Senior Specialist, IPA Quality & Performance

Akido•Ontario, CA

About The Position

The Senior Specialist, IPA Quality & Performance drives quality, cost, and risk adjustment results across the Chaffey Medical Group and My Family Medical Group IPA networks. Working under the direction of the IPA Operations Manager, this role develops and executes each IPA’s performance plan, leads field engagement with practices, serves as the named quality contact for contracted health plans, and coordinates staff producing supplemental data and chart evidence. Most practices in these networks are independently owned, and many contract with more than one IPA. The position has no direct authority over how practices operate; results depend on building credibility and relationships with physicians and office managers and demonstrating the value of performance for the IPA. The role works across Medicare Advantage, commercial, and Medi-Cal lines of business. It leads practice performance improvement for HEDIS, Star Ratings, Part D adherence, patient experience, cost and utilization, and risk adjustment. It coordinates with the HEDIS Coordinator, HIM quality queue, CDI teams, Utilization and Care Management, Analytics, IPA leadership, and health plans. The position provides day-to-day work direction to the HEDIS Coordinator and HIM quality queue and gives performance input to a manager.

Requirements

Bachelor’s degree in health administration, public health, nursing, business, or a related field.
At least five years of value-based care quality experience in an IPA, MSO, health plan, ACO, or medical group.
At least three years of provider-facing performance improvement experience with independent or contracted practices.
Demonstrated record of improving HEDIS or Star Ratings results through practices the candidate did not directly manage; candidates should be able to describe specific results and how they achieved them.
Working knowledge of HEDIS specifications, CMS Star Ratings methodology, CMS-HCC risk adjustment, and the California delegated managed care model.
Experience presenting performance data to physicians, practice owners, and health plan quality leaders.
Advanced Excel skills.
Experience with population health or quality platforms such as Cozeva.
Valid California driver’s license, reliable transportation, and ability to travel regularly to practice sites.

Nice To Haves

Master’s degree (MHA, MPH, MBA, MSN, or related).
Certified Professional in Healthcare Quality (CPHQ).
Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC).
Experience with the IHA Align. Measure. Perform. program and Medi-Cal Managed Care Accountability Set measures.
Formal improvement methodology training (Lean, Six Sigma, or PDSA).
Bilingual English/Spanish.

Responsibilities

Develop and execute annual quality, cost, and risk adjustment performance plans for each IPA, with targets tied to health plan incentive contracts and subject to approval by the IPA Operations Manager.
Segment practices by membership, current performance, and potential incentive dollars; focus field time and staff effort where they are likely to improve results most.
Translate contract incentive economics into practice-level terms and explain the value of closing performance gaps to each practice.
Forecast year-end performance against plan cut points and contract targets, and adjust strategy during the year when forecasts fall short.
Build and maintain relationships with physician owners, office managers, and front-line staff, including at practices affiliated with competing IPAs.
Lead practice visits, performance reviews, and education on measure requirements, documentation, and workflow; provide usable gap lists and scorecards.
Design and run practice incentive and recognition programs within approved budgets and track their impact on behavior.
Apply the documented escalation process, record interventions and education, and escalate after two documented attempts in a quarter without movement through the monthly review with IPA leadership and the Medical Director, routing administrative or clinical matters appropriately.
Direct gap-closure strategy across HEDIS, Star Ratings, Part D adherence, patient experience (CAHPS), and contracted Medi-Cal and commercial program measures.
Direct the HEDIS Coordinator on supplemental data files, submission calendars, and portal submissions, and direct the HIM queue on chart retrieval; confirm capacity before committing to submission timelines.
Monitor performance rates against targets at least monthly at IPA, practice, and measure levels.
Partner with Utilization and Care Management to share practice-level utilization data and develop practice-specific improvement plans; incorporate cost and utilization results into practice reviews alongside quality.
Drive practice engagement in Annual Wellness Visit completion, chronic condition recapture, and suspected condition review; partner with CDI teams while leaving coding methodology, documentation review, and compliance guardrails to them.
Serve as the named health plan contact for quality performance, gap lists, intervention plans, and quality audits.
Attend every Joint Operations Committee meeting; prepare quality materials five business days in advance and assign an owner to each commitment.
Run monthly operational quality calls with each health plan.
Prepare written feasibility reviews of measure sets, submission requirements, and deadlines for leadership before new contracts or amendments are signed.
Assess the impact of annual measure and specification changes and raise definition or evidence-standard disputes to enterprise quality leadership.
Report performance, risks, and intervention results to IPA leadership and the quality committee.
Use Cozeva and health plan portals and partner with Analytics on dashboards and practice reporting.
Apply enterprise measure definitions and standards and contribute California network requirements to the enterprise quality and CDI platform build.
Provide day-to-day work direction to the HEDIS Coordinator and HIM quality queue on priorities and deadlines, and provide performance input to the manager.
Ensure submission processes and portal knowledge are documented and cross-trained rather than held by one person.