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<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 Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&amp;G) clinical unit.</p><p>This position is responsible for the quality review of complex and/or escalated clinical A&amp;G cases for all line of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved Customer Service to L.A. Care’s (LAC) membership. This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines. </p><p>Leads and works closely with assigned team daily. This position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and project completion.</p><h4>Duties</h4><p>Review and process complex and/or escalated clinical A&amp;G cases. Analyze the patient medical records, clinical documentation, and insurance policies to determine medical necessity. Prepares and reviews A&amp;G files for submission to providers and internal departments.</p><p>Work with other departments to ensure all aspects of a case are appropriately managed.</p><p>Conduct targeted and random clinical case audits to ensure that all regulatory and departmental guidelines, policies, procedures, and standards are met. Work closely with the leadership team to create and/or modify Desk Level Procedures and recommends enhancements to process and procedures. </p><p>Assist the Clinical Supervisors in identifying deviations in performance and process changes are implemented to redirect performance to acceptable levels. Recommend and implement resolutions, new processes, and/or process improvement. </p><p>Provides accurate and timely written statistical reports that includes historical and/or current data to aid in projecting or evaluating compliance status. Identify and analyze trends in appeals and grievances to find the root cause of denials.</p><h4>Duties Continued</h4><p>Check, verifies and ensure that all clinical A&amp;G cases are processed accurately and within established timelines to meet or exceed member satisfaction goals and regulatory (CMS, DMHC, DHCS, NCQA), Health and Safety Code and company compliance.</p><p>Maintains documentation of all communications in the A&amp;G system to ensure thorough tracking of case status.</p><p>Leads the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training, and feedback on performance to department management. Work closely with management to review performance and quality standards on an ongoing basis. As well as motivational programs needed to achieve regulatory standards.</p><p>Acts as a back-up to the Supervisor in leading meetings and handling escalations as required.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Associate's Degree in Nursing for Registered Nurses<h4>Education Preferred</h4>Bachelor's Degree in Nursing for Registered Nurses<h4>Experience</h4><p><b>Required:</b></p><p>At least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting,</p><p>At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment.</p><p>At least 1 year of leading a process, program, or staff experience.</p><p><b>Preferred:</b></p><p>Clinical acute experience.</p><h4>Skills</h4><p><b>Required:</b></p><p>Extensive knowledge of healthcare regulations and managed care guidelines</p><p>Demonstrated ability to provide recommendations towards resolution.</p><p>Strong critical thinking and problem-solving abilities to assess complex clinical cases and evaluate medical necessity.</p><p>Ability to communication, conflict resolution, and motivational skills. </p><p>Ability to work independently and closely with a team in a collaborative and interactive environment.</p><p>Ability to adjust to changing circumstances within the team. </p><p>Good verbal and written communication skills.</p><p><b>Preferred:</b></p><p>Strong project management skills with the ability to manage multiple training initiatives simultaneously.</p><h4>Licenses/Certifications Required</h4>Licensed Registered Nurse (RN) - Active, current and unrestricted California License and/or Physician Assistant (PA) - California License Required<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and occasional flexibility in hours/shift in critical situations and work on-call. </p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities, which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned.</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>                    Nursing, Medical, Registered Nurse, Medicare, Medicaid, Healthcare                                                    </p>

L.A. Care Health Plan

Lead Customer Solution Center Appeals and Grievances RN

<h4><em><strong>How you'll change lives</strong></em></h4><p>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.</p><h4><em><strong>What you'll be doing</strong></em></h4><p><strong>Patient care.</strong> You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. </p><p><strong>Teamwork.</strong> You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.</p><p><strong>Safety &amp; Quality.</strong> Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.</p>

