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<p><b>Salary Range:&nbsp;</b>&nbsp;$171,925.00&nbsp;(Min.) -&nbsp;$232,100.00&nbsp;(Mid.) -&nbsp;$292,274.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Director, Enterprise Analytics provides strategic leadership and operational oversight for one of two primary analytic domains: Provider Performance &amp; Experience or Member Experience &amp; Outcomes. This position plays a pivotal role in enabling data-driven decision-making across the enterprise by translating complex data into actionable insights that inform strategy, improve performance, and advance organizational goals. As a key leader, the Director ensures that analytic strategy and execution are tightly aligned with other cross functional areas to drive L.A. Care’s enterprise transformation and strategic outcomes.</p><p>The Director oversees analytic teams in the design, development, and delivery of insights that span multiple operational and strategic workstreams. Ensures efficiency and effectiveness in work outcomes. &nbsp;This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports</p><h4>Duties</h4><p>Lead strategic planning and prioritization for analytics efforts within the assigned domain, ensuring alignment with organizational objectives and enterprise priorities.</p><p>Oversee and mentor leadership, fostering development of technical, operational, and leadership capabilities.</p><p>Ensure delivery of enterprise-level dashboards, reports, and analytic products that support business performance, regulatory compliance, member outcomes, and provider experience.</p><p>Partner with executives, strategic pillar leaders, cross-functional stakeholders, and partners to translate organizational priorities into analytics strategies, work plans, and actionable insights.</p><p>Support and enforce analytic governance, standardization, and methodology consistency across teams and domains.</p><p>Serve as the first point of engagement for domain analytics needs, providing expert guidance, strategic recommendations, and escalation support.</p><p>Track and monitor analytic initiatives, ensuring timely delivery, quality, and relevance to business objectives.</p><p>Advocate for data-driven decision-making, assuring they are embedded into strategic planning performance management and transformation initiatives across the enterprise and provide thought leadership on analytic strategy, capabilities, and innovation.</p><p>Collaborate with key stakeholders to ensure alignment of data architecture, availability, and quality with analytic needs.</p><p>Continuously assess enterprise and domain-level analytic capabilities, identifying opportunities for process improvement, automation, and innovation. Support and enforce the development, standardization, and governance of analytic processes and outputs across domains to ensure consistency, accuracy, and quality. </p><h4>Duties Continued</h4><p>Integrating development and outputs from the Applied AI and Causal Impact Data Science Team into the domain portfolio and roadmap, ensuring predictive and explainable models and program causal impact evaluations are operationalized, actionable, and aligned with business needs. Serving as a primary analytics liaison to stakeholders for the position’s focal analytic domain.</p><p>Develop goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews, training, and disciplinary matters for direct reports.</p><p>Conduct strategic planning for resource management in order to meet current and future departmental and enterprise-wide goals.</p><p>Develop, and manage department budget, monitor expenditures and ensures financial sustainability.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p><b>Required:</b><br>At least 9 years of progressively responsible experience in analytics.</p><p>At least 7 years of experience supervising/managing staff. </p><p>Experience leading teams, projects, initiatives, or cross-functional groups.</p><p>Experience with SQL, Python, and Tableau (or comparable BI/visualization tools) in a server-based analytics environment.</p><p>Experience integrating outputs from advanced analytics or data science models into operational analytic portfolios.</p><p><b>Preferred:</b><br>Experience with stakeholder engagement, executive reporting, and strategic initiative management.</p><p>Experience implementing and enforcing enterprise-level analytic standards and governance.</p><h4>Skills</h4><p><b>Required:</b></p><p>Ability to lead multiple Managers and analytic teams, set priorities, and align work with enterprise strategy.</p><p>Deep knowledge of healthcare operations, quality measurement, risk adjustment, provider networks, provider performance, population health and member experience.