Senior Analyst, PACE Health Plan Operations - Kearny Mesa/Hybrid

Company: San Ysidro Health
Location: San Diego
Posted on: May 5, 2025

Job Description:

Position Summary:The Senior Analyst, Health Plan Operations at San Ysidro Health's (SYH) San Diego Program for the All-Inclusive Care of the Elderly (PACE), is responsible for overseeing the creation, revision, updating, maintenance, and dissemination of Best Use Practices guidelines, policies, and procedures.Essential Functions of the Job:

• Develop and apply evidence-based medical guidelines, policies, and procedures for Best Use Practices for both internal staff and external providers, ensuring optimal outcomes through education programs for SD PACE providers and IDT members.
• Work under the direction of the SD PACE Associate Chief Medical Officer and SD PACE-Health Plan Director, collaborating with the Director of Quality and Compliance to meet standards.
• Ensure evidence-based guidelines and relevant policies support participant care decisions made by PACE providers and IDT, and disseminate this information through ongoing education programs.
• Manage guidelines, policies, and procedures for external contracted and in-network providers, including education efforts.
• Maintain effective relationships with San Diego PACE PCPs, IDT members, external providers, and PACE regulatory agencies.
• Manage and train network providers on the provider portal, ensuring timely resolution of issues by coordinating communication with other departments.
• Collaborate with the Eligibility team to ensure requirements are current and properly disseminated.
• Educate the enrollment team on Best Use Practices guidelines, policies, and procedures.
• Work with the Finance Office and claims departments to ensure staff are knowledgeable about guidelines and protocols.
• Stay current on regulations and policies impacting the PACE program, developing guidelines that meet regulatory requirements and ensuring adherence through dashboards and workflows.
• Maintain audit readiness through ongoing training, competency assessments, monitoring, and corrective actions.
• Identify and resolve issues by analyzing problems, exploring solutions, and implementing action plans.
• Oversee program guideline, policy, and procedure development to ensure compliance with industry regulations.
• Plan and direct training and educational programs for department personnel and external providers.Additional Duties and Responsibilities:

• Update departmental policies and procedures as needed.
• Ensure compliance with all relevant regulations and standards.
• Participate in educational programs, literature review, meetings, and workshops for professional growth.
• Attend meetings as required and perform other duties as assigned.Job RequirementsExperience Required:
  • At least 1 year of related experience in geriatrics, medically fragile, or underserved populations.
  • Strongly preferred: 3+ years of related experience and clinical experience.
  • Excellent writing, analytical, and oral presentation skills.
  • Ability to work effectively in a dynamic environment with short-term and long-term deadlines.
  • Experience with PACE or related programs is strongly preferred.Education Required:
    • Bachelor's or Master's degree in business, accounting, finance, or a health-related field is preferred.Skills and Knowledge:
      • Excellent verbal and written communication skills.
      • Knowledge of diverse populations, community organizations, healthcare systems, and managed care principles.
      • Understanding of Medi-Cal/Medicare benefits and regulations.
      • Experience in program and policy development, administration, and coordination.
      • Familiarity with healthcare operations, LTC facilities, and financing systems.
      • Knowledge of healthcare, social services, and aging networks, as well as relevant federal and state systems.
      • Understanding of contract negotiations principles and procedures.Equipment Used:
        • Standard office equipment including PC, laptop, printers, and familiarity with Microsoft Office and Excel.Working Conditions and Physical Requirements:
          • Ability to sit for extended periods and work at a computer.
          • Work in an office environment with moderate noise and temperature control.Universal Requirements:Pre-employment requirements include I-9, physical, background checks, application completion, orientation, PPDs, and compliance with vaccination policies.About Us: San Ysidro Health is committed to providing accessible, high-quality healthcare. We value diversity and equal employment opportunity. Join our mission-driven team today!
            #J-18808-Ljbffr

Keywords: San Ysidro Health, Murrieta , Senior Analyst, PACE Health Plan Operations - Kearny Mesa/Hybrid, Professions , San Diego, California