IEHP

Architect

• Under the direction of the Manager, Learning & Organizational Development (L&OD), the Senior Learning Architecture Advisor leads the design and evolution of IEHP’s enterprise learning architecture.
• This role shapes holistic learning experiences, defines content governance standards, and ensures scalable, consistent, and innovative solutions aligned with IEHP’s strategic and operational priorities.
• The Senior Learning Architecture Advisor brings systems thinking, content strategy expertise, and deep adult learning knowledge to design connected, seamless learning journeys across digital and in-person modalities.
• This role partners cross-functionally to ensure learning solutions are human-centered, measurable, and operationally sustainable.
• Commit to incorporate IEHP’s Quality Program goals including HEDIS, CAHPS, and NCQA Accreditation.

Senior Learning Architecture Advisor

Learning and Development

• Find joy in serving others with IEHP!
• Lead the enterprise-wide learning partnership model, ensuring learning strategies support all Team Members and leaders across the organization.
• Oversee a team of L&D Partners who consult with business units to assess enterprise capability needs, align learning initiatives to business strategy, and deploy scalable solutions that drive performance.
• Oversee the design and deployment of enterprise learning and organizational development solutions that strengthen leadership capability, enhance team performance, and drive measurable business outcomes.
• Ensure learning solutions are aligned, practical, measurable, and consistent with enterprise objectives.
• Provide coaching and direction to L&D Partners, and collaborate closely with various stakeholders to deliver scalable, high-impact learning experiences.
• Establish governance and intake processes for enterprise learning requests.
• Ensure initiatives align with enterprise goals around performance, culture, engagement, and growth.

Manager, Learning & Development Partners

• Partner with leaders to assess capability gaps and align learning strategies with enterprise goals
• Develop annual and multi-year learning plans for assigned business areas
• Ensure learning initiatives support performance, engagement, and culture objectives
• Serve as a trusted advisor to senior leaders and HR Business Partners
• Conduct needs assessments using performance consulting methodologies
• Diagnose root causes of performance gaps and recommend systemic solutions (learning, process, structure, or leadership interventions)
• Facilitate strategic conversations related to leadership development, team effectiveness, and change management
• Engage in the design process of evidence-based learning solutions using adult learning principles
• Incorporate modern learning technologies and analytics to enhance engagement and measure impact
• Facilitate high-impact leadership and team development sessions as needed
• Support organizational effectiveness initiatives such as team interventions, culture initiatives, leadership development frameworks, and change efforts
• Establish success metrics and evaluate effectiveness of learning interventions
• Continuously identify opportunities to enhance learning impact and business value

Learning & Development Partner

Manager

• Develop and execute a comprehensive organizational effectiveness strategy aligned with IEHP’s mission, values, and evolving business priorities.
• Translate enterprise culture and change initiatives into function-level roadmaps that reflect operational realities while advancing shared organizational standards.
• Diagnose cultural, structural, and capability gaps and design targeted, evidence-based interventions.
• Apply action research methodologies and organizational analytics to identify systemic opportunities involving strategy, structure, people, and processes.
• Build and refine succession planning and talent review protocols for executive and critical roles, including process design, tools, governance, and cadence.
• Identify critical organizational capabilities and design targeted development strategies at the organizational, team, and individual levels.
• Partner closely with L&OD, HR Business Partners, and business leaders to shape strategies that strengthen leadership capability and organizational effectiveness.
• Leverage people and organizational data to generate insights, identify root causes, and guide decision-making.

Organizational Effectiveness Manager

Analyst

• Audit team output, analyze and assess data reports, and validate system configuration accuracy against contract interpretation, business rules, and regulatory requirements.
• Ensure errors are corrected and escalated issues are resolved within a timely manner.
• Report findings and trends to leadership to further support requirements of accuracy and productivity.
• Partner with the Product System Configuration Supervisor to define and uphold quality standards for Application Architects and Analysts performing claims system configuration (test coverage, evidence standards, defect SLAs).
• Identify data integrity gaps, recommend process improvements, and flag training needs.
• Provide insights and feedback to Product System Configuration Supervisor.
• Generate and audit quality reports (billing/handling practices, adjudication results, exception trends).
• Trigger improvement actions with Analysts.
• Own the weekly review of the Claim Check Run Audit and reconcile issues/discrepancies.
• Conduct in-depth root cause analysis of claims and integrated system configuration related issues that arise from claims and integrated system errors.
• Classify defects (e.g., large/difficult/complex) using quantitative thresholds and clear language.
• Review regulatory guidelines to determine if claims system configuration updates are required.
• Identify, communicate, and present on impact of system enhancements or configuration changes on integrated systems and processes related to regulatory guideline updates.
• Track compliance in QA matrices.
• Partner in the development of configuration standards and best practice guides for maintaining efficiency, accuracy, automation and successful integration with internal and external systems and programs.
• Analyze and identify system configuration based on claims auto adjudication standard metrics and business operational requirements to identify systematic quality risks and control improvements.
• Own and maintain a library of system requirements, specifications, test cases, defect logs, and test results.
• Ensure traceability from requirement to test evidence.
• Own UAT (User Acceptance Testing) test plan preparation and test execution of product delivery initiative(s), crossing multiple applications.
• Develop and run automated test scripts and evaluate results.
• Work with Compliance teams to determine solutions to help comply with regulations, guidelines, and All Plan Letters (APLs).
• Attend DHCS meetings, as needed.
• Develop and maintain policies, procedures, and training guidelines on behalf of the Product System Configuration team.
• Assist with claims system configuration updates as needed.
• Facilitate audit meetings to keep discussions focused, productive, and aligned with objective.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Product Configuration Quality Analyst