</p><p>Demonstrated ability to set enterprise analytic priorities, translate strategy into execution, and deliver actionable insights to executive leadership.</p><p>Knowledge of managed care, Medicare Advantage, Medi-Cal, commercial insurance operations, and compliance reporting</p><p>Knowledge of prescriptive analytics, predictive risk modeling, or causal impact modeling.</p><p>Ability to support and enforce the development, standardization, and governance of enterprise analytics outputs.</p><p>Ability to synthesize complex findings into actionable recommendations and communicate effectively with senior leaders.</p><p>Ability to provide oversight of multiple complex analytic initiatives, ensuring on-time and high-quality delivery.</p><p>Ability to partner effectively across Information Technology (IT), Data Governance, operational and clinical teams, and business stakeholders.</p><p>Ability to mentor Senior Managers, Managers, and analytic leaders, building enterprise analytic capability. </p><p>Excellent written and verbal communication skills. Strong negotiation and interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.</p><p>Strong strategic and operational acumen, with the ability to collaborate across business areas, anticipate analytic needs, and ensure alignment with enterprise priorities and transformation initiatives. Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p><b>Preferred:</b></p><p>Advanced knowledge of visualization design, executive dashboards, and Key Performance Indicators (KPI) frameworks.</p><p>Strategic planning skills for enterprise analytic initiatives.</p><p>Change management expert knowledge to drive adoption of standardized processes and tools.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Professional in Healthcare Quality (CPHQ)Project Management Professional (PMP)Tableau Desktop or Tableau Server CertificationSnowflake SnowPro Core CertificationOther analytics or data-focused certifications (e.g., Microsoft Certified: Data Analyst Associate, Python for Data Science certifications)<h4>Required Training</h4><p><b>Preferred:</b></p><p>Snowflake or SnowPro training</p><p>Healthcare analytics training (e.g., HEDIS, Risk Adjustment, MLTSS)</p><p>Executive leadership or strategic analytics training</p><p>Training in data governance, reproducibility, and analytic methodology best practices</p><p>Familiarity with predictive modeling, prescriptive analytics, and causal inference methods</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Domain Specific Experience and Skills: </b></p><p><b>Domain Focus: Provider Performance &amp; Experience Analytics<br>Required:</b></p><p>Proven experience leading and executing analytics strategy across at least one of the following managed care domains: Authorizations, Claims and Medical Cost Driver Analytics, Provider Network Strategy Analytics, or Risk Adjustment and Encounter Analytics.</p><p>Demonstrated ability to align operational, financial, and clinical analytics to improve provider performance, experience, and value-based outcomes.</p><p>Experience integrating analytic insights into provider engagement, performance improvement, and contracting strategies.</p><p><b>Preferred: </b><br>Experience with predictive modeling, cost driver analytics, and provider performance dashboards to support strategic decision-making.</p><p>Deep understanding of provider network contracting, credentialing, utilization management, and claims operations.</p><p>Knowledge of managed care regulations, compliance requirements, and operational reporting standard.</p><p><b>Domain Focus: Member Experience &amp; Outcomes Analytics</b></p><p><b>Required:</b></p><p>Experience leading and executing analytics strategy across Member Experience, Quality, Population Health, and Access to Care domains.</p><p>Knowledge of population health frameworks, risk stratification methodologies, and social determinants of health analytics.</p><p>Proven ability to align analytics to drive measurable improvements in member satisfaction, clinical quality outcomes, care access, and population health performance.</p><p>Demonstrated success in developing and operationalizing analytics that inform strategic decision-making, program evaluation, and performance improvement initiatives.<br><b>Preferred:</b></p><p>Experience with Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality and satisfaction measurement programs.</p><p>Experience incorporating predictive, explainable, and causal impact models into analytics solutions to enhance member insights and guide strategic interventions.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicare, Performance Management, Insurance, Healthcare, Human Resources                                                    </p>

