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Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>The Enterprise Data Analyst III serves as a Subject Matter Expert (SME) contributor responsible for leading complex analytic projects that link insights directly to enterprise goals, resource allocation, and performance improvement. This position leads the full analytic development process from business case definition and structured scoping through peer review, deployment, and post-implementation evaluation, ensuring high-quality, reproducible, and impactful outputs.The Analyst III applies advanced analytic reasoning and strong business acumen to deliver analyses that inform both operational and financial decision making. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp; <h4>Duties</h4>Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights.Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance.Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows.Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards.Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.Maintains awareness of data lineage and governance compliance throughout all analytic work.Manages project planning, tracking, and post-implementation assessment for assigned deliverables.Mentors and models adherence to analytic development best practices.Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures 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. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.Perform other duties as assigned.<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>Required:At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health.Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights.Experience analyzing multiple data sources and translate findings into actionable recommendations.Preferred:Experience with advanced analytics techniques, including multivariate analysis, regression, control charts, or predictive modeling.Experience in domain specific operations, such as network strategy, risk adjustment, or medical cost driver analysis.Experience mentoring junior analysts or providing guidance on analytic best practices.Proficient with Process Improvement Methodology including defining and documenting workflow.&nbsp;Knowledge of program and project level planning, mobilization and management<h4>Skills</h4>RequiredExpert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes supporting enterprise dashboards, reports, and analytic deliverables.&nbsp;Advanced proficiency in Tableau (or equivalent BI tools) to design, optimize, and automate dashboards and visualizations for enterprise level insights.Strong statistical and analytical skills, including multivariate analyses, regression, and control charts to identify drivers of operational, clinical, and financial performance.Knowledge of version control (Git, GitHub) and collaborative development workflows, including peer review, continuous integration, and reproducible analytic practices.Ability to develop and maintain reusable analytic frameworks, templates, and processes that support recurring reporting and performance monitoring.&nbsp;Proficiency in data validation, reconciliation, and adherence to governance standards, including data lineage tracking and quality control.Ability to translate complex business problems into structured analytic requirements and actionable insights.&nbsp;Ability to interpret analytic results in the context of organizational performance, operational priorities, and enterprise goals.&nbsp;Ability to apply critical thinking to identify patterns, opportunities, and risks across multiple data domains.&nbsp;Ability to collaborate effectively with IT, operational teams, and business partners to operationalize analytic outputs.&nbsp;Demonstrated knowledge of healthcare concepts, such as quality measures, utilization patterns, and key operational drivers in a managed care environment.Ability to lead analytic projects end-to-end, including business case definition, requirements gathering, analysis, and post-implementation assessment.&nbsp;Ability to mentor junior analysts and promote adherence to analytic best practices. Ability to manage multiple projects simultaneously, prioritize tasks, and escalate issues appropriately. Ability to communicate findings effectively to both technical and non-technical stakeholders.&nbsp;<h4>Domain Specifics</h4>Domain Specific Experience and Skills:Domain Focus: Authorization &amp; Claims Operations AnalyticsRequired: 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.Domain Focus: Network Strategy AnalyticsRequired: Experience supporting initiatives to optimize cost, access, and quality within provider networks. Experience analyzing provider networks, including contracting, credentialing, and panel optimization. Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.Domain Focus: Risk Adjustment AnalyticsRequired: 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.Preferred Certification: AAPC Certified Risk Adjustment Coder (CRC®); Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™); NAMAS Certified HCC Coder (CHCC™); AHIMA Certified Coding Specialist (CCS®)Domain Focus: Medical Cost Driver AnalyticsRequired: 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.<h4>Domain Specifics</h4>Domain Specific Experience and Skills: Domain Focus: Population Health AnalyticsRequired: 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. Ability to evaluate population level outcomes and operational performance metrics. Preferred: Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM. Domain Focus: Quality Improvement AnalyticsRequired: 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.Preferred: Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS).Experience supporting provider focused incentive program analytics. Preferred Certification: Certified Professional in Healthcare Quality (CPHQ)<h4>Domain Specifics</h4>Domain Specific Experience and Skills:Domain Focus: Access to Care AnalyticsRequired: 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. Knowledge access measurement frameworks and regulatory requirements. Ability to evaluate member access metrics, network capacity, and operational performance. Domain Focus: Enterprise Support AnalyticsRequired: Experience supporting enterprise level KPI maintenance, cross domain dashboards, and measure ROI analyses. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains. 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.Preferred: Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.Domain Focus: Member Experience AnalyticsRequired: Experience analyzing call center operations, enrollment services, and appeals &amp; grievances. 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. Ability to assess member touchpoints, satisfaction metrics, and operational KPIs.<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 CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.<h4>Physical Requirements</h4>LightSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles Job Segment: Claims, Medicaid, Medical Coding, Medicare, Pharmacy, Insurance, Healthcare

