Position Summary:

The Senior Analyst Health Plan operations of the San Ysidro Healths (SYH) San Diego Program for the AllInclusive Care of the Elderly (PACE). Responsible for overseeing the creation revision updating maintenance and dissemination of Best Use Practices guidelines policies and procedures.

Essential Functions of the Job:

• Responsible for the development and application of evidencebased medical guidelines and policies and procedures for Best Use Practices both for internal providers and staff and for external network contracted providers and noncontracted providers. Ensures optimal outcomes through an educational program for SD PACE providers and all other IDT members and for both contracted and noncontracted providers.
• Under the direction of the SD PACE Associate Chief Medical Officer and the SD PACEHealth Plan Director. Works closely with the Director of Quality and Compliance to ensure standards are met.

• As PACE providers and IDT are responsible for participant care decisions the Analyst ensures that evidencebased guidelines and any relevant policies and procedures are in place to support them. The Analyst is also responsible for dissemination of this information through a comprehensive and ongoing education program for providers and IDT members.

• For external Providers on contract and in network as well as those with Letters of Agreements the Analyst is responsible for their guidelines policies and procedures including education.

• Maintain effective relationships with San Diego PACE PCPs and IDT members.

• Identify develop and maintain effective relationships with external contracted providers and PACE regulatory agencies.

• Manages and trains network providers on provider portal.

• Ensures provider issues and concerns are addressed timely by coordinating communication with other PACE departments.

• Works with Eligibility team to ensure requirements are updated maintained and disseminated.

• Educate enrollment team on San Diego PACEs Best Use Practices guidelines policies and procedures.

• Works with the SD PACE Finance Office and claims departments to ensure staff are well versed in the guidelines protocols and procedures of the Best Use Practices operation.

• In collaboration with PACE executive team keeps current on regulation and policy impacting the PACE program.

• Develops guidelines and policies that meet applicable regulatory agency and PACE requirements and ensures adherence to guidelines policies and regulations by developing dashboards and related workflows .

• Maintains audit readiness by ongoing training competency assessment audit monitoring of metrics and corrective action.

• Resolve issues by identifying the problem examining solution options implementing an action plan and providing resources.

• Oversees program guideline policy and procedure development to ensure compliance with current industry regulations.

• Plan and direct the development and delivery of training and educational programs for all department personnel and external providers.

Additional Duties and Responsibilities:

• Maintains and updates established departmental policies and procedures as needed.

• Keeps abreast of all regulations and standards to ensure compliance with orders or directives issued by duly constituted government/regulatory agencies.

• Enhances professional growth and development through participation in educational programs current literature inservice meetings and workshops.

• Attends meetings as required.

• Performs other related duties as assigned or requested.

Job Requirements

Experience Required:

• (1) year of related experience in at least one of the following: geriatrics medically fragile and/or underserviced populations;
• (3) years of related experience strongly preferred.
• Clinical experience strongly preferred.
• Strong writing analytical and oral presentation skills.
• Candidate must be comfortable working in a dynamic environment with both shortterm and long term deadlines.
• Experience with PACE or related programs strongly preferred.

Education Required:

• Preferred: Bachelors or Masters degree in business accounting finance or health related field.

Verbal and Written Skills Required to Perform the Job:

• Excellent written and verbal communication skills.

Technical Knowledge and Skills Required to Perform the Job:

• Culture and needs of the socially and ethnically diverse population that San Diego PACE serves.
• Communitybased organizations agencies and community services.
• Principles and practices of health care health care systems and managed care.
• MediCal/Medicare benefits and regulations.
• Techniques of program and policy development administration and coordination.
• Health Plan Hospital and Medical Group operations and strategies.
• Knowledge and experience working with LTC facilities SNF hospice etc.
• Working knowledge of health care delivery and financing systems including Medicaid Medicare waiver programs prospective and capitated systems public health programs and HMO/Managed Care.
• Good working knowledge of healthcare social services and aging networks as well as relevant federal and state systems.
• Working knowledge of the principles procedures and techniques governing contract negotiations.

Equipment Used:

• PC Laptop printers and other equipment found in an office setting. Microsoft Officesuite and Excel knowledge strongly preferred.

Working Conditions and Physical Requirements:

• Employee must be able to sit for extended periods of time as well as work at the computer for long periods.
• Employee must be able to work in an office setting with moderate noise levels and controlled office temperatures.

Universal Requirements:

Preemployment requirements include I9 physical positive background and reference check results complete application new hire orientation preemployment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality compassionate accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later San Ysidro Health now provides innovative care to over 108000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our missiondriven team! San Ysidro Health has a longstanding commitment to equal employment opportunity for all applicants for employment. Employment decisions including but not limited to those such as employee selection performance evaluation administration of benefits working conditions employee programs transfers position changes training disciplinary action compensation and separations are made without regard to race color religion (including religious dress and grooming) creed national origin nationality citizenship status domestic partnership status ancestry gender affectional or sexual orientation gender identity or expression marital status civil union status family status age mental or physical disability (including AIDS or HIVrelated status) atypical heredity cellular or blood trait of an individual genetic information or refusal to submit to a genetic test or make available the results of a genetic test military status veteran status or any other characteristic protected by applicable federal state or local laws.