U.S. Renal Care

Dialysis Registered Nurse Part Time | MWF

<h4><em><strong>How you will change lives</strong></em></h4><p>As a Patient Care Technician (PCT) at US Renal Care, you will be an integral part of a cross-functional team providing care and delegated activities of treatment to patients. The PCT will work under the supervision of a Registered Nurse (RN) or Charge Nurse (CN) for patients with renal failure.</p><h4><em><strong>What you'll be doing</strong></em></h4><p><strong>Patient care.</strong> You will work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include gathering patient stats before and after treatment, initiating treatment, monitoring patients during treatment, terminating treatment, and collecting patient blood samples per physician orders.</p><p><strong>Technician Duties. </strong>You will ensure quality comes first by preparing machines for hemodialysis treatments, cleaning and disinfecting machines after treatment, and conducting machine safety checks and logging results for quality control, ensuring all protocols and regulations are followed.</p><p><strong>Safety and Quality. </strong>You will use appropriate safety measures, including personal protective equipment. Working under the supervision of a Charge Nurse, you will adhere to all company policies, procedures, and state/federal laws and regulations. You will participate in all required staff meetings and continuing education offerings.</p><p><strong>PATIENT CARE TECHNICIAN<br>STATE SPECIFIC BOARD OF NURSING REQUIREMENTS </strong></p><strong>California</strong><ul><li>Must possess current Certified Hemodialysis Technician (CHT) certificate from California Department of Public Health (CDPH) at time of hire OR</li><li>Hired at USRC location recognized by state of California as an approved dialysis technician training program and obtain California state certification (CHT) within six (6) weeks of successful completion of training program. </li></ul><strong>Maryland</strong><ul><li>Must possess current Certified Nursing Assistants -- Dialysis Technicians (CNA-DT) certificate from Maryland Board of Nursing OR</li><li>Hired at USRC location recognized by state of Maryland as an approved dialysis technician training program and obtain Maryland CNA-DT certificate within three (3) months from date of hire OR</li><li>Out-of-state applicant must have active BONENT certification and provide proof of initial application for CNA-DT certification.</li></ul><strong>New Mexico</strong><ul><li>Must have New Mexico dialysis technician certificate at time of hire <strong>OR</strong></li><li>Hired at USRC location recognized by state of New Mexico as an approved dialysis technician training program and obtain New Mexico state certification within six (6) months of successful completion of training program <strong>OR</strong></li><li>New Mexico certification of hemodialysis technician is required for out of state applicant with active state or national hemodialysis certification; must obtain New Mexico state certification prior to working as a Certified Hemodialysis Technician. </li><li>After January 1st, 2024, all initial applications for the certified hemodialysis technician will require a national hemodialysis technician certificate.</li><li>The applicant must submit proof of a valid national hemodialysis technician certificate from a recognized organization.</li><li>Hemodialysis technician students must have a current basic life support credential prior to and while the student has contact with patients</li></ul><strong>OHIO</strong><ul><li>Must have Ohio dialysis technician intern certificate at time of hire OR</li><li>Hired at USRC location recognized by state of Ohio as an approved dialysis technician training program and submit application for Ohio dialysis technician intern certificate to board no later than four (4) weeks prior to completion of the approved training program.</li><li>Must obtain Ohio Board of Nursing Certificate (OCDT) not less than twelve (12) months and not later than eighteen (18) months of enrolling in the USRC OCDT program.</li></ul><strong>OREGON</strong><ul><li>Must possess current Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division at time of hire OR</li><li>Must obtain Oregon dialysis technician provisional certificate within three (3) weeks of successful completion of training program and obtain Certified Hemodialysis Technician (CHDT) certificate from Oregon Public Health Division within eighteen (18) months. An Oregon Provisional Certification is valid for six months and can be renewed for one additional six month period.</li></ul>&nbsp;<br>