L.A. Care Health Plan

Enterprise Data Analyst III

Salary Range:&nbsp;&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>The Solutions and Data Analyst III serves as a Subject Matter expert (SME), technical and analytic integrator, responsible for designing, developing, and operationalizing advanced analytic solutions that drive strategic insight and organizational performance. This position combines strong data engineering fluency with analytical acumen transforming complex, multi-domain data (membership, encounters, providers, claims, quality metrics) into interpretable and actionable insights used by leaders across the health plan.This position emphasizes the development of insight rich, production ready analytic assets, delivering repeatable, governed analyses that illuminate key drivers of care quality, efficiency, and financial outcomes.&nbsp;Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp;&nbsp; <h4>Duties</h4>Designs and maintains reusable analytic data models and Extract, Transform, and Load (ETL) pipelines that support recurring insight generation and performance monitoring.Leads development of advanced dashboards, reports, and analytic tools that surface trends, correlations, and performances opportunities across enterprise domains.Partners with analysts, data scientists, and operational stakeholders to embed insights directly into workflows and decision processes.Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.Ensures adherence to data lineage, governance, and reproducibility standards across all analytic products.Supports enterprise level measure refresh cycles and ensures alignment with standardized data abstraction layers.Drives continuous enhancement of the analytic ecosystem by integrating new data sources, improving data structures, and optimizing performance.Translates analytic findings into business relevant narratives and partners with stakeholders to act on insights.Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures 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. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.Performs other duties as assigned.<h4>Duties Continued</h4>Domain Specific Experience and Skills: Domain Focus: Authorization &amp; Claims Operations Analytics Required: 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 KPIs (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights.Domain Focus: Network Strategy AnalyticsRequired: Experience supporting initiatives to optimize cost, access, and quality within provider networks.Experience analyzing provider networks, including contracting, credentialing, and panel optimization.Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.Domain Focus: Risk Adjustment AnalyticsRequired: 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.Preferred Certifications: AAPC Certified Risk Adjustment Coder (CRC®), Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™), NAMAS Certified HCC Coder (CHCC™), AHIMA Certified Coding Specialist (CCS®). Domain Focus: Medical Cost Driver AnalyticsRequired: 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.<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>Required:At least 5 years of progressive analytics experience in healthcare, managed care, or related industries.Proven experience designing, developing, and operationalizing analytic solutions across multiple domains.Ability to operate with high autonomy, manage complex or ambiguous projects, and influence operational or strategic decisions.Experience translating multi-domain analytics into actionable insights for leadership and enterprise-wide initiatives.Demonstrated successful experience in communicating insights effectively to senior leadership and executives.Preferred:Experience with enterprise level initiatives, such as Key Performance Indicator (KPI) maintenance, cross-domain dashboards, measure ROI, or strategic investment analytics.Strong experience managing care operations, including capitation, provider networks, risk adjustment, or quality incentive programs.<h4>Skills</h4>Required:Expertise in designing, building, and maintaining complex ETL pipelines and analytic data models that support enterprise reporting, dashboards, and predictive insights. Advanced experience with BI tools (Tableau, Power BI) to design insight rich, production ready dashboards and analytic products. Proficiency with SQL and/or Python/R for large-scale data manipulation, advanced analyses, and operationalization of analytic workflows. Strong knowledge of version control (Git/GitHub) and CI/CD processes for analytic code and pipelines. Ability to integrate, optimize, and enhance multiple data sources for performance, governance, and reproducibility. Ability to apply advanced statistical, predictive, and diagnostic methods to uncover drivers of quality, efficiency, and financial outcomes. Deep understanding of managed care operations, such as capitation models, provider networks, utilization management, and quality incentive programs. Ability to translate multi-domain data into actionable insights that directly inform strategic and operational decisions. Ability to conduct root-cause analyses, scenario modeling, and complex problem solving with minimal guidance.Ability to operate with high autonomy, independently defining priorities and managing complex, ambiguous analytic projects. Ability to communicate complex analytic findings effectively to senior leadership, executives, and external stakeholders. Ability to translate insights into actionable recommendations and strategic narratives that influence enterprise decision making. Ability to mentor and guide other analysts, promoting analytic best practices across teams. Ability to drive continuous improvement of analytic tools, data structures, and reporting ecosystems, proactively identifying opportunities to enhance organizational performance.