IEHP

Title: Care Manager, RN -Hybrid Location: Rancho Cucamonga United States Job Description: Health Services Hybrid What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Reporting to Health Services department leadership, this position is responsible for working effectively to provide high quality, effective care management to IEHP members. Care management is broadly defined, and can include outreach and engagement to members, engaging members in skilled therapeutic interactions to promote health behaviors, other behavioral health interventions within scope, coordination of care, resource linkages, working with other professionals and organizations in the community to ensure quality of care for members, seamless transitions of care, and facilitating the right care and the right time for the member. This position works collaboratively with members of the Integrated Care Team, members and families, and other professionals, in addition to working collaboratively with the designated health care organization’s (HCO) medical team. This position, like all positions within IEHP, is expected to model whole health principles of relationship-based care, as well engage in promoting education and understanding of physical health and healthy behaviors to those within IEHP and in the community. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. - Competitive salary - State of the art fitness center on-site - Medical Insurance with Dental and Vision - Life, short-term, and long-term disability options - Career advancement opportunities and professional development - Wellness programs that promote a healthy work-life balance - Flexible Spending Account – Health Care/Childcare - CalPERS retirement - 457(b) option with a contribution match - Paid life insurance for employees - Pet care insurance Education & Requirements - Minimum two (2) years clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting required - Two (2) or more years of care management experience in a health care delivery setting preferred - Experience in a Managed Care (HMO, IPA) or in acute facility (i.e. hospital) care management preferred - Associate’s degree in Nursing from an accredited institution required - Bachelor’s degree in Nursing from an accredited institution preferred - Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Key Qualifications - Knowledgeable and skilled in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies - Understanding of and sensitivity to multi-cultural community - Deep understanding and knowledge of self-management philosophies and practices, especially as they relate to chronic medical conditions - Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both - Must have knowledge of whole health and integrated principles and practices - Bilingual (English/Spanish) preferred - Highly skilled in interpersonal communication, including conflict resolution - Effective written and oral communication skills, as well as reasoning and problem-solving skills - Skillful in informally and formally sharing expertise - Must have the resiliency to tolerate and adapt to a moderate level of change and development around new models of care and care management practices - Proficient in the use of computer software including, but not limited to, Microsoft Word, Excel, PowerPoint - Demonstrated proficiency with all electronic medical management systems (e.g., Cisco, MHK/Care Prominence, MediTrac, SuperSearch and Web Portal) is preferred - Proven ability to: - Sufficiently engage members and providers on the phone as well as in person - Work as a member of a team, executing job duties and making skillful decisions within one’s scope - Establish and maintain a constructive relationship with diverse members, leadership, Team Members, external partners, and vendors - Prioritize multiple tasks as well as identify and resolve problems - Have effective time management and the ability to work in a fast-paced environment - Be extremely organized with attention to detail and accuracy of work product - Have timely turnaround of assignments expected - To form cross-functional and interdepartmental relationship - Work Model Location: Hybrid work schedule, Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA. Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range - $91,249.60 USD Annually - $120,910.40 USD Annually

Title: Provider Quality Review Nurse, RN Location: Rancho Cucamonga United States ID 2026-6652 Health Services Job Description: This is a short-term assignment. What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! At Inland Empire Health Plan (IEHP), we believe the highest quality of care should be delivered to all in the Inland Empire. We are thinking beyond the way Quality is viewed today - we believe it should be holistic and transformative. IEHP's provider incentive programs serve an important role in achieving IEHP's quality goals. Reporting to the Manager of Provider Quality Oversight, the Provider Quality Review Nurse, RN is responsible for: - Receive and research all PQI and QR cases as assigned, provide a summary and recommendations to the Medical Director of case assignments - Effectuate all action items as determined by the Medical Director to resolution of case assignments - Reviewing escalated issues - Discussing and reviewing cases with Medical Directors referred to the Quality Management (QM) department - Investigation of cases includes, but not limited to, the documentation of case summaries, follow up actions, outreach efforts, and communications in the QM database Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Education & Requirements - Three (3) or more years of any individual or combined healthcare experience in quality assurance, quality management, quality improvement, utilization management, discharge planning, and/or case management - Three (3) or more years of work experience in a managed care, hospital, provider practice, or other comparable healthcare experience - Experience preferably in a quality/performance improvement setting - Bachelor's degree in Nursing from an accredited institution required - In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position - This experience is in addition to the minimum years listed in the Experience Requirements above - Certified Professional in Healthcare Quality (CPHQ), Certified Professional in Healthcare Risk Management (CPHRM), or Clinical certification in area specialty) preferred - Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required Key Qualifications - Must have a valid California Driver's License - Excellent understanding of performance improvement, quality assurance, and utilization management - Knowledgeable in clinical analysis of health records, assessing or evaluating quality, and identifying problems or issues with care delivery - Microcomputer applications: spreadsheet, database, and word processing - Excellent written and verbal communication skills - Excellent coordination skills - Ability to communicate findings and form recommendations based on clinical case reviews - Ability to demonstrate critical thinking, strong problem-solving capability. Strong attention to detail - Ability to prioritize work to ensure adherence to project deadlines. Ability to effectively escalate issues as identified, following established protocols - Positive attitude and ability to work in a team setting - Self-direction and ability to work with minimal supervision - Word processing and data entry involving computer keyboard and screens, automobile travel within the Inland Empire - Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range - $91,249.60 USD Annually - $120,910.40 USD Annually

• Full responsibility for procurement services and tangible items • Recognition of and advisement on the most appropriate procurement type to mitigate exposure to risk • Oversight of public sector procurement processes to ensure compliance with policies, regulations, and standards • Develop and manage a vast array of contracts • Assist with the development and issuance of Solicitations such as Requests for Proposals, Bids, Quotations, and Qualifications • Conduct solicitation evaluations, contract negotiations and amendments, contract management and records management • Train staff on Lean Methodologies and lead Process improvement projects impacting overall supply chain performance • Optimize supply chain efficiency by implementing best practices and fostering continuous improvement initiatives • Streamline procurement processes, enhance supplier relationships, and drive cost savings throughout the supply chain • Collaborate cross-functionally to align procurement strategies with organizational goals

• Evaluating professional, high dollar and outpatient/inpatient institutional claims while determining coverage and payment levels • Evaluating and resolving provider disputes & appeals, issuing resolution letters, and processing adjustment requests timely and accurately in accordance with standard procedures that ensure compliance with regulatory guidelines • Payment adjustment projects and complex claims as assigned