Senior Specialist, IPA Quality & Performance

The Opportunity

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 IPA Opeations Manager, the role develops and executes the performance plan for each IPA, leads practice engagement in the field, serves as the named quality contact for contracted health plans, and coordinates the work of the staff who produce supplemental data and chart evidence.

Most practices in these networks are independently owned, and many contract with more than one IPA. This role has no direct authority over how those practices operate. Results come from relationships, credibility with physicians and office managers, and the ability to show each practice why performing for this IPA is worth their time and money. Measure knowledge can be taught quickly; the ability to move independent practices cannot, and it is the core qualification for this job.

What you’ll do

Network performance strategy

• Develop and execute the annual quality, cost, and risk adjustment performance plan for each IPA, for approval by IPA Operations Manager, with targets tied to health plan incentive contracts across Medicare Advantage, commercial, and Medi-Cal lines of business.
• Segment practices by membership, current performance, and dollars at stake. Direct field time and staff effort to where they will move results most.
• Translate contract incentive economics into practice-level terms, so each practice understands what closing its gaps is worth to it.
• Forecast year-end performance against plan cut points and contract targets, and adjust strategy mid-year when forecasts fall short.

Practice engagement and influence

• Build and sustain working relationships with physician owners, office managers, and front-line staff, including at practices that are also affiliated with competing IPAs.
• Lead practice visits, performance reviews, and education on measure requirements, documentation, and workflow. Deliver gap lists and scorecards in a form practices will actually use.
• Design and run practice incentive and recognition programs within approved budget, and track whether they change behavior.
• Apply the documented escalation process. Interventions and education are recorded; two documented attempts over a quarter without movement trigger escalation through the standing monthly review with IPA leadership and the Medical Director, routed as administrative or clinical as appropriate.

Quality (HEDIS and Star Ratings)

• Direct gap-closure strategy across HEDIS, Star Ratings, Part D adherence, and patient experience (CAHPS) measures, and Medi-Cal and commercial program measures as contracted.
• 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 any submission timeline.
• Monitor rates against targets at least monthly, at the IPA, practice, and measure level.

Cost and utilization

• Partner with Utilization and Care Management to share practice-level utilization data (emergency department visits, admissions, readmissions, post-discharge follow-up, referral patterns, pharmacy) and build practice-specific improvement plans.
• Incorporate cost and utilization results into practice performance reviews alongside quality.

Risk adjustment and CDI (HCC)

• Drive practice engagement in Annual Wellness Visit completion, chronic condition recapture, and suspected condition review.
• Partner with the CDI Specialist and central CDI team, who own coding methodology, documentation review, and compliance guardrails. This role owns practice engagement and follow-through, not coding decisions.

Health plan relationships

• Serve as the named health plan contact for quality performance, gap lists, intervention plans, and quality audits.
• Attend every Joint Operations Committee meeting. Prepare the quality prep pack five business days in advance and assign a named owner to every commitment made.
• Run monthly operational quality calls with each plan.
• Prepare written feasibility review of measure sets, submission requirements, and deadlines for leadership before any new contract or amendment is signed.
• Assess the impact of annual measure and specification changes. Raise definition or evidence-standard disputes to enterprise quality leadership for decision.

Reporting, data, and enterprise alignment

• Report performance, risks, and intervention results to IPA leadership and the quality committee.
• Use Cozeva and health plan portals effectively, 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.

Team coordination

• Provide day-to-day work direction to the HEDIS Coordinator and HIM quality queue on priorities and deadlines, and give input to [manager title] on their performance. Ensure submission processes and portal knowledge are documented and cross-trained, not held by one person.

Who you are

Required Qualifications:

• Bachelor’s degree in health administration, public health, nursing, business, or a related field.
• Five or more years of value-based care quality experience in an IPA, MSO, health plan, ACO, or medical group, including at least three years of provider-facing performance improvement with independent or contracted practices.
• A 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 and 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.

Preferred Qualifications:

• 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.

Benefits

• Stock-options package
• Health benefits include medical, dental and vision
• 401K
• Long-term disability
• Unlimited PTO
• Life insurance
• Paid Leave Program