&nbsp;Preferred:Proficient with Process Improvement Methodology including defining and documenting workflow. Knowledge of program and project level planning, mobilization and management.<h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Tableau Certified Data Analyst or Tableau Desktop SpecialistSnowflake SnowPro Core CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Python Institute PCEP™ or PCAP™ (Python Programming)SnowPro® Specialty: Snowpark CertificationDataCamp Certified Data Analyst (Python or R)HarvardX or Johns Hopkins Data Science Certificate (R)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.Certified Analytics Professional (CAP)or related<h4>Required Training</h4>Domain Specific Experience and Skills: Domain Focus: Member Experience AnalyticsRequired: Experience analyzing call center operations, enrollment services, and appeals &amp; grievances.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. Ability to assess member touchpoints, satisfaction metrics, and operational KPIs. Domain Focus: Population Health AnalyticsRequired: 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.Preferred: Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM. <h4>Physical Requirements</h4>Light<h4>Additional Information</h4>Domain Specific Experience and Skills: Domain Focus: Quality Improvement AnalyticsRequired: 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.Preferred: &nbsp;Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS). Experience supporting provider focused incentive program analytics. Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives.Preferred Certification: Certified Professional in Healthcare Quality (CPHQ) Domain Focus: Access to Care AnalyticsRequired: 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. Knowledge of access measurement frameworks and regulatory requirements.Ability to evaluate member access metrics, network capacity, and operational performance. Domain Focus: Enterprise Support AnalyticsRequired: 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.Preferred: &nbsp;Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles Job Segment: Claims, Medicaid, Medical Coding, Pharmacy, Call Center, Insurance, Healthcare, Customer Service

Solutions and Data Analyst III

Salary Range:&nbsp;&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>The Solutions and Data Analyst III serves as a Subject Matter expert (SME), technical and analytic integrator, responsible for designing, developing, and operationalizing advanced analytic solutions that drive strategic insight and organizational performance. This position combines strong data engineering fluency with analytical acumen transforming complex, multi-domain data (membership, encounters, providers, claims, quality metrics) into interpretable and actionable insights used by leaders across the health plan.This position emphasizes the development of insight rich, production ready analytic assets, delivering repeatable, governed analyses that illuminate key drivers of care quality, efficiency, and financial outcomes.&nbsp;Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp;&nbsp; <h4>Duties</h4>Designs and maintains reusable analytic data models and Extract, Transform, and Load (ETL) pipelines that support recurring insight generation and performance monitoring.Leads development of advanced dashboards, reports, and analytic tools that surface trends, correlations, and performances opportunities across enterprise domains.Partners with analysts, data scientists, and operational stakeholders to embed insights directly into workflows and decision processes.Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.Ensures adherence to data lineage, governance, and reproducibility standards across all analytic products.Supports enterprise level measure refresh cycles and ensures alignment with standardized data abstraction layers.Drives continuous enhancement of the analytic ecosystem by integrating new data sources, improving data structures, and optimizing performance.Translates analytic findings into business relevant narratives and partners with stakeholders to act on insights.Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures 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. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.Performs other duties as assigned.<h4>Duties Continued</h4>Domain Specific Experience and Skills: Domain Focus: Authorization &amp; Claims Operations Analytics Required: 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 KPIs (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights.Domain Focus: Network Strategy AnalyticsRequired: Experience supporting initiatives to optimize cost, access, and quality within provider networks.Experience analyzing provider networks, including contracting, credentialing, and panel optimization.Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.Domain Focus: Risk Adjustment AnalyticsRequired: 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.Preferred Certifications: AAPC Certified Risk Adjustment Coder (CRC®), Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™), NAMAS Certified HCC Coder (CHCC™), AHIMA Certified Coding Specialist (CCS®). Domain Focus: Medical Cost Driver AnalyticsRequired: 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.<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>Required:At least 5 years of progressive analytics experience in healthcare, managed care, or related industries.Proven experience designing, developing, and operationalizing analytic solutions across multiple domains.Ability to operate with high autonomy, manage complex or ambiguous projects, and influence operational or strategic decisions.Experience translating multi-domain analytics into actionable insights for leadership and enterprise-wide initiatives.Demonstrated successful experience in communicating insights effectively to senior leadership and executives.Preferred:Experience with enterprise level initiatives, such as Key Performance Indicator (KPI) maintenance, cross-domain dashboards, measure ROI, or strategic investment analytics.Strong experience managing care operations, including capitation, provider networks, risk adjustment, or quality incentive programs.<h4>Skills</h4>Required:Expertise in designing, building, and maintaining complex ETL pipelines and analytic data models that support enterprise reporting, dashboards, and predictive insights. Advanced experience with BI tools (Tableau, Power BI) to design insight rich, production ready dashboards and analytic products. Proficiency with SQL and/or Python/R for large-scale data manipulation, advanced analyses, and operationalization of analytic workflows. Strong knowledge of version control (Git/GitHub) and CI/CD processes for analytic code and pipelines. Ability to integrate, optimize, and enhance multiple data sources for performance, governance, and reproducibility. Ability to apply advanced statistical, predictive, and diagnostic methods to uncover drivers of quality, efficiency, and financial outcomes. Deep understanding of managed care operations, such as capitation models, provider networks, utilization management, and quality incentive programs. Ability to translate multi-domain data into actionable insights that directly inform strategic and operational decisions. Ability to conduct root-cause analyses, scenario modeling, and complex problem solving with minimal guidance.Ability to operate with high autonomy, independently defining priorities and managing complex, ambiguous analytic projects. Ability to communicate complex analytic findings effectively to senior leadership, executives, and external stakeholders. Ability to translate insights into actionable recommendations and strategic narratives that influence enterprise decision making. Ability to mentor and guide other analysts, promoting analytic best practices across teams. Ability to drive continuous improvement of analytic tools, data structures, and reporting ecosystems, proactively identifying opportunities to enhance organizational performance.&nbsp;Preferred:Proficient with Process Improvement Methodology including defining and documenting workflow. Knowledge of program and project level planning, mobilization and management.<h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Tableau Certified Data Analyst or Tableau Desktop SpecialistSnowflake SnowPro Core CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Python Institute PCEP™ or PCAP™ (Python Programming)SnowPro® Specialty: Snowpark CertificationDataCamp Certified Data Analyst (Python or R)HarvardX or Johns Hopkins Data Science Certificate (R)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.Certified Analytics Professional (CAP)or related<h4>Required Training</h4>Domain Specific Experience and Skills: Domain Focus: Member Experience AnalyticsRequired: Experience analyzing call center operations, enrollment services, and appeals &amp; grievances.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. Ability to assess member touchpoints, satisfaction metrics, and operational KPIs. Domain Focus: Population Health AnalyticsRequired: 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.Preferred: Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM. <h4>Physical Requirements</h4>Light<h4>Additional Information</h4>Domain Specific Experience and Skills: Domain Focus: Quality Improvement AnalyticsRequired: 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.Preferred: &nbsp;Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS). Experience supporting provider focused incentive program analytics. Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives.Preferred Certification: Certified Professional in Healthcare Quality (CPHQ) Domain Focus: Access to Care AnalyticsRequired: 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. Knowledge of access measurement frameworks and regulatory requirements.Ability to evaluate member access metrics, network capacity, and operational performance. Domain Focus: Enterprise Support AnalyticsRequired: 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.Preferred: &nbsp;Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles Job Segment: Claims, Medicaid, Medical Coding, Medicare, Pharmacy, Insurance, Healthcare

Salary Range:&nbsp;&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>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. <h4>Duties</h4>Analyze business processes, workflows, and performance data to identify inefficiencies and areas for improvement.Perform root cause analyses and develop solutions that address quality, cost, and productivity challenges.Design, test, and implement process improvement initiatives across departments.Partner with leadership and frontline staff to ensure alignment of improvement efforts with organizational goals.Facilitate workshops, Kaizen events, and process mapping sessions.Establish, monitor, and report on performance metrics and key performance indicators (KPIs).Document new processes, create standard operating procedures (SOPs), and ensure sustainability of improvements.Support change management and training to build a culture of continuous improvement.Collaborate with Information Technology (IT), Operations, Finance, and other stakeholders to implement process automation and system enhancements.<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>Required:At least 5 years of experience in process improvement, industrial engineering, operations, or related experience.Experience leading Lean Six Sigma, or continuous improvement initiatives with measurable outcomes.Experience with data collection, statistical analysis, and process modeling tools.Preferred:Experience in a manufacturing, healthcare, technology, or service environment.<h4>Skills</h4>Required:Strong analytical, problem-solving, and change management skills to drive measurable improvements in performance, cost reduction, and customer satisfaction.Proficient skills with process improvement tools (process mapping, root cause analysis, value stream mapping).Proficient skills with data analysis software (Excel, Minitab, SQL, Power BI, Tableau).Strong project management and organizational skills with the ability to manage multiple priorities.Strong communication, facilitation, and interpersonal skills to work effectively across teams.Ability to influence employees at all levels of the organization.Ability to adapt and lead organizational change in dynamic and complex settings.<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>Experience in high stakes process improvement in health care maybe substitutes for professional license/certification.Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles Job Segment: Medical Technology, Healthcare