Dialysis Patient Care Technician - Float

<p><strong>Join the Clean Energy Revolution</strong></p><p>Become an <strong>Accountant Senior </strong>at Southern California Edison (SCE) and build a better tomorrow. In this job, you’ll become a key member of general ledger and benefit accounting team. As an <strong>Accountant Senior</strong>, your work will help power our planet, reduce carbon emissions, and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future?</p><h4><b>Responsibilities</b></h4><ul><li>Initiates and prepares the general ledger and month end close entries</li><li>Coordinates with internal staff and external accounting firm to facilitate the annual financial statement audit</li><li>Executes the preparation, compilation and review of monthly and annual financial statements and other reports  in accordance with generally accepted accounting principles.</li><li>Conducts a monthly variance analysis and identifies variance causes and trends</li><li>Gathers data for a monthly cash report for management, detailing the current cash position for each bank account and reconciling all temporarily restricted fund balances</li><li>Carries out the year-end audit; compile and prepare supporting schedules, work papers, and financial reports as requested by auditors</li><li>Facilitates the creation of various reports for financial, tax, and regulatory purposes</li><li>Undertakes financial analysis and support for quarterly forecasts and annual budgets</li><li>A material job duty of all positions within the Company is ensuring the protection of all its physical, financial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, confidential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity.</li></ul><h4><b>Minimum Qualifications</b></h4><ul><li>Five or more years of experience in accounting.</li><li>Experience with interpreting and applying Generally Accepted Accounting Principles (GAAP)</li></ul><p><strong>Preferred Qualifications</strong></p><ul><li>Certified Public Accountant (CPA) </li><li>Bachelor’s or higher degree in accounting or related field</li><li>Proficiency with SAP or similar enterprise software</li><li>Experience in a public accounting firm and/or regulated utility</li><li>Experience with handling employee benefit accounting</li></ul><p><strong>Additional Information</strong></p><ul><li>This position’s work mode is <strong>hybrid. </strong>The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days.  Unless otherwise noted, employees are required to work and reside in the state of California.  Further details of this work mode will be discussed at the interview stage.The work mode can be changed based on business needs.</li></ul><ul><li>Visit our Candidate Resource page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more! </li><li>Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.</li><li>The primary work location for this position is Rosemead, CA.&nbsp;</li></ul><p><strong>About Southern California Edison</strong></p><p>The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world. Southern California Edison is a proud Equal Opportunity Employer, including disability and protected veteran status. We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodations at (833) 343-0727.</p>

