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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

L.A. Care Health Plan

Process Improvement Engineer 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 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;$77,265.00&nbsp;(Min.) -&nbsp;$100,445.00&nbsp;(Mid.) -&nbsp;$123,625.00&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 Enteprise Data Analyst II collaborates and contributes in the design, development, and delivery of analytic solutions that inform operational, quality, and financial performance across the organization. This focuses on transforming business questions into structured, validated, and well-communicated analytic outputs using approved enterprise data assets and governance standards.The Enterprise Data Analyst II contributes to every stage of the analytics lifecycle from intake through code development, peer review, and ongoing maintenance and plays a key role in ensuring data accuracy and consistency across recurring enterprise reports and dashboards.<h4>Duties</h4>Translate defined business questions into structured analytic requirements and specifications.Participate in structured requirements elicitation, documentation, and verification.Develop and automate recurring reports and dashboards, applying standardized definitions and refresh cycles (daily, weekly, monthly, quarterly).Validate data integrity and ensure compliance with data lineage and governance standards.Contribute to analytic code review and continuous integration processes to maintain transparency, version control, and quality.Collaborate with IT, business partners, and fellow analysts to resolve data issues and confirm analytic accuracy.Apply foundational statistical methods (e.g., control charts, variance analysis) to interpret patterns in performance.Participate in project tracking and post-implementation review to ensure solutions deliver measurable business value.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.&nbsp;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. 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 3 years of experience in analytics, data management, or reporting, preferably within healthcare, managed care, or a related industry.Hands-on experience with SQL, reporting tools (Tableau, Power BI), and operational dashboards.Experience in one or more domains (Authorization &amp; Claims, Population Health, Quality, etc.) at a functional or project level.Preferred:Experience in health plan operations or managed care analytics.Experience participating in enterprise reporting or dashboard projects with governance standards.<h4>Skills</h4>Required:Proficient in SQL for complex exploratory analysis and foundational Extract, Transform, and Load&nbsp;(ETL) work to support dashboards, reports, and analytic deliverables.Working knowledge of Tableau for building standard visualizations and dashboards.Knowledge of version control tools (e.g., Git, GitHub) and collaborative development workflows. Implement and maintain version control, peer review (pull request), and continuous integration practices for analytic codebases.Ability to conduct analyses to identify trends, patterns, and opportunities across organizational data.Ability to translate business questions into structured requirements and actionable insights.Ability to apply descriptive statistics and basic trend analysis to support operational decision-making.Knowledge of general operations and performance drivers in a complex, data driven organization.Ability to use Jira or Atlassian tools for task tracking and coordination within analytics projects.Ability to communicate findings effectively to business partners with varying technical backgrounds.Ability to work on multiple assignments simultaneously, prioritize tasks and know when to escalate issues.Ability to work under challenging deadlines.<h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Tableau Certified Data Analyst or Tableau Desktop SpecialistMicrosoft Certified: Power BI Data Analyst AssociateSnowflake SnowPro Core CertificationSnowPro® Specialty: Snowpark CertificationCertified Health Data Analyst (CHDA)Certified Analytics Professional (CAP)SQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)<h4>Required Training</h4>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. &nbsp;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: &nbsp;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. 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. 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. &nbsp;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, Medicare, Pharmacy, Call Center, Insurance, Healthcare, Customer Service

Enterprise Data Analyst II

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

Causal Impact Scientist III

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

Applied Artificial Intelligence Scientist 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 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

Enterprise Data Analyst III

Castle Biosciences Earns "Top Workplaces USA Award" for Phoenix, Pittsburgh, and Friendswood! Learn more at <a href="http://www.CastleBiosciences.com" target="_blank">www.CastleBiosciences.com</a>Castle Biosciences Inc. is growing, and we are looking to hire a full-time Reimbursement RCM Trainer working from our Friendswood, TX office location, with a start date of February 9, 2026.Why Castle Biosciences?Exceptional Benefits Package:<ul><li>Excellent Annual Salary + 20% Bonus Potential</li><li>20 Accrued PTO Days Annually</li><li>10 Paid Holidays</li><li>401K with 100% Company Match up to 6%</li><li>3 Health Care Plan Options + Company HSA Contribution</li><li>Company Stock Grant Upon Hire</li></ul>A DAY IN THE LIFE OF A Reimbursement RCM TrainerA typical day for the RCM Trainer includes preparing and delivering engaging training sessions for revenue cycle staff in both virtual and onsite settings, covering topics such as billing, appeals, payer workflows, documentation, and system navigation. When not actively facilitating training, the RCM Trainer collaborates closely with leadership and subject matter experts to create, update, and refine training materials, curriculum, and standard operating procedures. Daily responsibilities also include assessing learner comprehension, reviewing trainee progress, answering questions, and providing coaching and ongoing support, particularly related to workflow enhancements or system updates. Additionally, the RCM Trainer manages training schedules, completes assigned projects, responds to ad hoc requests, and may travel occasionally for on-site training and team meetings.REQUIREMENTS<ul><li>Bachelor's degree in education, business, or related field, required and/or equivalent combination of experience and education.</li><li>A minimum of 5 years of proven experience as a trainer in healthcare billing, reimbursement, and payer workflows.</li><li>Strong ability to learn new processes quickly and convert them into effective training programs that can be delivered virtually and in person. </li><li>Experience training in a large group setting. </li><li>Proficient in delivering training in both virtual and in-person settings.</li><li>Typing speed of 35 or more words per minute, with 90% or greater accuracy.</li></ul>*Please see the full job description at the end of the job ad.SCHEDULE<ul><li>Monday-Friday, 8:00 AM - 5:00 PM, working from our Friendswood, Texas office location. May consider remote candidates.</li></ul>READY TO JOIN OUR BIOTECH TEAM?We truly appreciate your time. If this feels like the right opportunity for you, we'd love for you to complete our mobile-friendly application. We're excited to learn more about you and look forward to connecting soon!Castle Biosciences Awards and Research Developments!WORK AUTHORIZATIONAll candidates must be legally authorized to work in the United States. Currently, Castle Biosciences does not sponsor H-1B visas, OPT, or employment-related visas.ABOUT CASTLE BIOSCIENCES INC.At Castle, it all comes down to people. After all, disease doesn't just happen - it happens to people. We believe that disease management and treatment decisions can be better informed through a person's unique biology, which is revealed through the scientific rigor of our innovative, laboratory-developed tests. We are committed to empowering healthcare providers and patients with the goal of improved outcomes. Every employee at Castle has an impact on patient care, and we work to ensure that everyone finds their work to be both challenging and rewarding. We behave with integrity and treat our colleagues with respect and kindness. Our culture fosters an environment of trust, transparency, and collaboration. We prioritize and encourage internal growth and professional development.Castle Biosciences is an equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities. If you have a disability and you believe you need a reasonable accommodation in order to search for a job opening or to submit an online application, please e-mail <a href="mailto:ReasonableAccommodationsRequest@castlebiosciences.com" target="_blank">ReasonableAccommodationsRequest@castlebiosciences.com</a>.This email was created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues not related to a disability, will not receive a response.** No third-party recruiters, please

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