Process Improvement Engineer II

Salary Range:&nbsp;&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>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. 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. 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.<h4>Duties</h4>Manage the planning, execution, and delivery of projects across diverse business areas, including operational, clinical, strategic, and technology initiatives.Define project scope, goals, deliverables, timelines, and success metrics in collaboration with sponsors and stakeholders.Conduct high-level data and process analysis to inform project design, evaluate outcomes, and identify opportunities for improvement.Develop detailed project plans, schedules, budgets, and resource allocations.Monitor progress against milestones, manage risks, issues, and dependencies, and implement mitigation strategies.Prepare and present project updates, dashboards, and analytical reports to leadership and governance bodies.Facilitate cross-functional collaboration to ensure alignment and communication across departments.Ensure project compliance with legislation and organizational policies, procedures, and managed care regulatory requirements.Support post-implementation evaluation, including benefits realization, lessons learned, and continuous improvement.Mentor and guide project teams and business partners in project management and analytical best practices.Track maintenance of business needs and requirements.Develop detailed project plans, schedules, budgets, and resource allocations. <h4>Duties Continued</h4>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.Partner with key stakeholders to monitor budgets, forecast resource needs, and track key performance indicators.Ensure project documentation is maintained according to Project Management Office (PMO) standards and audit requirements.Collaborate with key stakeholders to coordinate implementation and sustainment activities. 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.Performs other duties as assigned.<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>Required:At least 5 years of progressive experience in project management, business analysis, or operations management within a healthcare or managed care organization.At least 4 years of moderate to complex project management experience. Experience working simultaneously on multiple projects.Experience and knowledge with different project management frameworks, including waterfall and agile.Proven experience leading complex, cross-functional projects involving multiple stakeholders.Strong experience in data and process analysis, performance measurement, and reporting.Preferred:Experience in regulatory complianceExperience managing project budgets.<h4>Skills</h4>Required:Advanced project management skills, including knowledge of Agile, Waterfall, and hybrid methodologies.Ability to build strong relationships and communicate effectively with internal and external stakeholders.Strong grasp of current communication, project tracking, and budget management technologies.Excellent facilitation skills, with proven knowledge of how to foster attendee participation and collaboration in small and large groups.Solid technical understanding and ability to define and refine requirements through a project lifecycle.Strong problem-solving skills to manage shifting priorities, demands and timelines.Strong analytical and critical thinking skills, with ability to interpret complex data and translate insights into actionable recommendations.Proficiency in project management and analytics tools (e.g., MS Project, Smartsheet, Jira, Power BI, Tableau, Excel).Excellent written and verbal communication skills, including executive-level reporting and presentations.Strong organizational, facilitation, and stakeholder management skills.Ability to build relationships and influence cross-functional teams and leadership.Deep understanding of managed care operations, quality improvement, and regulatory compliance.Adaptability and resilience in managing complex, fast-paced initiatives.Demonstrated ability to manage competing priorities and deliver results in a matrixed environment.Preferred:Knowledge of vendor management.Ability to understand healthcare or managed care landscape.<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>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles

Enterprise Project Manager III

Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>The Risk Adjustment Strategies and Initiatives Analytics Program Manager II plays a valuable role in executing high-impact risk adjustment system implementations to continuously improving data and reporting processes to increase the effectiveness of risk adjustment programs and operations Infrastructure. The Program Manager II structures and coordinates cross-functional teams on technical initiatives in risk adjustment data platforms. The Program Manager II works closely with Information Technology (I.T.) and Business leads to conceptualize solutions, organize and align multiple teams for data regression testing, track and monitor system test cases, and user acceptance deliveries and drive towards meeting risk adjustment key performance indicator (KPI) metrics and reports for all three lines of business (Commercial, Medicare and Medi-Cal). The Program Manager II standardizes technical meetings and data discussions, ensures execution is efficient and consistent, and sets accountability by tracking progress, resolving dependencies, identifying issues, evaluating risks, and communicating with cross-functional business partners. The Program Manager II engages the analyst team to continue to support, test and upgrade multi-functional software programs for risk adjustment data collection and processing, often with tight deadlines and competing projects and priorities.