Strategic Clinical Operations & Health Data Leader

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

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