Southern California Edison

Accountant Senior

<p><strong>Responsibilities</strong></p><p><strong>About Howmet Aerospace</strong></p><p>Howmet Aerospace Inc. (NYSE: HWM), headquartered in Pittsburgh, Pennsylvania, is a leading global provider of advanced engineered solutions for the aerospace and transportation industries. Our primary businesses focus on jet engine components, aerospace fastening systems, titanium structural parts and forged wheels. With $7.4 Billion in revenue in 2024, our products play a crucial role in enabling fuel efficiency and lightweighting, contributing to our customers’ success and making a positive impact on the world. To learn more about the way Howmet Aerospace Inc. is advancing the sustainability of our customers, markets, and communities where we operate, review the 2024 Environmental Social and Governance report at&nbsp;<a href="http://www.howmet.com/esg-report" target="_blank">www.howmet.com/esg-report</a>. Follow:&nbsp;LinkedIn,&nbsp;Twitter,&nbsp;Instagram,&nbsp;Facebook, and&nbsp;YouTube.</p><p>Howmet Fastening Systems (HFS) is seeking an <strong>Machine Maintenance Technician (Electronics)&nbsp;</strong>for our&nbsp;<strong>Carson, CA</strong>&nbsp;location. HFS is a business unit of Howmet Aerospace, headquartered in Torrance, California.&nbsp; We hold the number one global position in aerospace fastening systems, and we’re the North American leader in commercial transportation fasteners. Our high-tech, multi-material fastening systems are found nose to tail on aircraft and aerospace engines. Our products are also critical components of industrial gas turbines, automobiles, commercial transportation vehicles, and construction and industrial equipment.</p><p><strong>Primary Purpose</strong></p><p>The primary function of this position is to maintain, repair, adjust, and modify the facilities machinery and equipment, as well as the building and its grounds, according to a set schedule and in emergency and non-emergency situations.</p><p><strong>Responsibilities</strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p><ul><li>Perform technician skills including but not limited to, mechanical, electrical, pneumatic, hydraulic, troubleshooting, and repair of production machines.&nbsp;</li><li>Connects power supply wires to machines and equipment and connects cables and wires between machines and equipment.</li><li>Diagnoses malfunctioning apparatus such as transformers, motors and lighting fixtures and replaces damaged or broken wires and cables.</li><li>Tests malfunctioning machinery and discusses malfunction with other appropriate personnel to diagnose malfunction.</li><li>Replaces faulty electrical components such as relays, switches, motors, and sensors.</li><li>Replaces PLC's.</li><li>Plans layout of wiring and installs wiring, conduit, and electrical devices in manufacturing equipment.</li><li>Strictly adhere to safety regulations and plant policies.</li><li>Perform highly diversified duties to install and maintain production machines and the plant facility’s tools and equipment.</li><li>Provide emergency/unscheduled repairs of production equipment during production and perform scheduled maintenance repairs of production equipment during machine service.</li><li>Read and interpret equipment manuals and work orders to perform required maintenance and service.</li><li>Diagnose problems, repair or replace parts, test and make adjustments.</li><li>Use a variety of hand and power tools, electric meters and material handling equipment in performing duties.</li><li>Detect faulty operations, defective material and report those and any unusual situations to proper supervision.</li><li>Perform all other duties as assigned or needed.</li></ul><p><strong>Qualifications</strong></p><p><strong>Basic Qualifications</strong></p><ul><li>High School Diploma or GED equivalent</li><li>Minimum +3&nbsp;years of experience troubleshooting and repairing production and/or manufacturing equipment&nbsp;</li><li>Employees must be legally authorized to work in the United States.&nbsp;Verification of employment eligibility will be required at the time of hire.&nbsp; Visa sponsorship is not available for this position</li><li>This position entails access to export-controlled items and employment offers are conditioned upon an applicant’s ability to lawfully obtain access to such items</li></ul><p><strong>Preferred Knowledge &amp; Skills</strong></p><ul><li>+5 years of experience with diagnosing, repairing, and troubleshooting electrical systems for production equipment</li><li>Experience maintaining machinery such as CNC Machines, machine washers, salt lines, and etc.</li><li>Familiarity with Davenport, Traub, Sasspi and/or Waterbury machines</li><li>Experience working with PLC (Siemens, Allen Bradley, etc.)</li><li>Knowledge of or experience in working with Screw Machines, Drillers, Tappers, and other manufacturing equipment, as well as troubleshooting the above-mentioned machines.</li><li>Detail oriented and has the ability to follow both oral and written directions, ability to work unsupervised</li><li>Demonstrable knowledge and/or understanding of codes, rules, regulations and standards of electrical equipment</li><li>Ability to read and interpret electrical, hydraulic and pneumatic schematics and drawings</li><li>Familiar with commercial building codes</li></ul><p><strong>Additional Requirements</strong></p><ul><li>Must be able to work on site in Carson, California</li><li>Must be able to work on the 1st shift and overtime and/or weekends as needed<ul><li>1st Shift: 4 AM - 2 PM</li></ul></li><li>Able to lift 15-30lbs. Unassisted and repetitively</li><li>Lifting, standing, climbing, bending, grasping, sitting, pulling, pushing, stooping, stretching, and carrying are generally required to perform the functions of this position</li></ul><p><strong>Benefits/Salary:</strong></p><p>The position includes competitive wages and a comprehensive benefits package, including health insurance (medical, dental, vision), excellent 401k matching program, paid holidays and vacation. Howmet Aerospace curates a strong working environment through opportunities for career progression, community engagement activities, and flexible schedules contingent upon role and location. The pay range for this position is $22-$31/hr.</p><p><strong>About us</strong></p>﻿Howmet Aerospace Inc. (NYSE: HWM), headquartered in Pittsburgh, Pennsylvania, is a leading global provider of advanced engineered solutions for the aerospace and transportation industries. Our primary businesses focus on jet engine components, aerospace fastening systems, titanium structural parts and forged wheels. With $7.4 Billion in revenue in 2024, our products play a crucial role in enabling fuel efficiency and lightweighting, contributing to our customers’ success and making a positive impact on the world. To learn more about the way Howmet Aerospace Inc. is advancing the sustainability of our customers, markets, and communities where we operate, review the 2024 Environmental Social and Governance report at&nbsp;<a href="https://www.howmet.com/esg-report/" target="_blank">www.howmet.com/esg-report</a>. Follow: <a href="https://www.linkedin.com/company/howmet-aerospace" target="_blank">LinkedIn</a>, <a href="https://twitter.com/howmetaerospace" target="_blank">Twitter</a>, <a href="https://www.instagram.com/howmetaerospace/" target="_blank">Instagram</a>, <a href="https://www.facebook.com/Howmetaerospace/" target="_blank">Facebook</a>, and <a href="https://www.youtube.com/howmetaerospace" target="_blank">YouTube</a>. Equal Opportunity Employer: Howmet is proud to be an Equal Employment Opportunity employer. We are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or other applicable legally protected characteristics. If you need assistance to complete your application due to a disability, please email&nbsp;<a href="mailto:TalentAcquisitionCoE_Howmet@howmet.com" target="_blank">TalentAcquisitionCoE_Howmet@howmet.com</a>

Howmet Aerospace

Machine Maintenance Technician (Electronics)

The We’ll Buy Your Car (WBYC) In-Store Associate will be focused and specifically trained to acquire additional inventory for the dealership by actively prospecting outside of the AutoNation Customer Network.&nbsp; &nbsp;The WBYC Associate will utilize all available prospecting resources to identify and engage private parties looking to sell their vehicle.&nbsp; Resources include third party websites, 3rd party lead sources, service drive traffic and other means. This Associate will enjoy consistent interaction with customers throughout the day, both in person and over the phone. This role will primarily make cold contact with prospects who have their vehicle advertised for sale, both online and as walk-ins to the store.<h2>Job Responsibilities:</h2><ul><li>Review vehicle condition reports</li><li>Determine wholesale and retail prices</li><li>Inspect and accept vehicles arriving onsite</li><li>Create and execute reconditioning plan to prepare vehicle for sale</li><li>Using sound judgement, research, and excellent interpersonal skills to make offers on vehicles and close sales</li><li>Driving incremental business through a high-level of engagement with customers.</li><li>Turn prospective Vehicle Procurement Customers over to an “elite” sales team for a sales opportunity</li><li>Work with management to identify current inventory needs.</li></ul><h2>Qualifications:</h2><ul><li>High School diploma or equivalent.</li><li>Extremely self-motivated&nbsp;</li><li>Ability to set and achieve targeted goals.</li><li>Ability to drive an exceptional Customer experience.</li><li>Demonstrated communication, prospecting, and interpersonal skills.</li><li>Organization and follow-up skills.</li><li>Experience and desire to work with technology.</li><li>Valid In-State Driver's License and an acceptable, safe driving record</li></ul><h2>Physical Requirements:</h2><ul><li>Ability to sit and stand for prolonged periods of time.</li></ul><p>This position is commission-based with an average income of $2-9k.month.</p><h2>Exciting Benefits and Perks Await You:</h2><ul><li><p>Competitive compensation and 401k matching</p></li><li><p>Enjoy a healthy work-life balance with insurance plans (health, dental, vision) and maternity benefits.</p></li><li><p>Associate purchase and discount programs for new and pre-owned vehicles, services, parts, collision, accessories, and AutoGear</p></li><li><p>Access amazing deals and discounts through YouDecide, a website with offers from top providers and retailers</p></li><li><p>Join our DRVPNK mission to raise and donate millions of dollars to cancer research and treatment, partnering with cancer charities nationwide</p></li></ul><p>AutoNation is one of the largest automotive retailers in the United States, offering innovative products, exceptional services, and comprehensive solutions, empowering our customers to make the best decisions for their needs. With a network of dealerships nationwide strengthened by a recognized brand, we offer a wide variety of new and used vehicles, customer financing, parts, and provide expert maintenance and repair services. Through DRV PNK, we have raised over $40 million for cancer-related causes, demonstrating our commitment to making a positive difference in the lives of our Associates, Customers, and the communities we serve.<br>&nbsp;</p><p>AutoNation is committed to creating a diverse, equitable, and inclusive environment in our workplace and the services we provide. We welcome candidates from all backgrounds who are passionate about making a positive impact. Even if you do not meet every requirement, we encourage you to apply. Join our team and help us foster a culture of belonging while contributing to our revolutionary work in the automotive industry. We value innovation, teamwork, and a commitment to making a positive impact in the world.</p>