&nbsp; The Program Manager II coordinates meetings, captures project discussions, develops project action plans, and completes business requirements and business case documents for technical implementations. Support and perform general data validation, clarify and address questions to drive projects and priorities. Track progress, coordinate with department analysts to resolve dependencies and evaluate risks, and communicate status to upper management and project partners. Serves as a resource on projects, technical documentation expert, and updates existing and develops new system architecture flow charts as risk adjustment activities evolve. Oversees and administers all facets of the day-to-day operations of the various programs and activities related to the position.<h4>Duties</h4>Develop, propose and implement program strategies and objectives. &nbsp;Responsible for monitoring program budget and expenditures. &nbsp;Plans, develops, and implements strategies for generating funding and/or resource opportunities for program activities. &nbsp;Provide program management and partnership with technical project team, and communicate and document concise project timelines, risks, escalation path, roles/responsibilities, and accountabilities. &nbsp; Facilitate technical meetings related to encounters and claims data for risk adjustment for all product lines (Commercial, Medicare, and Medi-Cal), capture notes and action plans. &nbsp;Synchronize the work of cross-functional project teams and provide direct or indirect oversight scope of work.&nbsp;Evaluates and oversee the development and implementation of Centers for Medicare and Medicaid Services (CMS) and Department of Health Care Services (DHCS) risk adjustment program changes; incorporate changes and requirements into strategy.&nbsp;Develop and manage risk adjustment data Infrastructure programs and manage deliveries from beginning to end, including project scope, timeline, software or hardware requirements, resource allocation, and project execution coordinating with inter/intra Technical and Business Functional teams. Ensure program objectives and deliverables are in alignment with department and LA Care &nbsp;goals. &nbsp;Develop program initiative timelines, goals and ensure everything is on schedule and within stated budgets.Serve as a liaison between all I.T. teams &nbsp;to ensure alignment with project goal(s). &nbsp;Coordinate cross-project activities.Partners with Business Owner(s) to develop communications plan, test plan, training plan, risk management/mitigation plan, and plan of record. Monitor inter-connected programs/project work product, outcome and interplay to be able to make necessary enhancements or modifications as appropriate to ensure alignment with department objectives. &nbsp;Coordinate cross-program/project activities as necessary. <h4>Duties Continued</h4>Formulate, organize and coordinate &nbsp;inter-connected projects in encounter and supplemental data collections, &nbsp;system processes, and regulatory data submissions for risk adjustment data management and methodologies for all three product lines (Commercial, Medicare, and Medi-Cal).Develops and distributes reports for senior leaders as it relates to risk adjustment metrics and performance. .Assess program performance and aim to maximize return on investment (ROI), utilize change management strategies to implement enhancements and process improvements as necessary.Navigate and create reports that monitors key performance indicators. &nbsp;Ensures the accuracy and timeliness of report and data given to senior leaders and stakeholders.Identify issues determined to impact risk adjustment, and work with the affected teams to resolve those issues in a manner that complies with all applicable internal and external governing rules and regulations.Perform other duties assigned.<h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4>Required: At least 5 years of experience in handling &nbsp;encounter data and/or risk adjustment projects or programs. &nbsp;Experience with Process Improvement Methodology including defining and documenting workflow.Experience with Workflow Tools - JIRA, Data Lake, Project Server etc.Technical project experience in large distributed systems, complex competing environments, Micro services Architecture, Cloud computing etc.Experience resolving effective program critical metrics and using them to measure program success and identify issues.Experienced in project management tools. Familiar with both Agile and Waterfall methodologies and able to apply them when best suited.Preferred: At least 5 years experience in Health Care, Managed Care<h4>Skills</h4>Required: Proven ability to work closely and skillfully with the all stake holders across the organization.Strong organizational, analytical and truth-seeking mentality skills to juggle many tasks without losing sight of the highest priority or roadmap projects.&nbsp;Excellent in identifying process gaps, measuring progress, efficiency and balancing with process overhead and be exceptional at facilitating discussions.Proven technical capability and an understanding of technical designs, challenges, and risks.&nbsp;Ability to influence, motivate, and align people across a broad variety of job functions through your project/program management skills. Basic understanding of IT driven technologies and Architectures.Working knowledge of SQL Server, Visual Studio, Oracle, MS Office, Visio, Project Server &amp; Jira ManagementAbility to articulate and communicate effectively and follow the project management and Systems Development Life Cycle (SDLC) lifecycles.Strong problem solving skills with the demonstrated ability to identify research and make decisions.&nbsp;Demonstrated ability to be an effective, collaborative partner with internal and external stakeholders.Understanding of encounter and supplemental data collections, &nbsp;system processes, and regulatory data submissions for risk adjustment data management and methodologies for Commercial, Medicare, and Medi-Cal product lines.Have an understanding of end-to-end encounters/claims, supplemental, and risk adjustment data software systems.Ability to lead cross functional internal teams to execute on complex tasks<h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Project Management Certificate<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles Job Segment: Medicare, Claims, Medicaid, Risk Management, Healthcare, Insurance, Finance