L.A. Care Health Plan

Director, Enterprise Analytics

<p><b>Salary Range:&nbsp;</b>&nbsp;$135,136.00&nbsp;(Min.) -&nbsp;$175,676.00&nbsp;(Mid.) -&nbsp;$216,218.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Senior Manager of Emerging Technologies and Artificial Intelligence (AI) leads L.A. Care’s advancement into innovative digital health solutions, focusing on the adoption and integration of artificial intelligence and other disruptive technologies. This position crafts a forward-thinking technology vision to propel L.A. Care’s service delivery, member engagement, and operational efficiency. Acting as both strategist and champion, the role evaluates next-generation tools, fosters experimentation, and ensures responsible implementation that meets legal and ethical standards positioning L.A. Care as a tech-enabled health plan prepared for the future of healthcare.&nbsp; The position leads L.A. Care’s governance, program management of adoption and implementation of AI in partnership with IT, analytics and project management.</p><p>The Senior Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.&nbsp; Responsible for driving performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.&nbsp; Oversees the development, implementation, administration, and maintenance of the department's programs, policies, and procedures. Responsible for driving management and performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.</p><h4>Duties</h4><h4>Manages staff and the day-to-day activities in the department. Participates in the department budgeting process.&nbsp; Responsible for scheduling, training, performance, corrective actions, mentoring, developing of the team(s). Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentors and develops staff, building technical and problem-solving skills across the team.</h4><p>Shape digital innovation strategy, prioritizing high-impact tech investments for L.A. Care.</p><p>Serve as a thought leader on emerging tech, guiding adoption in clinical and administrative domains.</p><p>Anticipate industry trends and regulatory shifts to maintain competitive edge.</p><p>Lead end-to-end delivery of AI and technology pilot and production solutions.</p><p>Manage vendor and partner relationships; oversee tech evaluation and integration.</p><p>Collaborate with IT on data governance and ensure regulatory and ethical compliance in tech use.</p><p>Mentor multidisciplinary teams</p><p>Cultivate innovative thinking and continuous learning within the team.</p><p>Educate and develop training modules for L.A. Care’s workforce and members on AI</p><p>Partner with coalitions and other associations to keep up to date on the latest market trends, developments in industry</p><h4>Duties Continued</h4><p>Lead and implement an AI intake process for vendor management in close partnership with IT</p><p>Encourage collaboration across IT, business, and clinical functions.</p><p>Maintains up to date knowledge of compliance requirements and supports with regulatory body reporting, as requested. Works with analytic teams to properly assess program performance and build in maximize return on investment (ROI) or health, utilizes change management strategies to implement enhancements and process improvements as necessary. Prepares reports as needed for key stakeholders.</p><h4>Implements and provides guidance to the departmental and organizational processes and policies and works with senior and/ or executive management to define, prioritize, and develop projects and programs.</h4><h4>Responsible for Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.</h4><h4>Responsible for overseeing and managing the budgets of their respective departments.</h4><h4>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</h4><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.</p><p>Performs other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Public Health or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Public Health or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 7 years of experience doing problem solving, policy, and/or project implementation in a health care or a related field.</p><p>At least 5 years of leading staff or supervisory/management experience.</p><p>At least 5 years of experience in leading project teams.</p><p>Experience building relationships with organizations and business partners.</p><h4>Skills</h4><p><b>Required:</b></p><p>Demonstrated critical thinking, problem solving, and project planning and implementation skills.</p><p>Demonstrated strong writing and communication skills.</p><p>Ability to implement pilots, integrate AI systems, and address cybersecurity/data governance.</p><p>Ability to apply AI and analytics to clinical workflow transformation and care management improvement.</p><p>Ability to ensure AI usage meets regulatory, privacy, and ethical standards.</p><p>Ability to align AI roadmap and emerging tech initiatives with broader organizational goals.</p><p>Ability to evaluate new tools, support solution development, and stay ahead of industry advancements.</p><p>Strategic planning skills in technology</p><p>Strong collaboration skills </p><p>Strong data-driven decision-making skills.</p><p>Advanced knowledge of AI, analytics, and emerging technology</p><p>Strong project and vendor management skills</p><p>Knowledge of regulatory and risk management for health tech.</p><p>Demonstrated ability to synthesize and analyze qualitative and/or quantitative data.</p><p>Knowledge of health care operations or health care systems.</p><p>Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.</p><p>Skilled in mediating disputes and resolving conflicts in a fair and constructive manner. </p><p>Must have a deep understanding of financial principles.&nbsp; Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.</p><p>Deep knowledge of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Public Health, Defense, Risk Management, Healthcare, Government, Finance                                                    </p>