AutoNation

Acquisition Specialist at Hyundai Valencia AutoNation

<p><b>Salary Range:&nbsp;</b>&nbsp;$60,778.00&nbsp;(Min.) -&nbsp;$75,950.00&nbsp;(Mid.) -&nbsp;$91,166.00&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 Customer Solution Center Appeals and Grievances (A&amp;G) Specialist II &nbsp;will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance (NCQA) regulatory requirements. This position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations, and complex provider claim disputes. &nbsp;The position is further responsible for tracking, trending and reporting complaints and appeals, as well as participating in internal and external oversight activities.</p><p>The position is responsible for maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, adhering to company policy and procedures, including accreditation requirements, applicable federal, state and local laws and regulations.</p><h4>Duties</h4><p>Identifies, investigates, and resolves administrative complaints, complex provider appeals and State Fair Hearing adhering to CMS, DHCS, DMHC, MRMIB and NCQA standards and regulations.</p><p>Intakes, acknowledges, prepares case files and routes complaints to appropriate internal department for investigation and resolution, exercising strong independent judgment.&nbsp;</p><p>Ensures integrity of A&amp;G database by thorough, timely and accurate assignment of cases. &nbsp;Monitors closure of complaints and works with Quality Control Supervisor to resolve all database issues.&nbsp;</p><p>Prepare and analyze monthly appeal and grievance reports to meet internal and external reporting requirements.</p><p>Participates in internal and external oversight activities, inter-rater reliability reviews and focused audits. &nbsp;Recommends opportunities for improvement</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 2 years of experience in Managed Care with specific experience in resolving member and provider complaint and appeals issues, including eligibility, access to care, claims, benefit, and quality of care concerns.&nbsp;</p><p><br>Experience working with firm deadlines, able to interpret and apply regulations. &nbsp;</p><p>At least 5 years of experience in Managed Care working with Medicare, Medi-Cal and other State Sponsored programs. &nbsp;</p><p>Knowledge of Medical terminology and strong advocacy experience.</p><h4>Skills</h4><p><b>Required:</b><br>Must be organized, detail oriented, able to exercise strong independent judgment; poses conflict resolution and persuasion skills. &nbsp;</p><p>A team player with excellent communication and presentation skills, able to work effectively with various internal departments/service areas, plan partners, participating provider groups and other external agencies.<br><br>Proficient in MS Office applications, Word, Excel and Power Point.&nbsp;</p><p>Requires strong knowledge of regulatory standards and claims processing; strong analytical, oral, written and presentation skills, able to monitor and be compliant with strict regulatory deadlines.&nbsp;</p><p><b>Preferred:</b><br>Proficient in MS Office applications, Access, Visio.</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>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</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, Medicaid, Healthcare, Insurance                                                    </p>

Customer Solution Center Appeals and Grievances Specialist II (Temporary)

<p><b>Salary Range:&nbsp;</b>&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&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 Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level appeals and grievances work supporting the higher level position in this class series to ensure positive outcomes for members. It will support the Appeals and Grievances team to receive, investigate and resolve member and provider complaints and appeals; escalates complex issues or questions to leadership team as appropriate.</p><p>The position is responsible for maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, adhering to company policy and procedures, including accreditation requirements, applicable federal, state and local laws and regulations.</p><h4>Duties</h4><p>Primary function of this role is to learn the specialty level appeals and grievances work by resolving less complex cases to ensure positive outcomes for members. (20%)</p><p>Supports the identification, investigation and resolve administrative complaints, simple appeals while adhering to Center for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MRMIB) and National Committee for Quality Assurance (NCQA) standards and regulations. (20%)</p><p>Intakes, acknowledges, prepares case files and routes complaints to appropriate internal departments and external business partners for investigation and resolution, exercising strong independent judgment. (20%)</p><p>Processes assigned cases accurately and in a timely manner per instructions. Escalates complex issues or questions to leadership as appropriate. (20%)</p><p>Actively participates in team meetings and provides recommendation for improvement as appropriate based on discoveries. (10%) </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>Associate's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 1 year of experience in Managed Care working with Medicare, Medi-Cal and other State Sponsored programs.</p><p>Experience working with firm deadlines, able to interpret and apply regulations.&nbsp; </p><p>Strong advocacy experience.</p><h4>Skills</h4><p><b>Required:</b><br>Must be organized, detail oriented, able to exercise strong independent judgment; poses conflict resolution and persuasion skills. &nbsp;</p><p>A team player with excellent communication and presentation skills, able to work effectively with various internal departments/service areas, plan partners, participating provider groups and other external agencies.<br><br>Proficient in MS Office applications including Word, Outlook and Excel.&nbsp;</p><p>Ability to provide confidentiality and professional customer service skills.&nbsp;</p><p>Ability to work under tight deadline.</p><p>Strong analytical, verbal, written and presentation skills, able to monitor and be compliant with strict regulatory deadlines.&nbsp;</p><p>Knowledge of Medical terminology.</p><p><b>Preferred:</b><br>In depth knowledge of DHCS, NCQA, CMS, DMHC regulartories and guidelines.</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>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</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>                    Medicare, Medicaid, Healthcare                                                    </p>

