Analyst II - Policy & Regulatory Operations (Hybrid remote options)

Date: Aug 27, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5337 

 

Position Summary/Position

 

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 audit‐related submissions; managing cross‐functional 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.

Major Functions (Duties and Responsibilities)

 

1. Responsible for planning and managing cross‐functional 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 audit‐related submissions.
5. Facilitate cross‐functional 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.

Experience Qualifications

 

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.

Education Qualifications

 

Bachelor’s degree from an accredited institution required.

Professional Certification

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

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.

Skills Requirement

 

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.

Abilities Requirement

 

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 follow‐through to track all outstanding tasks and ensure these are completed timely.

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. 

 

Starting Salary: $66,040.00  - $84,219.20  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles