Senior Specialist, IPA Quality & Performance

Akido•Ontario, CA

20h

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. Reporting to the IPA Operations Manager, this role develops and executes each IPA’s performance plan, leads field engagement with independent practices, serves as the named quality contact for contracted health plans, and coordinates staff responsible for supplemental data and chart evidence. The role has no direct authority over independent practices; it relies on relationships, credibility with physicians and office managers, and the ability to demonstrate the value of performance improvement to each practice. The position covers performance strategy, practice engagement, HEDIS and Star Ratings, cost and utilization, risk adjustment and clinical documentation improvement, health plan relationships, reporting and data, and day-to-day coordination of the HEDIS Coordinator and HIM quality queue. It also contributes California network requirements to the enterprise quality and CDI platform.

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, with specific results and methods that can be described.
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, such as 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 across Medicare Advantage, commercial, and Medi-Cal lines of business, subject to IPA Operations Manager approval.
Segment practices by membership, current performance, and financial opportunity; focus field time and staff effort where they are likely to have the greatest impact.
Explain contract incentive economics in practice-level terms and forecast year-end performance against targets, adjusting strategy when forecasts fall short.
Build 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 effects on practice behavior.
Record interventions and education, apply the documented escalation process, and route escalations through monthly reviews with IPA leadership and the Medical Director as administrative or clinical matters as appropriate.
Direct gap-closure strategy across HEDIS, Star Ratings, Part D adherence, CAHPS, and contracted Medi-Cal and commercial 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 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; include cost and utilization results in practice performance reviews.
Drive practice engagement in Annual Wellness Visit completion, chronic condition recapture, and suspected condition review; partner with CDI teams while leaving coding methodology and decisions 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 and run monthly operational quality calls with each plan.
Prepare quality meeting materials five business days in advance and assign a named owner to every commitment.
Prepare written feasibility reviews of measure sets, submission requirements, and deadlines for leadership before new contracts or amendments are signed; assess annual measure and specification changes and escalate 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 enterprise quality and CDI platform development.
Provide day-to-day work direction to the HEDIS Coordinator and HIM quality queue on priorities and deadlines, and provide input to the manager on their performance.
Ensure submission processes and portal knowledge are documented and cross-trained rather than held by one person.