Procurement

• Find joy in serving others with IEHP!
• This position has full responsibility for both services and tangible items.
• This position involves the recognition of, and advisement on, the most appropriate procurement type to mitigate IEHP’s exposure to risk in alignment with public procurement policies, regulations, industry standards, and best practices, as well as regulatory requirements of the health plan.
• This position is responsible for the oversight of the public sector procurement processes to ensure compliance with IEHP’s Procurement, Legal, and Governing Board policies, and State and Federal requirements that govern public sector solicitations, award, and administration of contracts.
• The Supervisor, Procurement – Supply Chain Management provides effective and ethical leadership of subordinate staff members.
• The position manages and supervises the day-to-day operations of a variety of procurement-related activities including, but not limited to, the following: developing and managing a vast array of contracts; assisting with the development and issuance of Solicitations such as Requests for: Proposals, Bids, Quotations, and Qualifications, solicitation evaluations, contract negotiations and amendment, contract management, records management, materials management and oversees drafting of standard and non-standard contracts, amendments and other forms of agreements.
• Additional roles and responsibilities include training staff on Lean Methodologies and leading Process improvement projects that impact the organization’s overall supply chain performance.
• The Supervisor, Procurement – Supply Chain Management plays a vital role in optimizing supply chain efficiency by implementing best practices and fostering continuous improvement initiatives.
• They leverage their expertise to streamline procurement processes, enhance supplier relationships, and drive cost savings throughout the supply chain.
• Additionally, they collaborate cross-functionally to align procurement strategies with organizational goals and ensure seamless integration across all supply chain functions.

Supervisor, Procurement – IT Systems

Claims Specialist

• Review and process provider dispute resolutions according to state and federal designated timeframes.
• Research reported issues; adjust claims and determine the root cause of the dispute.
• Draft written responses to providers in a professional manner within required timelines.
• Independently review and price complex edits related to all claim types to determine the appropriate handling for each including payment or denial.
• Complete the required number of weekly reviews deemed appropriate for this position.
• Respond to provider inquiries regarding disputes that have been submitted.
• Maintain, track, and prioritize assigned caseload through IEHP’s provider dispute database to ensure timely completion.
• Maintain knowledge of claims procedures and all appropriate reference materials; participate in ongoing training as needed.
• Communicate with a variety of people, both verbally and in writing, to perform research, gather information related to the case that is under review.
• Recommend opportunities for improvement identified through the trending and analysis of all incoming PDRs.
• Coordinate with other departments as necessary to facilitate resolution of claim related issues.
• Identify and report claim related billing issues to various departments for provider education.
• Any other duties as required to ensure Health Plan operations are successful.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance.

Claims Specialist I – Provider Claims

Compliance

• Responsible for planning and managing cross-functional projects supporting regulatory compliance
• Developing and defining the project scope, goals, and deliverables
• Managing changes to the scope, schedule, and deliverables
• Communicating potential risks and ensuring successful relationships between project stakeholders
• Reporting and escalating project status and barriers to management
• Review, update and manage internal and Provider policies for assigned department(s)
• Facilitate the assessment of current policies against new regulations
• Responsible for identifying and gathering evidence for regulatory and/or audit-related submissions

