Senior Specialist, IPA Quality & Performance
Core
Drive quality, cost, and risk adjustment results across IPA networks by leading practice engagement, developing performance plans, and managing health plan relationships.
Role type
Senior Specialist, IPA Quality & Performance
Builds
Quality performance plans, practice scorecards, gap-closure strategies, and health plan compliance reports
Domain
Healthcare administration, Value-based care, Managed care (Medicare Advantage, Commercial, Medi-Cal)
Deliverable
dashboards & analysis
Required skills
IPA operations, HEDIS, CMS Star Ratings, CMS-HCC risk adjustment, California delegated managed care model, practice engagement, data forecasting, Excel, population health platforms
Preferred skills
Master's degree (MHA/MPH/MBA/MSN), CPHQ, CRC, CPC, Lean/Six Sigma/PDSA, Bilingual English/Spanish
Technologies
Cozeva, health plan portals, IHA Align
Responsibilities
Develop and execute annual quality/cost/risk adjustment performance plans for IPA networks; Lead practice visits and engagement to improve HEDIS, Star Ratings, and risk adjustment scores; Manage relationships with health plans as the named quality contact; Coordinate data collection and chart evidence for quality submissions; Analyze utilization and cost data to build practice improvement plans; Report performance metrics to leadership and quality committees.
Seniority
Senior, hands-on IC