Senior Manager, Emerging Technologies and Artificial Intelligence

<p><b>Salary Range:&nbsp;</b>&nbsp;$47,840.00&nbsp;(Min.) -&nbsp;$57,062.00&nbsp;(Mid.) -&nbsp;$68,474.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Medical Document Management Specialist II is responsible for the secure, accurate and efficient management of medical records and any other documentation for the Enterprise Risk Adjustment (ERA) department in compliance with all healthcare regulatory agencies and organizational standards. This position utilizes the most current technology for faxing, emailing, scanning, secure file transfer protocol (SFTP) and various technological platforms/application softwares in the management of medical documents.</p><h4>Duties</h4><p>Document Management: Manages the collection, processing, organizing, storing of all medical documents while ensuring completeness, accuracy, and compliance with all regulatory, legal, and organizational standards. (50%)</p><p>Compliance and Quality Assurance: Ensures all medical documents meet compliance and quality standards per organizational policies and procedures, Health Insurance Portability and Accountability Act (HIPPA), legal and regulatory requirements. (10%)</p><p>Audit and Review: Performs routine audits of medical documents to ensure proper categorization, quality standards, completeness and compliance with organizational policies and procedures and regulatory requirements. (15%)</p><p>Record Retention: Ensures proper organization of all medical documents, storage, retention, and destruction of in accordance with organizational policies and procedures and regulatory requirements. (5%)</p><p>Document Retrieval &amp; Distribution: Manages the retrieval, copying and distribution of medical documents as requested from internal and/or external partners. (5%)</p><p>Collaboration: Works with internal and external partners to ensure seamless integration document processes and data management across various technological platforms/application software. (5%)</p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>Minimum of 1 year of experience in medical document management or health information management.</p><p>Experience working with Microsoft Office Suite, copying, faxing, scanning, and uploading documents to various technological platforms/applications.</p><h4>Skills</h4><p><b>Required:</b></p><p>Proficient with medical terminology and medical document management standards.</p><p>Excellent communication and interpersonal skills.</p><p>Knowledge of HIPAA regulations and privacy standards.</p><p>Excellent organizational, and problem-solving skills, with attention to detail and the ability to manage multiple tasks simultaneously.</p><p>Ability to collaborate with cross-functional teams.</p><p>Ability to maintain confidentiality with sensitive information.</p><h4>Licenses/Certifications Required</h4>Medical Terminology Certificate within 180 days of hire<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medical, Healthcare                                                    </p>

