Manager, Quality Operations

Position Summary/Position

At Inland Empire Health Plan (IEHP), we believe the highest quality of care should be delivered at all in the Inland Empire.  We are thinking beyond the way Quality is viewed today – we believe it should holistic and transformative.  IEHP’s quality programs serve an important role in achieving IEHP’s quality goals.

Reporting to the Director, Accreditation Programs, the Manager, Quality Operations is responsible for:
- Ensuring all quality program activities meet compliance standards as outlined by IEHP’s regulatory agencies.
- Ensuring quality program activities across the organization are effectively implemented.
- Managing IEHP Quality Management Committee and Subcommittee processes to ensure all QM/QI Work Plan deliverables are reviewed, regulatory requirements are met, and IEHP goals are achieved.

Major Functions (Duties and Responsibilities)

1. Manage Quality Systems Administration Team ensuring effective resource management and prioritization of work in support of meeting Quality Systems goals and priorities.
2. Facilitate business processes to support reporting requirements through the understanding of regulatory reporting requirements that are supported by the Quality Systems department.
3. Maintain working knowledge of regulatory requirements as they relate to Quality Management operations and protocols.
4. Guide the development and implementation of protocols and projects with the Quality Systems Administration department through the comprehension of the various databases utilized by Quality Systems for regulatory reporting, as well as a clear understanding of IEHP business operation.
5. Development, coordinate, and oversee departmental policies and procedures.
6. Oversee the Quality Systems Administration team and operations including managing timeframes, regulatory reporting, and other processes to ensure compliance with regulatory requirements and optimal operations. This includes:
    a. Validate memos for Committee.
    b. Develop Standard Operating Procedures (SOPs) and training materials providing administrative support for regulatory required activities.
    c. Develop work plans in collaboration with Quality Systems leadership to ensure activities and goals are planned and achieved.
7. Manage regulatory audit activities and Quality Systems deliverables.
8. Implement activities as outlined in the Quality Management Program Description and QM/QI Work Plan.
9. Manage IEHP Quality Management Committee and Subcommittees to ensure all QM/QI Work Plan deliverables are reviewed, regulatory requirements are met, and IEHP goals are achieved. 
10. Collaborate with IEHP departments and external providers to identify quality initiatives and support the development of studies. This includes planning, facilitating, and documenting collaborative workgroup meetings.
11.Facilitate correspondence with regulatory agencies as needed to ensure adherence to regulatory requirements.
12. Demonstrate a commitment to incorporate LEAN principles into daily work.
13. Establish and maintain effective working relationships with others throughout the organization.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Five (5) or more years of any individual or combined experience in quality management within a healthcare organization. Including experience in: 
- Leading multi-disciplinary project teams in healthcare setting
- Implementing multiple large scale incentive programs
- Working with staff from various backgrounds including clinical, IT and business 
Two (2) years of experience with quality committees and committee standards.

Preferred Experience

Education Qualifications

Bachelor's degree in Business or Healthcare related field from an accredited institution required.

Preferred Education

Master’s degree in Business or Healthcare related field from an accredited institution preferred.

Professional Certification

Professional Licenses

Drivers License Required

Knowledge Requirement

Strong knowledge of DHCS, DMHC, CMS, Covered CA, and NCQA regulations related to quality management.

Skills Requirement

Strong project management skills. Excellent written and verbal communication skills that adapts to targeted audience.

Abilities Requirement

Ability to effectively solve escalated issues as identified, following established protocols. Positive attitude and ability to work in a team setting. Ability to demonstrate critical thinking, strong problem solving capability. 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

Word processing involving computer keyboard and screens, automobile travel within the Inland Empire and plane travel within California.

Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Work Model Location

Physical Requirements