Quality Improvement Facilitator III - Medicare Stars

Inland Empire Health Plans; Rancho Cucamonga (CA); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Competitive salary

On-site fitness center

Medical, dental, vision insurance

Life, disability coverage

Career development opportunities

Wellness programs

Retirement plans (CalPERS)

457(b) with match

Pet care insurance

Job summary

Inland Empire Health Plans (IEHP) seeks a Quality Improvement (QI) Facilitator III – Medicare Stars to serve as an SME for Medicare Stars regulations and program requirements. You will lead cross-functional projects, translate CMS expectations into actionable workflows, and drive Stars performance excellence.

Reporting to the Director, Medicare Stars, you will manage resource prioritization, deliverables, and continuous improvement initiatives across clinical, operational, and provider-facing

Qualifications

• Master’s degree in public health or related field is required.
• PMI/CPHQ or equivalent quality cert required or to be completed within 1 year of hire.
• Advanced knowledge of CMS/NCQA/HEDIS and quality measurement is expected.
• Strong analytical skills and proficiency in MS Office, especially Excel, PowerPoint, Visio.

Responsibilities

• Lead complex Medicare Stars quality initiatives across cross-functional teams.
• Translate CMS expectations into actionable workflows and ensure alignment with CMS Star Ratings program requirements.
• Oversee quality improvement projects, prioritize resources, and manage deliverables to improve organizational performance.

Education

Master’s degree in public health, health administration, public administration, or related field

Project Management Professional (PMP) Certificate or Certified Professional of Healthcare Quality (CPHQ) or similar

Advanced knowledge of healthcare quality performance and measurement sets (CMS, NCQA, HEDIS)

Strong analytical and Excel proficiency

Tools

MS Office (Excel, PowerPoint, Visio)

Job description

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!

Reporting to the Director, Medicare Stars, the Quality Improvement (QI) Facilitator III – Medicare Stars serves as a Medicare Stars regulatory and operational subject matter expert, ensuring Medicare-related quality improvement functions align with CMS regulations, CMS Star Ratings Program requirements, the Medicare Managed Care Manual, audit protocols, evolving CMS guidance, and IEHP organizational policies. This role independently leads and oversees complex Medicare Stars quality initiatives involving the prioritization of resource utilization, delegation of project deliverables, and application of quality concepts and standards to ensure improvements in organizational performance. This position translates CMS expectations into actionable workflows across operational, clinical, and provider facing teams. The QI Facilitator III facilitates Stars driven organizational improvement by applying improvement methodologies, managing cross functional project deliverables, and aligning initiatives with IEHP’s strategic goals for sustained Stars performance excellence.

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

Education & Requirement

• A minimum of six (6) years demonstrated experience, at a professional level, in process/project management including participation in quality improvement projects or operations
• Prior experience in the health care setting required
  • Prior experience designing Medicare Star Measure interventions preferred. Demonstrated experience increasing Plan Star Ratings through targeted quality improvement activities preferred
  • Knowledge of Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred
• Master’s degree in public health, health administration, public administration, or other healthcare related focus from an accredited institution from an accredited institution required
  • Project Management Professional (PMP) Certificate, Certified Professional of Healthcare Quality (CPHQ), or other recognized quality improvement certificate required or successful completion within one (1) year of hire

Key Qualifications

• Must have a valid California Driver’s license
• Advanced knowledge and in-depth understanding of:
  • Healthcare quality performance and measurement sets including CMS quality withhold, NCQA Quality Improvement Standards and HEDIS
  • Project management techniques, tools of continuous improvement, and work process redesign
  • Standardized QI concepts
  • Standard coding sets as they are used in quality measurement including ICD-10, CPT, CPT Category II, HCPCS, LOINC, NDC
• Strongly preferred advanced knowledge and understanding of:
  • Risk Adjustment calculations and financial analysis related to Medicare Advantage membership populations preferred
  • CMS quality programs, Medicare Star Ratings methodology, HEDIS, CAHPS, Pharmacy Part D measures, NCQA standards, Risk Adjustment basics, and regulatory documentation requirements
  • Supporting CMS audits, data validation reviews, or compliance reporting
  • Medicare Managed Care Manual, HPMS guidance, and CMS regulatory updates.
• Advanced proficiency in:
  • Analytical and critical thinking skills
  • All Microsoft Office applications, with an emphasis on Excel, PowerPoint, and Visio
  • Communication skills (verbal, written and listening) with ability to interact effectively and demonstrated comfort with public speaking to varied audiences
  • Successfully applying facilitation techniques to quality improvement project teams to achieve optimal outcomes
  • Problem solving, leadership qualities, conflict management, and team building skills to ensure a productive work environment and achievement of quality goals
  • Successfully working with and motivating diverse teams including group process facilitation, change management and conflict resolution
  • Teaching quality improvement concepts and principles
• Demonstrated ability to:
  • Increase Quality Ratings through targeted quality improvement activities
  • Read and interpret data
  • Be results and outcome oriented
  • Perform complex tasks, prioritize multiple projects and work under pressure to meet deadlines in a fast-paced environment
  • Successfully apply facilitation techniques to quality improvement project teams to achieve optimal potential
  • Demonstrate excellent project and time man agement skills
  • Exhibit high attention to detai