Medical Document Management Specialist II

<p><b>Salary Range:&nbsp;</b>&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Process Improvement Engineer II is responsible for identifying, analyzing, and implementing solutions to improve operational efficiency, quality, and effectiveness across the organization. This position partners with cross-functional teams to evaluate current processes, eliminate waste, and streamline workflows using continuous improvement methodologies such as Lean, Six Sigma, and Kaizen. </p><h4>Duties</h4><p>Analyze business processes, workflows, and performance data to identify inefficiencies and areas for improvement.</p><p>Perform root cause analyses and develop solutions that address quality, cost, and productivity challenges.</p><p>Design, test, and implement process improvement initiatives across departments.</p><p>Partner with leadership and frontline staff to ensure alignment of improvement efforts with organizational goals.</p><p>Facilitate workshops, Kaizen events, and process mapping sessions.</p><p>Establish, monitor, and report on performance metrics and key performance indicators (KPIs).</p><p>Document new processes, create standard operating procedures (SOPs), and ensure sustainability of improvements.</p><p>Support change management and training to build a culture of continuous improvement.</p><p>Collaborate with Information Technology (IT), Operations, Finance, and other stakeholders to implement process automation and system enhancements.</p><h4>Stay current on industry best practices, tools, and methodologies related to process improvement.</h4><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Industrial Engineering or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 5 years of experience in process improvement, industrial engineering, operations, or related experience.</p><p>Experience leading Lean Six Sigma, or continuous improvement initiatives with measurable outcomes.</p><p>Experience with data collection, statistical analysis, and process modeling tools.</p><p><strong>Preferred:</strong></p><p>Experience in a manufacturing, healthcare, technology, or service environment.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong analytical, problem-solving, and change management skills to drive measurable improvements in performance, cost reduction, and customer satisfaction.</p><p>Proficient skills with process improvement tools (process mapping, root cause analysis, value stream mapping).</p><p>Proficient skills with data analysis software (Excel, Minitab, SQL, Power BI, Tableau).</p><p>Strong project management and organizational skills with the ability to manage multiple priorities.</p><p>Strong communication, facilitation, and interpersonal skills to work effectively across teams.</p><p>Ability to influence employees at all levels of the organization.</p><p>Ability to adapt and lead organizational change in dynamic and complex settings.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Lean Six Sigma Green Belt or Master Black Belt or related certification Project Management Professional (PMP) certification.Certified Quality Engineer (CQE)Certified Process Improvement Specialist (CPIS)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Experience in high stakes process improvement in health care maybe substitutes for professional license/certification.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medical Technology, Healthcare                                                    </p>

Process Improvement Engineer II

<p><b>Salary Range:&nbsp;</b>&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Enterprise Project Manager III is responsible for managing high priority and complex projects across the enterprise.&nbsp; The position is responsible for managing projects across the strategic priorities as well as programs across the business. This position integrates advanced project management practices with high-level analytical capabilities to ensure that initiatives are delivered on time, within scope and budget, and with measurable impact. </p><p>The Project Manager III interfaces with all areas affected by the project, including end users, distributors, and vendors. &nbsp;This position partners with leadership and cross-functional teams to plan, execute, and evaluate projects to improve operational efficiency, regulatory compliance, and organizational performance. </p><p>The Project Manager III applies both strategic insight and tactical execution skills to drive data-informed decision-making and deliver organizational value. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Manage the planning, execution, and delivery of projects across diverse business areas, including operational, clinical, strategic, and technology initiatives.</p><p>Define project scope, goals, deliverables, timelines, and success metrics in collaboration with sponsors and stakeholders.</p><p>Conduct high-level data and process analysis to inform project design, evaluate outcomes, and identify opportunities for improvement.</p><p>Develop detailed project plans, schedules, budgets, and resource allocations.</p><p>Monitor progress against milestones, manage risks, issues, and dependencies, and implement mitigation strategies.</p><p>Prepare and present project updates, dashboards, and analytical reports to leadership and governance bodies.</p><p>Facilitate cross-functional collaboration to ensure alignment and communication across departments.</p><p>Ensure project compliance with legislation and organizational policies, procedures, and managed care regulatory requirements.</p><p>Support post-implementation evaluation, including benefits realization, lessons learned, and continuous improvement.</p><p>Mentor and guide project teams and business partners in project management and analytical best practices.</p><p>Track maintenance of business needs and requirements.</p><p>Develop detailed project plans, schedules, budgets, and resource allocations. </p><h4>Duties Continued</h4><p>Facilitate project meetings, status reports, and communications with cross-functional teams. Distribute project communication artifacts such as charter, budgets routinely to management, project team members, and other key stakeholders, actively soliciting and addresses feedback.</p><p>Partner with key stakeholders to monitor budgets, forecast resource needs, and track key performance indicators.</p><p>Ensure project documentation is maintained according to Project Management Office (PMO) standards and audit requirements.</p><p>Collaborate with key stakeholders to coordinate implementation and sustainment activities. </p><p>Apply subject expertise in evaluating business operations and processes. Identify areas where technical solutions would improve business performance. Consult across business operations, provide mentorship, and contribute specialized knowledge. Ensure that the facts and details are correct so that the projects meets the needs of the department, organization and legislation's policies, standards, and best practices. Provide training, recommend process improvements, and mentor junior level staff, department interns, etc. as needed.</p><p>Performs other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Business Administration or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 5 years of progressive experience in project management, business analysis, or operations management within a healthcare or managed care organization.</p><p>At least 4 years of moderate to complex project management experience. </p><p>Experience working simultaneously on multiple projects.</p><p>Experience and knowledge with different project management frameworks, including waterfall and agile.</p><p>Proven experience leading complex, cross-functional projects involving multiple stakeholders.</p><p>Strong experience in data and process analysis, performance measurement, and reporting.</p><p><b>Preferred:</b></p><p>Experience in regulatory compliance</p><p>Experience managing project budgets.</p><h4>Skills</h4><p><b>Required:</b></p><p>Advanced project management skills, including knowledge of Agile, Waterfall, and hybrid methodologies.</p><p>Ability to build strong relationships and communicate effectively with internal and external stakeholders.</p><p>Strong grasp of current communication, project tracking, and budget management technologies.</p><p>Excellent facilitation skills, with proven knowledge of how to foster attendee participation and collaboration in small and large groups.</p><p>Solid technical understanding and ability to define and refine requirements through a project lifecycle.</p><p>Strong problem-solving skills to manage shifting priorities, demands and timelines.</p><p>Strong analytical and critical thinking skills, with ability to interpret complex data and translate insights into actionable recommendations.</p><p>Proficiency in project management and analytics tools (e.g., MS Project, Smartsheet, Jira, Power BI, Tableau, Excel).</p><p>Excellent written and verbal communication skills, including executive-level reporting and presentations.</p><p>Strong organizational, facilitation, and stakeholder management skills.</p><p>Ability to build relationships and influence cross-functional teams and leadership.</p><p>Deep understanding of managed care operations, quality improvement, and regulatory compliance.</p><p>Adaptability and resilience in managing complex, fast-paced initiatives.</p><p>Demonstrated ability to manage competing priorities and deliver results in a matrixed environment.</p><p><b>Preferred:</b></p><p>Knowledge of vendor management.</p><p>Ability to understand healthcare or managed care landscape.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Agile or Scrum certification (e.g., Certified ScrumMaster)Lean Six Sigma Green BeltProject Management CertificateProject Management Professional (PMP)Program Management Professional (PgMP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

Enterprise Project Manager III

<p><b>Salary Range:&nbsp;</b>&nbsp;$77,265.00&nbsp;(Min.) -&nbsp;$100,445.00&nbsp;(Mid.) -&nbsp;$123,625.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Enteprise Data Analyst II collaborates and contributes in the design, development, and delivery of analytic solutions that inform operational, quality, and financial performance across the organization. This focuses on transforming business questions into structured, validated, and well-communicated analytic outputs using approved enterprise data assets and governance standards.</p><p>The Enterprise Data Analyst II contributes to every stage of the analytics lifecycle from intake through code development, peer review, and ongoing maintenance and plays a key role in ensuring data accuracy and consistency across recurring enterprise reports and dashboards.</p><h4>Duties</h4><p>Translate defined business questions into structured analytic requirements and specifications.</p><p>Participate in structured requirements elicitation, documentation, and verification.</p><p>Develop and automate recurring reports and dashboards, applying standardized definitions and refresh cycles (daily, weekly, monthly, quarterly).</p><p>Validate data integrity and ensure compliance with data lineage and governance standards.</p><p>Contribute to analytic code review and continuous integration processes to maintain transparency, version control, and quality.</p><p>Collaborate with IT, business partners, and fellow analysts to resolve data issues and confirm analytic accuracy.</p><p>Apply foundational statistical methods (e.g., control charts, variance analysis) to interpret patterns in performance.</p><p>Participate in project tracking and post-implementation review to ensure solutions deliver measurable business value.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><p><b>Domain Specific Experience and Skills:</b></p><p><b>Domain Focus: Authorization &amp; Claims Operations Analytics</b></p><p><b>Required: </b>Experience with Utilization Management (UM) authorization workflows and prior authorization metrics. Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution. Knowledge of clinical and financial aspects of UM/claims and collaboration with operations or provider teams. Ability to analyze operational Key Performance Indicators (KPIs) (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights.</p><p><b>Domain Focus: Network Strategy Analytics</b></p><p><b>Required:</b> Experience supporting initiatives to optimize cost, access, and quality within provider networks.Experience analyzing provider networks, including contracting, credentialing, and panel optimization.&nbsp;Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.</p><p><b>Domain Focus: Risk Adjustment Analytics</b></p><p><b>Required:</b> Experience with risk adjustment methodologies, including Hierarchical Condition Category (HCC) coding, hierarchical models, and member risk scoring. Knowledge of diagnosis documentation, encounter data, and coding completeness to optimize plan revenue and quality scores. Knowledge of regulatory requirements impacting risk adjustment (e.g., Centers for Medicare and Medicaid Services (CMS) guidelines). Ability to assess encounter submission and processing operations, identifying trends, anomalies, or gaps in risk capture across provider or member populations.<br></p><p><b>Domain Focus: Medical Cost Driver Analytics</b></p><p><b>Required:</b> Experience analyzing medical cost drivers across populations, conditions, and service types. Experience developing dashboards or analytic tools to monitor and optimize medical spend. Knowledge of claims, provider, and condition level analyses to support financial and operational decision-making. Ability to identify high-cost services, utilization patterns, and opportunities for cost containment.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 3 years of experience in analytics, data management, or reporting, preferably within healthcare, managed care, or a related industry.</p><p>Hands-on experience with SQL, reporting tools (Tableau, Power BI), and operational dashboards.</p><p>Experience in one or more domains (Authorization &amp; Claims, Population Health, Quality, etc.) at a functional or project level.</p><p><b>Preferred:</b></p><p>Experience in health plan operations or managed care analytics.</p><p>Experience participating in enterprise reporting or dashboard projects with governance standards.</p><h4>Skills</h4><p><b>Required:</b></p><p>Proficient in SQL for complex exploratory analysis and foundational Extract, Transform, and Load&nbsp;(ETL) work to support dashboards, reports, and analytic deliverables.</p><p>Working knowledge of Tableau for building standard visualizations and dashboards.</p><p>Knowledge of version control tools (e.g., Git, GitHub) and collaborative development workflows. Implement and maintain version control, peer review (pull request), and continuous integration practices for analytic codebases.</p><p>Ability to conduct analyses to identify trends, patterns, and opportunities across organizational data.</p><p>Ability to translate business questions into structured requirements and actionable insights.</p><p>Ability to apply descriptive statistics and basic trend analysis to support operational decision-making.</p><p>Knowledge of general operations and performance drivers in a complex, data driven organization.</p><p>Ability to use Jira or Atlassian tools for task tracking and coordination within analytics projects.</p><p>Ability to communicate findings effectively to business partners with varying technical backgrounds.</p><p>Ability to work on multiple assignments simultaneously, prioritize tasks and know when to escalate issues.</p><p>Ability to work under challenging deadlines.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Tableau Certified Data Analyst or Tableau Desktop SpecialistMicrosoft Certified: Power BI Data Analyst AssociateSnowflake SnowPro Core CertificationSnowPro® Specialty: Snowpark CertificationCertified Health Data Analyst (CHDA)Certified Analytics Professional (CAP)SQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)<h4>Required Training</h4><p><b>Domain Specific Experience and Skills:</b></p><p><b>Domain Focus: Member Experience Analytics</b></p><p><b>Required:</b> Experience analyzing call center operations, enrollment services, and appeals &amp; grievances.</p><p>Experience translating data into actionable insights to improve member experience and member engagement operations. Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys or other member satisfaction measurement tools. &nbsp;Ability to assess member touchpoints, satisfaction metrics, and operational KPIs.<br><b>Domain Focus: Population Health Analytics</b></p><p><b>Required:</b> Experience analyzing community supports, care management, health education, Managed Long-Term Support Services (MLTSS), and intervention programs. Experience translating data into actionable insights to guide interventions, resource allocation, program improvements, and new ideas for member programs based on population needs. Knowledge of population health management frameworks and social determinants of health. &nbsp;Ability to evaluate population level outcomes and operational performance metrics.<br><b>Preferred: </b>&nbsp;Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM.<br></p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Domain Specific Experience and Skills:</b></p><p><b>Domain Focus: Quality Improvement Analytics</b></p><p><b>Required:</b> Experience analyzing Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality measurement programs across both medical and pharmacy domains. Experience translating data into actionable insights to inform interventions, compliance, and performance improvement strategies. Knowledge of quality measurement frameworks, regulatory requirements, and reporting standards. Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives.</p><p><b>Preferred: </b>Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS).Experience supporting provider focused incentive program analytics.<br><br><b>Domain Focus: Access to Care Analytics</b></p><p><b>Required: </b>Experience analyzing appointment timeliness, access, and provider availability. Experience translating data into actionable insights to improve access, reduce barriers, and optimize provider scheduling. Experience supporting initiatives to improve network adequacy and member access, including operational interventions and performance monitoring. &nbsp;Knowledge of access measurement frameworks and regulatory requirements. Ability to evaluate member access metrics, network capacity, and operational performance.<br><br><b>Domain Focus: Enterprise Support Analytics</b></p><p><b>Required:</b> Experience supporting enterprise-level KPI maintenance, cross-domain dashboards, and measure ROI analyses. Experience translating data into actionable insights for strategic investments, operational decisions, and organizational performance monitoring. Knowledge of analytics frameworks, governance standards, and enterprise reporting processes. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains.</p><p><b>Preferred: &nbsp;</b>Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicaid, Medicare, Pharmacy, Call Center, Insurance, Healthcare, Customer Service                                                    </p>