Analyst II – Policy & Regulatory Operations

Supply Chain

• This position has full responsibility for both services and tangible items.
• This position involves the recognition of, and advisement on, the most appropriate procurement type to mitigate IEHP’s exposure to risk in alignment with public procurement policies, regulations, industry standards, and best practices, as well as regulatory requirements of the health plan.
• This position is responsible for the oversight of the public sector procurement processes to ensure compliance with IEHP’s Procurement, Legal, and Governing Board policies, and State and Federal requirements that govern public sector solicitations, award, and administration of contracts.
• Provides effective and ethical leadership of subordinate staff members.
• Manages and supervises the day-to-day operations of a variety of procurement-related activities including, but not limited to, the following: developing and managing a vast array of contracts; assisting with the development and issuance of Solicitations such as Requests for: Proposals, Bids, Quotations, and Qualifications, solicitation evaluations, contract negotiations and amendment, contract management, records management, materials management and oversees drafting of standard and non-standard contracts, amendments and other forms of agreements.
• Additional roles and responsibilities include training staff on Lean Methodologies and leading Process improvement projects that impact the organization’s overall supply chain performance.
• Plays a vital role in optimizing supply chain efficiency by implementing best practices and fostering continuous improvement initiatives.
• Leverages expertise to streamline procurement processes, enhance supplier relationships, and drive cost savings throughout the supply chain.
• Collaborates cross-functionally to align procurement strategies with organizational goals and ensure seamless integration across all supply chain functions.

Supervisor, Procurement – Supply Chain

Director

• Develop and implement IEHP’s population health management strategy and approach.
• Collaborate with key internal and external leaders, which includes conducting periodic population needs assessments, implementing strategies to systematically move farther upstream to impact the social determinants of health for IEHP members, identifying health disparities and system gaps in care, as well as ensuring that the health delivery system is focusing on evidence-based interventions and programming for the various segments of the population.
• Participate in the development and implementation of evidence-based approaches to address social determinants of health and community health assessment/improvement projects, in collaboration with internal departments, local and state agencies, local stakeholders, and funders.
• Oversee the department of Health Education, Promotion, and Prevention and the Community Behavioral Health Department and their functions, staff, and programs. Potentially other departments pending restructure.
• Oversee the department of Population Health and its functions, staff, and programs, inclusive of the Health Services Evaluation Team.
• Serve as a representative and spokesperson for IEHP in support of integration and population health activities in the Inland Empire with key county partners as well as State and National organizations and conferences.
• Ensure IEHP compliance with population health management regulatory requirements under NCQA, CalAIM/Medi-Cal 2024 contract, and Covered California.
• Oversee partnership joint operating meetings (ex. with counties) and MOUs related to population health as required in the 2024 Medi-Cal contract.
• May have a lead role in IEHP Strategic Plan initiatives in Optimal Care and Vibrant Health.
• Participate in State and industry work groups such as DHCS, DMHC, CHCF, NCQA, ACAP and CAHP to expand IEHP’s influence on benefit design, regulations, and policy direction.
• Hire, train, and manage support staff, while monitoring and evaluating outcomes.
• Conduct performance reviews of each team Member within IEHP guidelines.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Senior Director, Population Health

Vice President

• Establish key strategic priorities across core operational care coordination and care management functions.
• Ensure member care strategies are harmonized, linked, and streamlined to support key priorities, including value based and quality objectives for all lines of business.
• Forecast care coordination, care management, and care outcome trends and needs mapped to regulatory and compliance requirements.
• Ensure that all department functions are elastic to meet the demands of a dynamic membership population across all risk types.
• Executive level accountability to ensure all regulatory and compliance requirements are executed on, across all regulators, including, but not limited to, DHCS, DMHC, CMS and Covered CA.
• Influence enterprise initiatives and priorities that focus on continuous improvement for member outcomes, including the use of modern tools and techniques such as artificial intelligence where applicable.
• Partner and built trust with key stakeholders, including, but not limited to, Quality, Medical Management, Population Health, Pharmacy, Hospital and Ancillary Relations, and Provider Network to ensure care is managed and coordinated appropriately across all risk categories.
• Serve as a lead in all regulatory audits, including representation in key state, local, and regional committees as applicable.
• Develop, grow and cultivate high performing teams, while fostering a culture of accountability, collaboration, responsiveness, and performance.
• Create a data informed decision-making process to optimize membership needs.
• Ensure transparency, consistency, integrity, and accountability within the departments caring for IEHP members.

Senior Learning Architecture Advisor

Manager, Learning & Development Partners

Learning & Development Partner

Organizational Effectiveness Manager

Product Configuration Quality Analyst

Supervisor, Procurement – IT Systems

Claims Specialist I – Provider Claims

Analyst II – Policy & Regulatory Operations

Supervisor, Procurement – Supply Chain

Senior Director, Population Health

Vice President, Care Coordination – Care Management

Claims Specialist I – Provider Claims