teams.
• Experience delivering provider education and training, both in-person and virtually.
• A proactive, solutions-oriented mindset with a passion for improving community health outcomes.

Our Commitment to You

• A comprehensive benefit package, with up to 85% of your health insurance premium paid for you and your family.
• A generous amount of paid time off to rest and restore.
• Other benefits that protect you and your family, including life and disability insurance.
• A retirement plan that you can start participating in immediately and matches up to 4%.
• A competitivesalary of $100,000-$130,000/ year.