Enterprise Data Analyst II

<p><b>Salary Range:&nbsp;</b>&nbsp;$135,136.00&nbsp;(Min.) -&nbsp;$175,676.00&nbsp;(Mid.) -&nbsp;$216,218.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Causal Impact Scientist III is a senior, hands-on practitioner responsible for developing and implementing scalable approaches to measure program impact across the organization. This position not only evaluates the historical effectiveness of interventions but also informs future program design, equity strategies, sub-population targeting, and policy decisions.</p><p>The Causal Impact Scientist III leads the creation of modular, reusable analytic pipelines and causal inference frameworks that can be applied across multiple programs and initiatives. This position sets methodological standards, ensures analytic reproducibility, and mentors staff in best practices for causal analysis, study design, and evidence communication.</p><p>The Causal Impact Scientist III collaborates with cross-functional teams integrating predictive and causal insights to drive enterprise-wide decisions. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp;&nbsp; </p><h4>Duties</h4><h4>Lead the design, implementation, and interpretation of advanced causal inference studies across multiple health plan programs using techniques such as difference-in-differences, propensity score methods, inverse probability weighting, synthetic controls, interrupted time series, and Randomized Control Trials (RCTs).</h4><h4>Develop scalable, modular frameworks for impact evaluation that can be ported across programs and interventions, ensuring reproducibility, transparency, and efficient deployment.</h4><h4>Identify which interventions deliver the greatest value, equity, and member outcomes, guiding sub-population targeting, program improvement, and policy recommendations.</h4><h4>Mentor and provide technical guidance to staff on methodology, coding, documentation, and analytic rigor.</h4><h4>Build and maintain robust, reproducible analytical pipelines in Python (PySpark, pandas) and R; leverage Snowflake/Snowpark, Spark, and cloud-based computing resources to scale analyses.</h4><h4>Lead GitHub version control, peer review, and code standardization practices to ensure high-quality, reusable analytic assets.</h4><h4>Manage project deliverables and team workflows in Jira; document methods, assumptions, and results clearly in Confluence.</h4><h4>Translate complex analytic findings into actionable insights, guiding executive decision-making and influencing strategic initiatives.</h4><h4>Collaborate with cross-functional teams to integrate causal and predictive insights for comprehensive program evaluation.</h4><h4>Stay current on emerging methods in causal inference, impact evaluation, and population health analytics, incorporating new approaches into the team’s analytic toolkit.</h4><h4>Apply subject matter expertise in evaluating business operations and processes. Identify areas where technical solutions would improve business performance. Consult across business operations, provide mentorship, and contribute specialized knowledge. Ensure that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provide training and recommend process improvements as needed.</h4><h4>Perform other duties as assigned</h4><h4>Duties Continued</h4><h4>Education Required</h4>Master's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Doctorate Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 6 years of professional experience conducting causal inference or program evaluation analyses in healthcare, public health, or a related field.</p><p>Proven experience applying advanced causal inference methods (e.g., difference-in-differences, matching, synthetic controls, RCTs) to observational and experimental healthcare data.</p><p>Hands-on experience developing and deploying scalable analytic pipelines in Python and/or R.</p><p>Experience collaborating with cross-functional teams, translating analytic findings into actionable recommendations.</p><p>Experience working with large-scale datasets in Spark or distributed computing environments.</p><p><b>Preferred:</b><br>Extensive experience in Managed Care Plans (Medicaid, Medicare, ACA Exchange), including understanding claims, encounters, eligibility, provider networks, and quality metrics.</p><p>Experience designing and implementing (RCTs) or complex quasi-experimental studies in healthcare operational settings.</p><p>Experience applying causal inference methods to program targeting, equity assessment, and policy evaluation.</p><p>Experience building reusable analytic tools and frameworks that can be applied across multiple use cases.</p><h4>Skills</h4><p><b>Required:</b><br>Expertise in causal inference methods: difference-in-differences, propensity score matching, synthetic controls, interrupted time series, RCT design, and related techniques.</p><p>Advanced programming skills in Python (pandas, PySpark, statsmodels) and R (dplyr, ggplot2, MatchIt, did, or similar).</p><p>Ability to design reproducible, modular, and scalable analytic pipelines.</p><p>Proficiency with GitHub, Confluence, and Jira for code collaboration, documentation, and project management.</p><p>Strong written and verbal communication skills; ability to translate complex analyses into actionable insights for stakeholders.</p><p>Strong collaboration skills and experience mentoring junior team members.</p><p>Ability to manage multiple projects and priorities in a fast-paced environment.</p><p>Ability to apply critical thinking skills in causal reasoning to address complex healthcare data problems.<br></p><p>Demonstrated ability to mentor and guide staff on methodology, coding, and documentation.</p><p>Strong communication skills, including documenting methodology, assumptions, and results for both technical and non-technical stakeholders.</p><p><b>Preferred:</b></p><p>Working knowledge of modern cloud-based analytic ecosystems (Snowflake, Azure).</p><p>Knowledge of visualization and reporting frameworks to communicate impact results to leadership.</p><p>Knowledge of Snowflake/Snowpark, cloud computing, and distributed data platforms.</p><p>Strong presentation skills, with experience briefing senior leadership on analytic findings and strategic implications.</p><p>Knowledge of health equity analytics and population segmentation for targeting interventions.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Health Data Analyst (CHDA)Certified Analytics Professional (CAP)Snowflake SnowPro Core CertificationSnowPro Specialty: Data Engineering or SnowparkHealth Economics and Outcomes Research (HEOR) Certification or Graduate CertificateCausal Inference for Data Science (e.g., University of Pennsylvania or MITx MicroMasters)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medicaid, Medicare, Equity, Claims, Public Health, Healthcare, Finance, Insurance                                                    </p>