Risk Adjustment Strategies and Initiatives Analytics Program Manager II

Salary Range:&nbsp;&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>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. 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. 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.<h4>Duties</h4>Manage the planning, execution, and delivery of projects across diverse business areas, including operational, clinical, strategic, and technology initiatives.Define project scope, goals, deliverables, timelines, and success metrics in collaboration with sponsors and stakeholders.Conduct high-level data and process analysis to inform project design, evaluate outcomes, and identify opportunities for improvement.Develop detailed project plans, schedules, budgets, and resource allocations.Monitor progress against milestones, manage risks, issues, and dependencies, and implement mitigation strategies.Prepare and present project updates, dashboards, and analytical reports to leadership and governance bodies.Facilitate cross-functional collaboration to ensure alignment and communication across departments.Ensure project compliance with legislation and organizational policies, procedures, and managed care regulatory requirements.Support post-implementation evaluation, including benefits realization, lessons learned, and continuous improvement.Mentor and guide project teams and business partners in project management and analytical best practices.Track maintenance of business needs and requirements.Develop detailed project plans, schedules, budgets, and resource allocations. <h4>Duties Continued</h4>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.Partner with key stakeholders to monitor budgets, forecast resource needs, and track key performance indicators.Ensure project documentation is maintained according to Project Management Office (PMO) standards and audit requirements.Collaborate with key stakeholders to coordinate implementation and sustainment activities. 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.Performs other duties as assigned.<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>Required:At least 6 years of progressive experience in project management, business analysis, or operations management within a healthcare or managed care organization.At least 4 years of moderate to complex project management experience. Experience working simultaneously on multiple projects.Experience and knowledge with different project management frameworks, including waterfall and agile.Proven experience leading complex, cross-functional projects involving multiple stakeholders.Strong experience in data and process analysis, performance measurement, and reporting.Preferred:Experience in regulatory complianceExperience managing project budgets.<h4>Skills</h4>Required:Advanced project management skills, including knowledge of Agile, Waterfall, and hybrid methodologies.Ability to build strong relationships and communicate effectively with internal and external stakeholders.Strong grasp of current communication, project tracking, and budget management technologies.Excellent facilitation skills, with proven knowledge of how to foster attendee participation and collaboration in small and large groups.Solid technical understanding and ability to define and refine requirements through a project lifecycle.Strong problem-solving skills to manage shifting priorities, demands and timelines.Strong analytical and critical thinking skills, with ability to interpret complex data and translate insights into actionable recommendations.Proficiency in project management and analytics tools (e.g., MS Project, Smartsheet, Jira, Power BI, Tableau, Excel).Excellent written and verbal communication skills, including executive-level reporting and presentations.Strong organizational, facilitation, and stakeholder management skills.Ability to build relationships and influence cross-functional teams and leadership.Deep understanding of managed care operations, quality improvement, and regulatory compliance.Adaptability and resilience in managing complex, fast-paced initiatives.Demonstrated ability to manage competing priorities and deliver results in a matrixed environment.Preferred:Knowledge of vendor management.Ability to understand healthcare or managed care landscape.<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>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles

Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)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. 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. <h4>Job Summary</h4>The Enterprise Data Analyst III serves as a Subject Matter Expert (SME) contributor responsible for leading complex analytic projects that link insights directly to enterprise goals, resource allocation, and performance improvement. This position leads the full analytic development process from business case definition and structured scoping through peer review, deployment, and post-implementation evaluation, ensuring high-quality, reproducible, and impactful outputs.The Analyst III applies advanced analytic reasoning and strong business acumen to deliver analyses that inform both operational and financial decision making. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp; <h4>Duties</h4>Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights.Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance.Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows.Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards.Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.Maintains awareness of data lineage and governance compliance throughout all analytic work.Manages project planning, tracking, and post-implementation assessment for assigned deliverables.Mentors and models adherence to analytic development best practices.Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures 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. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.Perform other duties as assigned.<h4>Duties Continued</h4>Domain Specific Experience and Skills:Domain Focus: Authorization &amp; Claims Operations AnalyticsRequired: 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.Domain Focus: Network Strategy AnalyticsRequired: Experience supporting initiatives to optimize cost, access, and quality within provider networks. Experience analyzing provider networks, including contracting, credentialing, and panel optimization. Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.Domain Focus: Risk Adjustment AnalyticsRequired: 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.Preferred Certification: AAPC Certified Risk Adjustment Coder (CRC®); Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™); NAMAS Certified HCC Coder (CHCC™); AHIMA Certified Coding Specialist (CCS®)Domain Focus: Medical Cost Driver AnalyticsRequired: 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.<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>Required:At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health.Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights.Experience analyzing multiple data sources and translate findings into actionable recommendations.Preferred:Experience with advanced analytics techniques, including multivariate analysis, regression, control charts, or predictive modeling.Experience in domain specific operations, such as network strategy, risk adjustment, or medical cost driver analysis.Experience mentoring junior analysts or providing guidance on analytic best practices.<h4>Skills</h4>RequiredExpert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes supporting enterprise dashboards, reports, and analytic deliverables.&nbsp;Advanced proficiency in Tableau (or equivalent BI tools) to design, optimize, and automate dashboards and visualizations for enterprise level insights.Strong statistical and analytical skills, including multivariate analyses, regression, and control charts to identify drivers of operational, clinical, and financial performance.Knowledge of version control (Git, GitHub) and collaborative development workflows, including peer review, continuous integration, and reproducible analytic practices.Ability to develop and maintain reusable analytic frameworks, templates, and processes that support recurring reporting and performance monitoring.&nbsp;Proficiency in data validation, reconciliation, and adherence to governance standards, including data lineage tracking and quality control.Ability to translate complex business problems into structured analytic requirements and actionable insights.&nbsp;Ability to interpret analytic results in the context of organizational performance, operational priorities, and enterprise goals.&nbsp;Ability to apply critical thinking to identify patterns, opportunities, and risks across multiple data domains.&nbsp;Ability to collaborate effectively with IT, operational teams, and business partners to operationalize analytic outputs.&nbsp;Demonstrated knowledge of healthcare concepts, such as quality measures, utilization patterns, and key operational drivers in a managed care environment.Ability to lead analytic projects end-to-end, including business case definition, requirements gathering, analysis, and post-implementation assessment.&nbsp;Ability to mentor junior analysts and promote adherence to analytic best practices.&nbsp;Ability to manage multiple projects simultaneously, prioritize tasks, and escalate issues appropriately.&nbsp;Ability to communicate findings effectively to both technical and non-technical stakeholders.&nbsp;<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 CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.<h4>Required Training</h4>General Skills Preferred:Proficient with Process Improvement Methodology including defining and documenting workflow.&nbsp;Knowledge of program and project level planning, mobilization and managementDomain Specific Experience and Skills: Domain Focus: Population Health AnalyticsRequired: 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. Ability to evaluate population level outcomes and operational performance metrics. Preferred: Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM. Domain Focus: Quality Improvement AnalyticsRequired: 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.Preferred: Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS).Experience supporting provider focused incentive program analytics. Preferred Certification: Certified Professional in Healthcare Quality (CPHQ)<h4>Physical Requirements</h4>Light<h4>Additional Information</h4>Domain Specific Experience and Skills:Domain Focus: Access to Care AnalyticsRequired: 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. Knowledge access measurement frameworks and regulatory requirements. Ability to evaluate member access metrics, network capacity, and operational performance. Domain Focus: Enterprise Support AnalyticsRequired: Experience supporting enterprise level KPI maintenance, cross domain dashboards, and measure ROI analyses. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains. 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.Preferred: Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.Domain Focus: Member Experience AnalyticsRequired: Experience analyzing call center operations, enrollment services, and appeals &amp; grievances. 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. Ability to assess member touchpoints, satisfaction metrics, and operational KPIs.Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.L.A. Care offers&nbsp;a wide range of benefits including<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> Nearest Major Market: Los Angeles Job Segment: Claims, Medicaid, Medical Coding, Medicare, Pharmacy, Insurance, Healthcare

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