Customer Solution Center Appeals and Grievances Specialist I (Temporary)

<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 Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan’s enterprise special investigations unit (SIU) and FWA program. The Director oversees internal and external investigations into potential misconduct, regulatory violations, and fraudulent activity while ensuring compliance with federal and state regulatory requirements. </p><p>The Director provides strategic direction, operational leadership, and subject matter expertise to safeguard L.A. Care’s integrity, protect member trust, and mitigate financial and reputational risks. This position leads investigative governance across the enterprise, coordinating with internal stakeholders and external regulators to ensure timely, thorough, and effective resolution of investigative matters. </p><p>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><b>Leadership and Program Oversight:</b></p><p>Lead L.A. Care’s Special Investigations Unit (SIU) in overseeing the internal and external investigations into fraud, waste, abuse, and compliance violations. </p><p>Drive the design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program, ensuring compliance with Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and state/federal requirements. </p><p>Ensure effective case intake, triage, investigation, tracking, and resolution processes, including referral to law enforcement, regulators, or external entities as needed. </p><p>Develop and support enterprise policies, procedures, and training programs supporting FWA prevention, detection, and response.</p><p><b>Investigations and Regulatory Engagement: </b></p><p>Direct and oversee investigations into allegations of non-compliance, ethical violations, or fraudulent behavior involving employees, delegated entities, providers, or vendors.</p><p>Partner with Legal, Compliance, and Human Resources on sensitive internal investigations to ensure confidentiality, integrity, and fairness.</p><p>Ensure timely and accurate reporting of SIU/FWA activity to external agencies to meet regulatory requirements.</p><p>Lead enterprise readiness for external audits, regulatory inquiries, and enforcement actions involving SIU and FWA matters. </p><h4>Duties Continued</h4><p><b>Risk Management and Oversight</b></p><p>Conducts strategic planning to use resources to meet current and future departmental and Enterprise-wide goals.</p><p>Monitor investigative trends, emerging risks, and regulatory developments to proactively adapt investigative strategy and resource allocation.</p><p>Develop dashboards, analytics, and reporting tools to provide executives and the Board with visibility into investigative outcomes, financial recoveries, and risk trends.</p><p>Ensure alignment of investigative and FWA activities with organizational risk appetite, compliance strategy, and enterprise risk management frameworks.</p><p><b>Collaboration and Culture:</b></p><p>Serve as a trusted advisor and subject matter expert to senior leadership, the Compliance Committee, and the Audit Committee on investigative matters.</p><p>Collaborate with cross-functional leaders to embed FWA prevention and detection mechanisms across operations.</p><p>Champion a culture of integrity, accountability, and transparency by promoting awareness of FWA risks and prevention strategies.</p><p>Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.</p><p>Manages budgets and resources effectively.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Criminal Justice or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Public Policy or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field.</p><p>At least 5years of experience in leading teams, projects, initiatives, or cross-functional groups.</p><p>Demonstrated experience managing complex investigations in a managed care or healthcare environment. </p><p>Experience in coordinating with external regulators and law enforcement agencies. </p><p><b>Preferred:</b></p><p>Prior leadership of a Special Investigations Unit (SIU) or equivalent function in a health plan, government agency, or large healthcare system.</p><p>Experience with compliance technology platforms and advanced data analytics for FWA detection.</p><h4>Skills</h4><p><b>Required:</b></p><p>Proven knowledge of CMS, DHCS, DMHC, OIG, and DOJ regulatory frameworks governing FWA programs</p><p>Strong investigative skills, including evidence gathering, interviewing, and case documentation. </p><p>Demonstrated success in leading complex, multi-party investigations with integrity and discretion.</p><p>Excellent communication skills, with the ability to present investigative findings clearly to executives, boards, and regulators. Presented at NHCAA, HCCA or other professional organizational conferences</p><p>Strong organizational and project management abilities; able to manage multiple investigations concurrently under tight deadlines.</p><p>Executive presence with ability to influence and build trust across the enterprise.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p><b>Preferred:</b></p><p>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese&nbsp;&nbsp; </p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>And/Or any of the following Licenses/ Certifications:Certified Fraud Examiner (CFE)Certified HealthCare Compliance (CHC)Certified Internal Auditor (CIA)Certified Coder, RN, MD,  PharmaD, or equivalent<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>                    Risk Management, Public Policy, Internal Audit, Medicaid, Medicare, Finance, Government, Healthcare                                                    </p>

Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

<p><b>Salary Range:&nbsp;</b>&nbsp;$121,056.00&nbsp;(Min.) -&nbsp;$160,400.00&nbsp;(Mid.) -&nbsp;$199,742.00&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 Application Architect III (AA) collaborates and supports a team of developers and architects to design and build L.A. Care's QNXT Solutions. Working closely with the business, application and Information Technology (I.T.) infrastructure teams, the AA assists in developing and formulating solutions that integrate with a new Service Oriented Architecture (SOA) bus framework to incorporate into QNXT event driven and batch processing entities. Supports the development of the QNXT integration architecture solutions roadmaps. Connects systems architecture to the business needs of the company by working closely with key stakeholders and partners.&nbsp; Plans and schedules all phases of system integration testing. Collaborates and supports the vendors and in-house development/configuration teams to implement roadmaps and QNXT solutions. Provides technical guidance to all departments and works closely with development teams to ensure compliance. Assists in creating roadmap documents, integration documents, process documents, standards documents and governance documents. Collaborates with program-level architects across the organization on the details of the systems architecture for their particular domain. Assists with the overall system design and architecture.&nbsp; Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.&nbsp;&nbsp; </p><h4>Duties</h4><p>Function as the QNXT Subject Matter Expert for IT, with full knowledge of all QNXT environment(s); User Interface; and backend functionality and processes.</p><p>Provide QNXT Enterprise Architecture support to IT Solution Delivery development departments, Data Architecture, and the Enterprise Architecture team. </p><p>Work with other architects with regards to QNXT business processes, data and databases, systems, and security needs, and understand how QNXT best integrates into the overall enterprise architecture solution.</p><p>Ability to integrate QNXT into a common SOA bus framework.&nbsp; </p><p>Establish standards around systems technology stacks and mechanisms for governing cloud-based infrastructure.</p><h4>Work closely with I.T. functional areas to identify and resolve QNXT integration considerations and issues. </h4><h4>Apply subject 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 project’s/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.</h4><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Computer Science or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><br><b>Required:</b></p><p>A minimum of 6 years of experience working in&nbsp; IT.</p><p>Experience in Designing/Developing/Implementing Interfaces, custom Services and solutions for QNXT suite of products, Trizetto UNITS and BizTalk processing models, Trizetto Hosting Topology, Trizetto QXI and QNXT event modeling framework.</p><p>Experience in data modeling PLANDATA, CUSTOM &amp; PLANINTEGRATION databases to define the relational tables, primary and foreign keys and stored procedures in order to meet the technical requirements of QNXT Custom solutions.</p><p>Experience in collaborating in cross-functional organization teams as well as Business SMEs to ensure that Architectural principles are successfully implemented into new QNXT Business Solutions.</p><p>Experience Healthcare business domain</p><h4>Skills</h4><p><br><b>Required:</b></p><p>Excellent communication skills with business teams/operational managers – listening and providing answers.</p><p>Strong problem solving skills.</p><p>Ability to form good relationships with clients/operational managers and colleagues.</p><p>Ability to keep up-to-date knowledge of technical applications.</p><p>Extensive knowledge of quality standards, legislation and best practices.</p><p>Ability to work under pressure and meet deadlines.</p><p>Ability to think ahead and anticipate problems, issues and solutions.</p><p>Excellent verbal and written communication skills.</p><p>Ability to quickly learn new tools and technologies.</p><p>Strong and advanced knowledge of Microsoft Office applications such as Word, Power Point, Excel, and Visio.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>The Open Group Architecture Frame Work (TOGAF)<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>

461 Full Time Jobs in Los Angeles, CA, USA