Clinical Operations and Health Information Manager

As the Clinical Operations and Health Information Manager at CHPIV you will be the bridge between our health plan and the provider community, ensuring that quality improvement, risk adjustment, and incentive programs are implemented effectively and sustainably. Your work will directly influence member health outcomes, provider performance, and the plan’s ability to deliver on its promise of exceptional care and service. By guiding providers through data-driven strategies, compliance requirements, EHR optimization, and incentive program participation, you will help close care gaps, improve HEDIS and STAR ratings, ensure accurate risk adjustment coding, and motivate providers to achieve shared goals—ultimately shaping the health of our community. What You'll Do Lead the implementation of initiatives to streamline operations and data exchange with contracted provider offices, focusing on referrals, authorizations and STARS performanceDrive risk adjustment initiatives, including provider education on accurate and compliant coding for Medicare and Medi-Cal populationsDesign, launch, and manage provider incentive programs and software solutions that reward performance in quality, risk adjustment, and member experience metricsAnalyze performance data to identify trends, gaps, and opportunities for improvement; translate insights into actionable strategies for providersAdvise provider offices on EHR optimization to support quality and risk adjustment goals—such as improving documentation workflows, integrating clinical decision support tools, and leveraging reporting functions to track care gapsCollaborate with internal teams (Quality, Compliance, Provider Relations, Data Analytics, Finance) to align initiatives, ensure regulatory adherence, and track incentive program performanceConduct on-site and virtual provider visits to deliver training, share performance dashboards, and support workflow optimizationMonitor and report on initiative outcomes, adjusting strategies to maximize impact and meet plan goalsServe as a subject matter expert on CMS, DHCS, and NCQA quality standards, risk adjustment guidelines, and value-based care models What You'll Bring Bachelor’s degree in Nursing, Healthcare Administration, Public Health, or related field (Master’s preferred)5+ years of experience in clinical operations, quality improvement, or risk adjustment within a health plan or provider networkStrong knowledge of HEDIS, STAR, CAHPS, and risk adjustment methodologies for Medicare and Medi-CalProven ability to design and implement provider incentive programs that drive measurable performance improvementHands-on experience advising providers on EHR optimization for quality reporting, coding accuracy, and care gap closureExceptional communication and relationship-building skills, with the ability to influence providers and multidisciplinary teamsExperience delivering provider education and training, both in-person and virtuallyA proactive, solutions-oriented mindset with a passion for improving community health outcomes Our Commitment to You A comprehensive benefit package, with up to 85% of your health insurance premium paid for you and your familyA generous amount of paid time off to rest and restoreOther benefits that protect you and your family, including life and disability insuranceA retirement plan that you can start participating in immediately and matches up to 4%A competitive salary of $100,000-$130,000/ year Powered by JazzHR uYB0ZS9w12