Causal Impact Scientist III

<p><b>Salary Range:&nbsp;</b>&nbsp;$135,136.00&nbsp;(Min.) -&nbsp;$175,676.00&nbsp;(Mid.) -&nbsp;$216,218.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Applied Artificial Intelligence (AI) Scientist III is a subject matter expert, hands-on practitioner who designs, builds, and implements advanced artificial intelligence (AI) and machine learning (ML) solutions that directly enable the organization to execute its strategic priorities. This role combines deep technical expertise with healthcare domain knowledge to deliver scalable, production-grade AI applications that improve quality, reduce administrative waste, and enhance member outcomes.</p><p>The Applied AI Scientist III independently leads complex projects from ideation through operational deployment, working across data, technology, and business teams to develop models and algorithms that power key functions such as claims accuracy, care coordination, quality improvement, and fraud detection. This position is highly collaborative, frequently partnering with leaders across departments to understand business needs and translate them into AI-driven capabilities that deliver measurable value.</p><p>&nbsp;The Applied AI Scientist III serves as a mentor and role model for staff promoting best practices in model design, documentation, version control, and interpretability. The position is central to advancing the organization’s AI maturity—driving both innovation and execution within an applied, results-oriented framework. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp;&nbsp; </p><h4>Duties</h4><p>Design, train, validate, and deploy complex AI and ML models to address enterprise use cases across departments such as Health Services, Payment Integrity, Quality Improvement, Finance, and Provider Network Management.</p><p>Lead all phases of the AI solution lifecycle – from problem framing and data engineering through model design, validation, and operational integration.</p><p>Implement production-grade ML pipelines using modern MLOps practices, ensuring scalability, reproducibility, and continuous model performance monitoring.</p><p>Serve as a subject matter expert in responsible and explainable AI, ensuring model fairness, transparency, and compliance with regulatory and ethical standards.</p><p>Partner with business and technology leaders to identify and prioritize new AI use cases that align with the organization’s transformation strategy.</p><p>Translate business challenges into well-structured analytical problems and lead cross-functional teams through data discovery, feature engineering, and algorithm development.</p><p>Work directly with cloud-based data and AI platforms (e.g., Snowflake, Azure ML, Databricks) to operationalize model delivery and integration with enterprise data assets.</p><p>Mentor and coach staff, providing technical guidance, code reviews, and knowledge sharing.</p><p>Document all model design assumptions, data sources, evaluation metrics, and deployment protocols for transparency and reproducibility.</p><p>Communicate complex technical results in accessible, actionable ways for both executive and operational stakeholders.</p><p>Contribute to the development of reusable AI assets, libraries, and standardized templates to accelerate future model development.</p><h4>Remain current on emerging AI/ML technologies, frameworks, and healthcare analytics applications, and advise leadership on adoption opportunities.</h4><h4>Apply subject matter expertise in evaluating business operations and processes. Identify areas where technical solutions would improve business performance. Consult across business operations, provide mentorship, and contribute specialized knowledge. Ensure that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provide training, recommend process improvements, and mentor staff, department interns, etc. as needed.</h4><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Master's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Doctorate Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 6 years of professional experience developing and deploying machine learning and AI solutions in enterprise or healthcare environments.</p><p>Demonstrated experience leading full AI solution lifecycles – from problem definition to deployment and monitoring.</p><p>Proven successful experience developing predictive models using structured and unstructured healthcare data (e.g., claims, encounters, eligibility, provider, quality metrics).</p><p>Experience with Python (Pandas, Scikit-learn, PySpark), distributed data frameworks (Spark), and MLOps concepts.</p><p>Strong collaboration and mentorship experience, including guiding junior data scientists and analysts.</p><p>Experience integrating AI solutions into production environments in collaboration with IT or Data Engineering.</p><p>Experience with version control (Git) and model documentation best practices.</p><p>Experience building and deploying models in production using MLOps frameworks and cloud platforms.</p><p><b>Preferred:</b></p><p>Experience within a Managed Care Organization (MCO) or health plan environment (Medi-Cal, Medicare, or ACA Exchange).</p><p>Experience developing and operationalizing Large Language Models (LLM)-based solutions, including prompt engineering or retrieval-augmented generation (RAG).</p><p>Experience in risk adjustment, payment integrity, or quality measurement modeling.</p><p>Experience with healthcare data analytics and modeling in Managed Care settings.</p><h4>Skills</h4><p><b>Required:</b></p><p>Advanced programming skills in Python, including libraries for data processing, modeling, and analytics (e.g., Pandas, Scikit-learn, PySpark).</p><p>Deep understanding of machine learning and AI techniques, including supervised and unsupervised learning, feature engineering, model optimization, and explainability.</p><p>Strong analytical problem-solving skills with the ability to structure complex problems into actionable modeling tasks.</p><p>Exceptional written and verbal communication skills, including documentation and presentation of technical material to non-technical audiences.</p><p>Excellent collaboration skills and ability to lead cross-functional projects involving IT, business stakeholders, and analytics peers.</p><p>Excellent communication, documentation, and stakeholder engagement skills.</p><p><b>Preferred:</b></p><p>Knowledge of generative AI tools and frameworks (e.g., LangChain, OpenAI APIs, Azure OpenAI).</p><p>Knowledge and understanding of responsible AI principles, including bias detection, fairness, and explainability.</p><p>Knowledge of R or SQL for complementary analytics tasks.</p><p>Knowledge of Snowpark for scalable model deployment.</p><p>Knowledge of Shiny or Streamlit for AI-driven application delivery.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Snowflake SnowPro Core CertificationSnowPro® Specialty: Snowpark CertificationPython Institute PCEP™ or PCAP™ (Python Programming)HarvardX or Johns Hopkins Data Science Certificate (R)Microsoft Certified: Data Scientist Associate (DP-100)Certified Analytics Professional (CAP)Certified Health Data Analyst (CHDA)Microsoft Certified Professional (MCP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicare, Defense, Insurance, Healthcare, Government                                                    </p>

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