Health Services Evaluator - Quality Systems

Date: Jan 23, 2023

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Team Members are eligible to apply for a transfer or promotion after successfully completing their six-month introductory period AND have no open/active performance improvement plan (PIP). In addition, Team Members must meet the minimum requirements of the position for which they are applying. Member Services Representatives and Registered Nurses must complete one year of service in their current role as well as the requirements above.

 

Position Summary/Position

 

Under  the direction  of the Manager of Health  Services  Evaluation,  the Health  Services  Evaluator  - Quality Systems will support the development, implementation and evaluation of intermediate to moderate levels of complex technical and analytical research and quality improvement projects to support the quality improvement efforts  at  IEHP. The Health Services Evaluator - Quality Systems will measure the effectiveness of programs in alignment with the organizational mission, vision, and values. The person in this role will support the design, implementation, and evaluation of programs across departments and provide expertise in designing and developing program evaluation tools, collecting and analyzing program data, interpreting findings, and recommending program changes.  The Health Services Evaluator - Quality  Systems  will work with a team of evaluators, data analysts, and healthcare informatics specialists   to model  complex healthcare related problems, discover insights and identify opportunities through the use of statistical, algorithmic, mining and visualization techniques to support business decision-making.

Major Functions (Duties and Responsibilities)

 

1. Evaluate the effectiveness of programs and service delivery through outcome monitoring and data analysis. Compare desired and actual program outcomes and suggest changes based on findings.
2. Develop and facilitate new and ongoing processes in all areas of program evaluation, serving as lead evaluator of small- and large-scale projects. Responsible for providing expertise in program design, implementation, and revision, with a focus on evaluating outcomes. 
3. Work closely with business units across the organization to make data-informed decisions regarding programs. This includes designing and implementing studies, conducting quantitative and qualitative data collection and analysis, performing descriptive and inferential statistics, writing reports, and disseminating findings for multiple audiences. 
4. Support the collaborative work of Quality Systems in a variety of evaluation, data collection, analysis, and reporting tasks, including preparing presentation and written materials for reports, regulatory requirements, Quality Programs, audits, and internal and external stakeholder meetings.
5. Must have advanced analytic skills to contribute to the integration and preparation of large, varied datasets, work in specialized databases and computing environments, and communicate results which are compliant with IEHP business rules and reporting requirements.
6. Serve as the project lead on moderately complex analysis/reporting projects and multi-departmental projects assigned to the Health Services Evaluation Unit. Responsible for coordinating and managing all aspects of program evaluation, program effectiveness studies, data analysis, and related support tasks, including the collaborative efforts of multiple teams. 
7. Model and frame business scenarios that will have meaningful impact on critical business processes and/or decisions for the health services department and other departments across the organization.
8. Acquire and maintain updated knowledge of the various data sources available within IEHP for reporting, as well as a clear understanding of IEHP business operations, to be able to appropriately apply criteria and methodology to meet requestors’ needs.
9. Collaborate with staff at all levels to solve analytics issues, documenting results and methodologies.
10. Coordinate and manage the collection, delivery, entry, verification, analysis, and reporting of data that support Health Services initiatives.
11. Collaborate with   data teams to ensure that information used follows the organization’s compliance, access management, and control standards.
12. Provide support to the ongoing tracking and monitoring of the performance of decision systems and statistical models that support Health Services initiatives.
13. Demonstrate proficiency in use of statistical software to analyze complex data and interpret results.
14. Plan and coordinate all aspects of major research programs across multiple clinical departments at IEHP. Support inter-disciplinary, inter-institutional, and inter-sectoral research collaborations.
15. Apply specialized knowledge and scientific principles to review, critically appraise and interpret published literature.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Leading: Self

Experience Qualifications

 

Minimum of two (2) years of program evaluation experience with relevant quantitative and qualitative research and analytics experience. Extensive utilization experience in Microsoft Access, SAS, and Excel are essential.

Preferred Experience

 

Experience in the healthcare field is preferred. Experience in program development, implementation, and/or management is preferred.

Education Qualifications

 

Doctoral degree in Public Health or related field from an accredited institution is required.


One of the following scenarios will be accepted in lieu of a Doctoral Degree:
1.)    Candidates with near completion of their Doctoral Degree in the field of Public Health or related field will be required to complete Doctoral Degree within 12 months of hire.
2.)  Candidates who possess a Master’s Degree from an accredited institution and four (4) years of applied experience will be accepted.

Preferred Education

Professional Certification

Professional Licenses

Drivers License Required

No

Knowledge Requirement

 

Proficiency using statistical packages (such as SAS, SPSS, R, Microsoft Access) and in statistical analysis, quantitative and qualitative analytics, forecasting/predictive analytics, multivariate testing, and optimization algorithms. In-depth knowledge in program and evaluation design and data collection and analysis. Familiarity with and ability to learn ICD-9/ICD-10/CPT/HCPCS/NDC medical coding, medical terminology and knowledge of managed care, claims payment processes and insurance terminology required. Compliance with Healthcare Regulations. Knowledge of HIPAA. Medical Coding and Billing.

Skills Requirement

 

Good communication and interpersonal skills required. Computer (Microsoft Office). Business Acumen. Communication (Written and Verbal). Data Analysis. Interpersonal Networking. Research and Statistics. Critical Thinking. Oral Presentation.

Abilities Requirement

 

Professional demeanor for interacting with business units, senior leaders, and external stakeholders. The ability to inform solutions to loosely defined business problems. Demonstrate ability to think creatively and critically and apply theoretical knowledge into practice. Manage multiple projects and requests in a time-sensitive and deadline-driven environment. Strong attention to detail.

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

Work Model Location

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Sitting - CONSTANTLY
Lighting - CONSTANTLY
Indoors - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

A reasonable salary expectation is between $103,708.80  - $132,225.60, based upon experience and internal equity.

 

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 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and 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 state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles