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<p><b>Working with Us</b><br>Challenging. Meaningful. Life-changing. Those aren’t words that are usually associated with a job. But working at Bristol Myers Squibb is anything but usual. Here, uniquely interesting work happens every day, in every department. From optimizing a production line to the latest breakthroughs in cell therapy, this is work that transforms the lives of patients, and the careers of those who do it. You’ll get the chance to grow and thrive through opportunities uncommon in scale and scope, alongside high-achieving teams. Take your career farther than you thought possible.</p><p>Bristol Myers Squibb recognizes the importance of balance and flexibility in our work environment. We offer a wide variety of competitive benefits, services and programs that provide our employees with the resources to pursue their goals, both at work and in their personal lives. Read more: careers.bms.com/working-with-us.</p><p>This position is the BI&amp;T, Commercialization Gross-to-Net Product Manager partnering with the Global MAx Pricing teams <i>(for Oncology, CV, Immunology &amp; Fibrosis, Hematology and Cell Therapy)</i>, accountable for supporting the strategic planning, design, integration and delivery of digital capabilities to enable gross-to-net solutions in the US.</p><p>The individual will drive the strategic partnership with the teams within the Global MAx and GTN Finance organizations, to identify digital capabilities, build comprehensive business cases that have the greatest impact on the enterprise, set the right expectations,&nbsp;and ensure that IT resources are appropriately engaged to fulfill the intended business outcomes.&nbsp; The individual will manage relationships with a wide range of VAP and IT associates.&nbsp; This role will directly impact the BMS Global market access programs through the effective use of technology in bringing key products to market.&nbsp;</p><p><b>Responsibilities:</b></p><ul><li>Accountable for the delivery, enhancement, and lifecycle management of gross-to-net digital solutions</li><li>Responsible for the strategic planning, integration and implementation of digital capabilities (Anaplan, PowerBI, etc.) related to gross-to-net.&nbsp; The strategic planning will include a focus on enablement and speed, simplification, and improved outcomes of this critical business process.</li><li>Responsible for the development of long-term (3-5 year) roadmaps identifying digital capabilities that have the greatest impact on gross-to-net business capabilities</li><li>Foster a mindset of innovation across the team to consistently look at ways of working and reduce manual effort through automation, leveraging AI/ML, (Artificial intelligence and Machine learning), and our external partners.</li><li>Provide digital capabilities that are reliable, adaptable, accessible, and secure. Embed strong operational excellence, cybersecurity, and resilience using the power of data and analytics in collaboration with third-party risk management. ​</li><li>Responsible for Developing comprehensive business case(s) to support business outcomes of new/upgraded digital capabilities.&nbsp;&nbsp;&nbsp;</li><li>Responsible for the communication, implementation and operation of the Digital Capability Governance process. Demonstrating the ability to identify high value differentiating capabilities when making digital capability platform choices.</li><li>Partner with the business unit representatives and internal IT organizations to convert business requirements into functional requirements.</li><li>Accountable for committed business outcomes of digital capabilities implemented within the respective area.</li><li>Partner with the various teams involved in the gross-to-net process to drive the adoption of digital capabilities by effective business process design, change management, end user training.</li><li>Matrix leadership of IT resources in other BI&amp;T functions: responsible for ensuring that all BI&amp;T functions are successful in their delivery of services to the MAx Pricing team and related groups.&nbsp; Key matrix IT partner functions include Capability Delivery, portfolio management, enterprise information management. This position will also partner with various market teams, BI&amp;T for Country teams, BI&amp;T for R&amp;D, and other teams within BI&amp;T for Commercialization to align and identify Opportunities / Synergies in digital capabilities and IT investments.</li></ul><p><b>Required: </b></p><ul><li>Demonstrated strength in the implementation of complex gross-to-net projects</li><li>Demonstrated ability to communicate, influence and partner with business leaders.</li><li>Experience with enterprise governance operations and demonstrated ability to balance customer responsiveness with identifying high value at the enterprise level.</li><li>Ability to lead the analysis of complex business needs and integrate those into compelling and actionable strategic plans.</li><li>Strong ability and comfort with matrix management in delivering digital capabilities.&nbsp; Matrix management includes business partners as well as multiple IT capability leaders.</li><li>Ability to manage business process analysis and improvement including benefit estimation and post implementation metrics.</li><li>Ability to scan technical landscape for leading edge business solutions and creates business case for support and application, including level of effort/ cost required to implement solutions / services, and facilitating risk assessments.</li><li>Mandatory strong <b>gross-to-net</b> expertise</li><li>Excellent collaboration and communication skills, with the confidence to build strong partnerships with Market Access, Pricing and related leaders and become a trusted adviser to executives.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</li></ul><p><b>Ideal Candidates Would Also Have:&nbsp; </b></p><ul><li>Strong financial experience with budget management and business case development</li><li>Implementations of digital capabilities in the gross-to-net domain preferred.</li><li>Working knowledge of agile software-development lifecycle methodologies.</li><li>Demonstrated ability to create and support a dynamic culture of innovation and continuous improvement in line reports and in the matrix.</li></ul><p><b>Other Qualifications:&nbsp; </b></p><ul><li>Bachelor’s Degree and 7-10 years of experience required; Master’s degree would be a plus.</li><li>Strong gross-to-net business knowledge with proven leadership abilities</li><li>Possesses familiarity with and awareness of the Pharmaceutical Industry</li><li>Capable of working cooperatively across boundaries and within a matrix to achieve results.</li><li>Ability to deliver complex systems to one or multiple geographies and business units.</li><li>Experienced in information technology and management, project and portfolio assessment, planning, systems development and business case development</li><li>Demonstrates strong influencing skills with key partners across the region.</li></ul><p><i>If you come across a role that intrigues you but doesn’t perfectly line up with your resume, we encourage you to apply anyway. You could be one step away from work that will transform your life and career.</i></p><p><b><b>Compensation Overview:</b></b></p>Princeton - NJ - US: $166,600 - $201,880 &amp;#xa;<p>The starting compensation range(s) for this role are listed above for a full-time employee (FTE) basis. Additional incentive cash and stock opportunities (based on eligibility) may be available. The starting pay rate takes into account characteristics of the job, such as required skills, where the job is performed, the employee’s work schedule, job-related knowledge, and experience. Final, individual compensation will be decided based on demonstrated experience.&nbsp;<br><br>Eligibility for specific benefits listed on our careers site may vary based on the job and location. For more on benefits, please visit  <a href="https://careers.bms.com/life-at-bms/" target="_blank">https://careers.bms.com/life-at-bms/</a>.<br></p><p>Benefit offerings are subject to the terms and conditions of the applicable plans in effect at the time and may require enrollment. Our benefits include:</p><ul><li><b>Health Coverage:</b> Medical, pharmacy, dental, and vision care.</li><li><b>Wellbeing Support:</b> Programs such as BMS Well-Being Account, BMS Living Life Better, and Employee Assistance Programs (EAP).</li><li><b>Financial Well-being and Protection:</b> 401(k) plan, short- and long-term disability, life insurance, accident insurance, supplemental health insurance, business travel protection, personal liability protection, identity theft benefit, legal support, and survivor support.</li></ul><p><b>​Work-life benefits include:</b></p><p>Paid Time Off</p><ul><li>US Exempt Employees: flexible time off (unlimited, with manager approval, 11 paid national holidays (not applicable to employees in Phoenix, AZ, Puerto Rico or Rayzebio employees)</li><li>Phoenix, AZ, Puerto Rico and Rayzebio Exempt, Non-Exempt, Hourly Employees: 160 hours annual paid vacation for new hires with manager approval, 11 national holidays, and 3 optional holidays</li></ul><p>Based on eligibility*, additional time off for employees may include unlimited paid sick time, up to 2 paid volunteer days per year, summer hours flexibility, leaves of absence for medical, personal, parental, caregiver, bereavement, and military needs and an annual Global Shutdown between Christmas and New Years Day.</p><p>All global employees full and part-time who are actively employed at and paid directly by BMS at the end of the calendar year are eligible to take advantage of the Global Shutdown.</p><p><i><b>*Eligibility Disclosure: </b><i>T</i>he summer hours program is for United States (U.S.) office-based employees due to the unique nature of their work. Summer hours are generally not available for field sales and manufacturing operations and may also be limited for the capability centers. Employees in remote-by-design or lab-based roles may be eligible for summer hours, depending on the nature of their work, and should discuss eligibility with their manager. Employees covered under a collective bargaining agreement should consult that document to determine if they are eligible. Contractors, leased workers and other service providers are not eligible to participate in the program.</i></p><p><b>Uniquely Interesting Work, Life-changing Careers</b><br>With a single vision as inspiring as “Transforming patients’ lives through science™ ”, every BMS employee plays an integral role in work that goes far beyond ordinary. Each of us is empowered to apply our individual talents and unique perspectives in a supportive culture, promoting global participation in clinical trials, while our shared values of passion, innovation, urgency, accountability, inclusion and integrity bring out the highest potential of each of our colleagues.</p><p><b>On-site Protocol</b></p><p>BMS has an occupancy structure that determines where an employee is required to conduct their work. This structure includes site-essential, site-by-design, field-based and remote-by-design jobs. The occupancy type that you are assigned is determined by the nature and responsibilities of your role:</p><p>Site-essential roles require 100% of shifts onsite at your assigned facility. Site-by-design roles may be eligible for a hybrid work model with at least 50% onsite at your assigned facility. For these roles, onsite presence is considered an essential job function and is critical to collaboration, innovation, productivity, and a positive Company culture. For field-based and remote-by-design roles the ability to physically travel to visit customers, patients or business partners and to attend meetings on behalf of BMS as directed is an essential job function.</p><p><b>Supporting People with Disabilities</b></p><p>BMS is dedicated to ensuring that people with disabilities can excel through a transparent recruitment process, reasonable workplace accommodations/adjustments and ongoing support in their roles. Applicants can request a reasonable workplace accommodation/adjustment prior to accepting a job offer. If you require reasonable accommodations/adjustments in completing this application, or in any part of the recruitment process, direct your inquiries to <a href="mailto:adastaffingsupport@bms.com" target="_blank">adastaffingsupport@bms.com</a>. Visit careers.bms.com/eeo-accessibility to access our complete Equal Employment Opportunity statement.</p><p><b>Candidate Rights</b></p><p>BMS will consider for employment qualified applicants with arrest and conviction records, pursuant to applicable laws in your area.</p><p>If you live in or expect to work from Los Angeles County if hired for this position, please visit this page for important additional information:&nbsp;<a href="https://careers.bms.com/california-residents/" target="_blank">https://careers.bms.com/california-residents/</a></p><p><b>Data Protection</b></p><p>We will never request payments, financial information, or social security numbers during our application or recruitment process. Learn more about protecting yourself at <a href="https://careers.bms.com/fraud-protection" target="_blank">https://careers.bms.com/fraud-protection</a>.</p><p>Any data processed in connection with role applications will be treated in accordance with applicable data privacy policies and regulations.</p><p>If you believe that the job posting is missing information required by local law or incorrect in any way, please contact BMS at <a href="mailto:TAEnablement@bms.com" target="_blank">TAEnablement@bms.com</a>. Please provide the Job Title and Requisition number so we can review. Communications related to your application should not be sent to this email and you will not receive a response. Inquiries related to the status of your application should be directed to Chat with Ripley.</p>R1598347 : Associate Director – BI&amp;T, Commercialization Gross-to-Net Product Manager

Bristol Myers Squibb

Associate Director – BI&T, Commercialization Gross-to-Net Product Manager

<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, Configuration develops and leads the strategy, execution, and continuous enhancement of authorization, benefit, pricing, provider, and&nbsp; configuration governance framework across L.A. Care’s core administrative platforms (QNXT) and associated tools. This position ensures that configuration is accurate, efficient, and designed to function as a preventative control mechanism mitigating downstream defects by strengthening upstream processes, validating requirements, and building predictable, repeatable system behaviors.</p><p>The Director oversees the full configuration life cycle – from impact assessment and requirements analysis through design, build, testing, and post-implementation validation, ensuring that changes are implemented with discipline and high reliability. The Director partners closely with cross-functional teams and other operational departments to ensure configuration supports a high-performing claims environment with strong control points, reduced rework, and timely, accurate adjudication.</p><p>The Director is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.&nbsp; Develops strategic plans, drives change and influences critical business outcomes.</p><p>The Director drives skill development, accountability, and operational consistency within the team. This position also serves a key role in supporting enterprise initiatives that require coordinated, scalable, and well-governed configuration changes. </p><h4>Duties</h4><h4>Develops, and implements standards, quality gates and governance frameworks.&nbsp; Ensures that the core system configuration is executed with rigor, transparency, and precision. Strengthens upstream quality and operational readiness by leading disciplined change processes, anticipating downstream impacts, and establishing a consistent framework that reduces defects, improves accuracy, and enhances the reliability of the claims environment. Through active planning, structured governance, and strong cross-functional partnerships, ensures configuration supports a more standardized, predictable, and efficient operational ecosystem.</h4><h4>Oversees the end-to-end configuration life cycle including analysis, requirements validation, design, build, testing, migration, and post-deployment monitoring. &nbsp;&nbsp;Establishes standardized processes, documentation requirements, and quality gates to ensure accuracy, traceability, and reliable execution of configuration changes. &nbsp;&nbsp;Ensures configuration solutions support accurate adjudication and align with operational needs, regulatory requirements, and enterprise readiness.&nbsp; Leads development and maintenance of configuration standards, controls, and governance frameworks that promote consistency and reduce manual rework.</h4><h4>Collaborates with cross functional teams on configuration priorities, impacts, and implementation timelines.&nbsp; Partners in configuration quality assurance (QA) activities to validate accuracy, completeness, and compliance with internal standards and regulatory expectations and to ensure clarity of requirements, appropriate test scenarios, and full understanding of configuration logic.&nbsp; Supports operational readiness by coordinating clarification, defect research, requirement updates, and post-deployment validation support.<br><br></h4><h4>Ensures configuration work meets established quality gates.&nbsp; Leads issue identification and root-cause analysis for configuration-related errors, ensuring sustainable upstream fixes.&nbsp; Establishes and monitors process-level controls that prevent recurring defects and improve configuration accuracy over time.&nbsp; Tracks and trends configuration errors, collaborating on remediation planning, systemic improvements, and prevention strategies.</h4><h4>Duties Continued</h4><h4>Oversees benefit configuration, pricing methodologies, provider reimbursement logic, and other adjudication rules requiring technical precision.&nbsp; Ensures configuration environments support stable performance, controlled releases, and effective integration with system enhancements and updates.&nbsp; Partners with key stakeholders to support migrations, module updates, automation opportunities, and system changes that strengthen functional performance.</h4><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. Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Develops, and manages budgets, utilizing resources effectively.&nbsp;</p><p>Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals.&nbsp; Identifies and actualizes enhancements to support company vision.&nbsp;</p><p>Develops and maintains relationships with key stakeholders.&nbsp; Leads discussions on policy operationalization and oversees key policy perspective sharing.</p><h4>Leads, trains, and develops staff, ensuring technical competence, consistency, and high-quality execution.&nbsp;&nbsp;&nbsp; Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.</h4><h4>Performs other duties as assigned.</h4><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 in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 7 years of experience in a system configuration or managed care operations involving core administrative platforms (e.g. Cognizant QNXT).</p><p>At least 5 years of experience leading, supervising and/or managing staff in technical or operational environments.</p><p>Significant experience configuring benefits, pricing methodologies, provider payment logic, and related adjudication rules.</p><p>Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies.</p><p>Advanced knowledge of and experience with American Health Information Management Association (AHIMA) coding standards.</p><p>Knowledge of and experience with utilizing Systems Development Life Cycle (SDLC), configuration change management methodologies, testing protocols, document standards, and best practices.</p><p>Experience supporting audits, corrective actions, and regulatory reviews.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.</p><p>Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.</p><p>Knowledge of SDLC procedures in planning system configuration changes (i.e., use of rigorous documentation, testing and quality assurance protocols prior to deployment of changes into production).</p><p>Advanced knowledge of standard programming and logic to facilitate the maintenance of system configuration files and tables, along with supporting documentation.</p><p>Strong ability to translate regulatory requirements and operational needs into clear, accurate system configuration.</p><p>Exceptional analytical, planning, organization, and communication skills.</p><p>Exceptional presentation skills, written and verbal communication skills, including executive communication skills with the ability to produce audit-ready documentation.</p><p>Proficiency with Microsoft Office and data/reporting tools.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p>Demonstrated ability to make sound and timely decisions.</p><p>Demonstrated ability to adapt to changing situations and adjust strategies accordingly.</p><p>Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p>Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medical Coding, Insurance, Healthcare                                                    </p>

L.A. Care Health Plan

Director, Configuration

<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, Payment Integrity defines the payment integrity operating model.&nbsp; As owner, is accountable for prevention, governance, analytics, risk reduction and sustained accuracy across all prepay and post pay activity.&nbsp; This position is responsible for designing, leading, and continuously improving the end-to-end Payment Integrity program. This position ensures the accuracy of provider payments, minimized inappropriate spend, and strengthens preventive and detective controls across all lines of business. The Director oversees clinical editing, data mining, cost-avoidance strategies, recovery operations, coordination of benefits (COB), third-party liability (TPL), and analytical review of billing and payment patterns.</p><p>The Director sustains a Payment Integrity operating model that prevents incorrect payments before they occur, improves the reliability of claims processing through strong upstream controls, identifies systemic issues contributing to payment errors, and drives operational, configuration, or provider-facing changes that improve accuracy over time. This leader partners closely with cross-functional teams and external vendors to ensure sustained, measurable impact on medical cost reduction, accuracy, audit readiness, and provider experience.</p><p>The Director leads a multi-functional team that includes internal data mining, clinical review, overpayment recovery, prospective pre-payment programs, and vendor management. The Director is responsible for building analytic and operational rigor, embedding standardized processes, and fostering a culture of accountability, operational consistency, and continuous improvement.</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.&nbsp; Develops strategic plans, drives change and influences critical business outcomes.</p><h4>Duties</h4><p>Strengthens accuracy, prevents financial leakage, and ensures upstream and downstream controls operate as a cohesive system. Refines and enhances disciplined processes, improves the sustainability of controls, and leverages data to identify and mitigate risks before they impact members, providers, or financial performance. Through cross-functional collaboration, structured execution, and proactive problem-solving, enhances the organization’s ability to manage medical spend responsibly and ensure accurate, compliant payment outcomes.</p><p>Develops and executes the Payment Integrity strategy, ensuring alignment with enterprise financial, operational, and regulatory priorities. Leads a comprehensive operating model that integrates pre-pay, post-pay, clinical editing, cost-avoidance, data mining, recovery operations, COB, and TPL functions.&nbsp; Designs and maintains governance frameworks, policies, workflows, and quality standards that strengthen preventive controls and reduce rework.&nbsp; Ensures consistent application of rules, benefit interpretation, pricing methodologies, and contract terms across all Payment Integrity activities.</p><p>Oversees the development and implementation of pre-payment controls including clinical editing, code auditing, configuration recommendations, automated and algorithm-based edits, and pre-pay clinical and non-clinical reviews. &nbsp;Partners with cross functional teams to implement upstream changes that prevent recurring payment errors and reduce operational burden.&nbsp; Leads initiatives that increase automation, improve first-pass accuracy, and reduce the volume of post-pay recoveries.</p><p>Oversees identification, validation, and recovery of overpayments across solicited and unsolicited sources, ensuring accuracy, transparency, and regulatory compliance.&nbsp; Leads recovery operations, including provider outreach, appeals support, repayment management, and reconciliation of recovery outcomes. Ensures post-pay findings feed into proactive improvements and preventive interventions, reducing future inappropriate payments.<br><br><br></p><h4>Duties Continued</h4><p>Directs internal data mining and analytical review functions to identify billing anomalies, emerging risk patterns, and cost avoidance opportunities.&nbsp; Partners with Analytics leaders to develop predictive models, dashboards, and trending tools that support smarter interventions and program scalability.&nbsp; Translates analytical insights into operational or system changes that reduce leakage and strengthen the accuracy of initial payment decisions.<br>Oversees COB and TPL programs to ensure correct payer order, maximize cost avoidance, and support regulatory reporting requirements.&nbsp; Ensures timely, accurate, and complete responses to inquiries from DHCS or other regulatory bodies.&nbsp; Strengthens processes to reduce inappropriate payments that result from eligibility, coordination, or primary payer errors.</p><p>Manages relationships with Payment Integrity vendors, ensuring contract compliance, performance against SLAs, timely implementation of new programs, and accurate financial reconciliation.&nbsp; Assesses vendor performance and identifies opportunities to optimize or expand program impact.&nbsp; Ensures vendor partners follow appropriate standards, quality controls, and documentation expectations.</p><p>Ensures Payment Integrity processes meet all regulatory and contractual requirements across Medicaid, Medicare, Commercial, and Exchange lines of business.&nbsp; Leads or supports responses to audits, inquiries, corrective action plans, and regulatory reviews related to payment accuracy.&nbsp; Partners with QA to validate accuracy and consistency of Payment Integrity findings, recoveries, and interventions.</p><p>Collaborates with Claims Administration, Configuration, Provider Network Management, EDI, Compliance, and Finance to address systemic issues and improve end-to-end payment outcomes.&nbsp; Advises leadership and internal partners on payment accuracy trends, root-cause drivers, provider impact, and mitigation strategies.&nbsp; Builds strong relationships with provider partners and communicates clearly on payment rules, system behaviors, and corrective actions.</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. Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Develops, and manages budgets, utilizing resources effectively.&nbsp;</p><p>Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals.&nbsp; Identifies and actualizes enhancements to support company vision.&nbsp;</p><p>Develops and maintains relationships with key stakeholders.&nbsp; Leads discussions on policy operationalization and oversees key policy perspective sharing.</p><p>Oversees succession planning to build technical expertise and operational consistency.&nbsp; Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.</p><h4>Perform other duties as assigned.</h4><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 in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 7 years of deep experience in Payment Integrity, Fraud/Waste/Abuse prevention, Claims Accuracy, Medical Cost Containment, and/or other Program Integrity functions.</p><p>At least 5 years of experience leading, supervising and/or managing staff.</p><p>Demonstrated experience in pre-pay and/or post-pay program oversight, cost-avoidance strategies, recovery operations, clinical editing, or data mining.</p><p>Experience working with and interpreting provider contracts, benefit structures, pricing methodologies, and Medicaid/Medicare regulatory requirements.</p><p><strong>Preferred:</strong></p><p>Experience developing and overseeing COB/TPL programs.</p><p><br>Experience engaging with regulators, responding to audits, and overseeing and managing vendor partners.</p><p><br>Experience implementing predictive analytics or algorithm-based Payment Integrity solutions.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.</p><p>Deep understanding of payment accuracy, claim rules, industry coding standards, reimbursement methodologies, and cost-containment strategies.</p><p>Strong analytical, financial, risk-management and problem-solving skills.</p><p>Ability to manage complex workflows, prioritize competing demands, and deliver results in high-volume environments.</p><p>Ability to build strong teams that work effectively together and collaborate across the organization</p><p>Ability to establish and maintain effective working relationships with representatives at provider organizations and with internal stakeholders.</p><p>Ability to interpret and apply complex operating instructions, state and federal regulations, and department/division procedures. Ability to understand, apply, and communicate rules, regulations and guidelines to others.</p><p>Excellent written and verbal communication skills; speaks clearly and persuasively in positive or negative situations.</p><p>Proficiency with Microsoft Office and data/reporting tools.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p>Demonstrated ability to make sound and timely decisions.</p><p>Demonstrated ability to adapt to changing situations and adjust strategies accordingly.</p><p>Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p>Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medicaid, Claims, Medicare, Risk Management, Healthcare, Insurance, Finance                                                    </p>

Director, Payment Integrity

<p><b>Salary Range:&nbsp;</b>&nbsp;$171,925.00&nbsp;(Min.) -&nbsp;$232,100.00&nbsp;(Mid.) -&nbsp;$292,274.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Senior Director, Core Administrative Operations is responsible for leading and optimizing L.A. Care’s core administrative functions, including Claims Administration, Payment Integrity, Configuration, Electronic Dara Interchange (EDI) and Quality Assurance. This leader ensures standardized, efficient, accurate, and compliant administrative operations that support high-quality service to providers, members, and internal business partners.</p><p>Steers top-level decision-making and implement initiatives that drive organization's forward. This role drives modernization, operational maturity, and continuous improvement across all core administrative operations, grounded in clear performance expectations, strong governance, and measurable outcomes. The Senior Director collaborates closely with cross functional teams to ensure effective alignment, operational readiness, and sustained performance The Senior Director will oversee a diverse team, ensuring talent development, performance management, and a culture of accountability and operational excellence.</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.&nbsp; Develops strategic plans, drives change and influences critical business outcomes.</p><h4>Duties</h4><p>Translates strategy into disciplined operational execution. &nbsp;Sets clear expectations, drives cross-functional alignment, and ensures that teams have the tools, data, and governance needed to operate effectively. Collaborates across multiple administrative functions, ensuring workflows, technical changes, performance indicators, and regulatory requirements are understood, synchronized, and executed consistently. Anticipates operational challenges, removes barriers, and strengthens end-to-end processes. &nbsp;Collaborates, plans, proactively problem-solves, leads with transparency, accountability, and focuses on continuous improvement. &nbsp;Elevates operational reliability and positions the organization for sustained success as systems, products, and regulatory standards evolve.</p><p>Leads strategy, operations, and modernization across service areas accuracy, efficiency, and strong control environments. Establishes and manages operational goals, key performance indicators (KPIs)/objectives and key results (OKRs), dashboards, and other metrics to transparently drive consistent performance and compliance.</p><p>Develops and implements standardized workflows, governance structures, and operating procedures.</p><p>Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.</p><p>Directs EDI operations supporting claims submissions, remittance transactions, provider and member exchanges, and other electronic transactions.&nbsp; Drives automation, data accuracy, and improved electronic submission performance. Oversees monitoring and timely resolution of technical issues, rejections, and systemic defects.</p><p>Ensures high-quality adjudication with strong accuracy, first-pass rates, correct benefit application, and compliance with DHCS, DMHC, CMS, Covered California, and NCQA requirement. Oversees configuration of benefits, reimbursement logic, pricing methodologies, and adjudication controls.</p><h4>Duties Continued</h4><p>Collaborates with key stakeholders on prioritization, execution, and validation of configuration updates, system enhancements, and benefit launches.</p><p>Leads strategy and operations related to pre-pay controls, cost-avoidance, post-pay recovery, clinical editing, coordination of benefits (COB), overpayments, and third-party liability (TPL)/subrogation.&nbsp; Partners with cross functional teams to support fraud mitigation and compliance with state and federal requirements.&nbsp; Improves financial accuracy and reduces inappropriate payments through robust controls and audit-ready processes.</p><p>Oversees QA programs across all Core Administrative Operations to ensure ongoing accuracy and compliance.&nbsp; Strengthens control environments through audits, desktop and other standard operating procedures, and performance monitoring.&nbsp; Partners with Compliance, Internal Audit, and Enterprise Risk Management on CAPs, audit responses, remediation plans, and sustainability efforts.</p><p>Oversees the performance of operational vendors in assigned areas. Ensures compliance with service level agreements (SLAs), audit standards, quality expectations, and contractual obligations. Evaluates vendor performance and ensures the implementation of improvements.</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. Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals.&nbsp; Identifies and actualizes enhancements to support company vision. &nbsp;Identifies and drives change initiatives.</p><p>Collaborates with cross-functional teams to achieve common goals. &nbsp;Leads discussions on policy operationalization and oversees key policy perspective sharing. &nbsp;Represents the company or organization in external interactions. &nbsp;Develops and maintains relationships with key stakeholders.</p><p>Develops and implements communication strategies.</p><p>Performs other duties as assigned.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 9 years of progressively responsible experience leading large operational teams and multi-functional departments in managed care operations, including Claims Administration, Payment Integrity, Configuration, or similar functions</p><p>At least 8 years of management/supervisory experience.</p><p>At least 5 years of experience with Payment Integrity operations.</p><p>At least 5 years of experience with claims system configuration, technical changes, and operational readiness for products, benefits, and system updates.</p><p>Demonstrated successful experience improving operational accuracy, reducing inappropriate payments, and driving regulatory compliance.</p><p>At least 5 years of experience supporting regulatory audits.</p><p><strong>Preferred:</strong></p><p>Experience in government-sponsored programs and large regional plans.</p><p>Experience with vendor management.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.</p><p>Expert knowledge of managed care administrative operations.</p><p><br>Strong strategic, analytical, and financial skills, including the ability to interpret trends, assess risk, and evaluate cost-avoidance opportunities.</p><p>Deep understanding of regulatory requirements for Medicaid (Medi-Cal), Medicare, Marketplace, and commercial lines of business.</p><p>Proven ability to lead in complex, high-volume, highly regulated environments with competing priorities.</p><p>Exceptional communication and stakeholder management skills, with the ability to translate complex concepts into actionable plans.</p><p><br>Exceptional leadership skills and abilities, with demonstrated ability to manage, mentor, and develop multi-level teams.</p><p>Ability to design and implement standardized processes, governance models, and operational controls.</p><p>Strong skills with claims platforms and analytics/reporting tools.</p><p>Proficient with Microsoft Office and data/reporting tools.</p><p>High level of organization, planning, prioritization and attention to detail.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p>Demonstrated ability to make sound and timely decisions.</p><p>Demonstrated ability to adapt to changing situations and adjust strategies accordingly</p><p>Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p>Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Lean Six Sigma Green BeltLean Six Sigma Black Belt<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>                    Internal Audit, Claims, Medicaid, Medicare, Risk Management, Finance, Insurance, Healthcare                                                    </p>

Senior Director, Core Administrative Operations

<p><b>Salary Range:&nbsp;</b>&nbsp;$171,925.00&nbsp;(Min.) -&nbsp;$232,100.00&nbsp;(Mid.) -&nbsp;$292,274.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Senior Director and Grievance Officer, Appeals and Grievances (A&amp;G), is responsible for leadership, operational execution, clinical and regulatory oversight, and enterprise governance of L.A. Care’s grievance, appeal, and State Fair Hearing functions across all product lines. This position ensures all cases are processed accurately and consistently with exceptional quality, and within required timeframes in alignment with federal and state regulations, contractual obligations, accreditation standards, and internal policies.</p><p>The Senior Director directs a comprehensive operating model that includes centralized intake and triage, general and clinical A&amp;G operations, regulatory auditing and reporting, quality assurance, internal controls, and enterprise-level grievance governance. The Senior Director oversees staff and ensures the organization maintains strong regulatory compliance, service quality, and documentation standards.</p><p>The Senior Director collaborates extensively with cross-functional key stakeholders to address systemic issues, strengthen preventive controls, improve service delivery, and support enterprise audit readiness. The Senior Director embodies a commitment to operational excellence, accountability, equitable member experience, and disciplined governance.</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. Develops strategic plans, drives change and influences critical business outcomes. Oversees operations, ensuring efficiency and effectiveness. Steer top-level decision-making and implement initiatives that drive organization's forward.</p><h4>Duties</h4><p>Proactively translates regulatory, clinical, and service strategy into disciplined operational execution by setting clear expectations, establishing consistent processes, and ensuring teams have the tools, training, and data needed to perform at a high level. Serves as the connective tissue between key stakeholders, ensuring complex regulatory requirements are converted into clear workflows, strong internal controls, and reliable, audit-ready outcomes. Strengthens organizational trust and supports L.A. Care’s mission by leading with transparency, leveraging data-driven insights, and prioritizing member and provider experience within a highly regulated environment.</p><p>Provides senior leadership oversight to ensure all A&amp;G operations are compliant, audit-ready, efficient, and aligned with organizational performance expectations. Leads and is accountable for the overall strategy, direction, and day-to-day operations of A&amp;G, including intake, triage, case handling, documentation, clinical decision coordination, State Fair Hearings, and regulatory submissions. Establishes departmental goals, key performance indicators (KPIs), dashboards, reporting structures, and operating rhythms to monitor and drive performance across all A&amp;G functions. Ensures consistent application of regulatory and internal requirements.</p><p>Drives operational reliability through standardized processes, workforce management, and transparent performance reporting. Ensures operational capacity aligns with demand through forecasting, workload monitoring, and resource planning. Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.</p><p>Serves as the enterprise authority on grievance and appeal requirements and ensures all case handling meets federal and state standards. Interprets, applies, and operationalizes regulatory requirements and guidance. Oversees regulatory reporting, including universe submissions, timeliness validation, case audits, quality-of-care review documentation, and readiness assessments. Ensures accurate, complete, and compliant preparation of State Fair Hearing cases, medical records, and evidentiary documentation. Responds to regulatory inquiries and leads root-cause analysis, corrective actions, and sustainability plans for identified compliance issues. Reviews and approves A&amp;G policies, procedures, templates, letters, decision frameworks, and escalation pathways.</p><p>Oversees the clinical components of A&amp;G operations to ensure appropriate medical necessity review, accurate and high-quality clinical documentation, and consistent application of evidence-based guidelines to support high-quality member care. Partners with key stakeholders to ensure clinical decision stewardship and alignment with regulatory expectations. Ensures timely identification, escalation, and resolution of quality-of-care concerns in collaboration with key stakeholders. Ensures consistency in documentation of clinical rationale, decision accuracy, and regulatory adherence across all clinical case types.</p><p>Leads a unified quality and internal control environment spanning general operations, clinical operations, and regulatory auditing. Oversees the A&amp;G quality assurance program, ensuring ongoing monitoring for accuracy, documentation quality, and compliance. Ensures development and maintenance of standard operating procedures, desktop guides, decision trees, templates, and training materials. Directs all audit readiness activities, including internal audits, mock audits, and enterprise corrective action plans. Collaborates with internal leaders to strengthen controls and ensure sustainable compliance. Oversees training and competency validation programs for all A&amp;G personnel, ensuring readiness and capability across the department.</p><h4>Duties Continued</h4><p>Leads enterprise-wide integration of A&amp;G insights into systemic improvements and supports risk mitigation across operational domains. Partners with internal departments to resolve root-cause issues and reduce grievance drivers. Collaborates with internal departments to support regulatory filings, investigations, enterprise risk assessments, and Corrective Action Plan management. Engages with external stakeholders to resolve escalated member issues and improve service continuity. Provides leadership support and A&amp;G expertise in enterprise forums, oversight committees, and quality and service governance structures.</p><p>Ensures transparent, accurate, and actionable reporting that supports operational decision-making and continuous improvement. Oversees reporting of case volumes, trends, timeliness, quality-of-care findings, regulatory metrics, and systemic issues. Ensures high-quality analytics that inform operational refinements, service improvements, and strategic initiatives. Presents findings to key stakeholders, identifying opportunities for enterprise improvement.</p><p>Leads a large, multi-disciplinary leadership team and ensures a high-performing, accountable, and engaged workforce. Manages leadership teams responsible for general operations, clinical services, quality assurance, and regulatory auditing. Promotes a culture of operational excellence, service commitment, accountability, integrity, and continuous learning. Supports succession planning and leadership development across multiple levels within the A&amp;G organization.</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. Conducts strategic planning to utilize resources to meet current and future departmental and Enterprise-wide goals. Leads discussions on policy operationalization and oversees key policy perspective sharing. Manages budgets and resources effectively. Identifies and drives change initiatives. Develops and implements communication strategies. Collaborates with cross-functional teams to achieve common goals. Represents the company or organization in external interactions. Identifies and actualizes enhancements to support company vision. Develops and maintains relationships with key stakeholders.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 9 years of experience in health plan operations, managed care, A&amp;G, utilization management, clinical operations, or regulatory compliance.</p><p>At least 8 years of leading staff, supervisor/management experience.</p><p>Experience leading teams, projects, initiatives, or cross-functional groups.</p><p>Extensive leadership experience in Medicaid, Medicare, and Commercial managed care lines of business., with deep understanding of their operational, regulatory, and service requirements.</p><p>Experience navigating regulatory and accreditation requirements, with a strong track record of applying complex regulatory standards to grievance, appeal, and quality-of-care operations.</p><p>Experience improving operational accuracy, strengthening documentation quality, and ensuring consistent alignment with federal and state regulatory expectations.</p><p>Experience leading organizations through high-stakes regulatory audits, with a consistent record of achieving compliant outcomes and driving sustainable remediation.</p><p><strong>Preferred:</strong></p><p>Extensive experience working within delegated, plan-partner, or subcontracted network environments, with demonstrated ability to oversee performance, ensure compliance, and manage complex accountability structures.</p><p>Experience leading vendor management activities, including performance oversight, Service Level Agreement (SLA) adherence, quality monitoring, and alignment with regulatory and contractual requirements.</p><p>Experience developing analytic dashboards and visualization tools (e.g., Power BI, Tableau) to support trend analysis, performance monitoring, and decision-making.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Exceptional interpersonal and leadership capabilities, with the ability to inspire, develop, and empower teams while driving accountability, consistency, and high performance across all levels.</p><p>Expert knowledge of grievance, clinical decision-making, and managed care regulatory standards, with the ability to translate complex requirements into effective operational processes.</p><p>Advanced strategic and analytical skills to interpret trends, assess operational and regulatory risk, and design sustainable, data-driven solutions.</p><p>Deep and comprehensive understanding of regulatory requirements for all lines of business.</p><p>Ability to lead effectively in complex, high-volume, and highly regulated environments with competing priorities, rapid demand shifts, and significant compliance requirements.</p><p>Exceptional influence and stakeholder engagement skills to translate complex concepts into clear, actionable guidance for diverse audiences.</p><p>Strong leadership presence and leadership acumen, with demonstrated success managing, mentoring, and developing multi-level teams in operational and regulatory disciplines.</p><p>Ability to design, implement, and sustain standardized processes, governance frameworks, and internal control structures that enhance accuracy, compliance, and operational reliability.</p><p>Strong planning, prioritization, and organizational skills with attention to detail and a proven ability to manage multiple concurrent priorities with urgency, accuracy, and sound judgment.</p><p>Proficient with Microsoft Office, reporting platforms, and case management systems, with the ability to leverage technology to improve operational visibility and performance.</p><p>Ability to lead comprehensive regulatory audit readiness and response efforts, including universe submissions, documentation validation, corrective action development, and sustainability planning.</p><p>Ability to lead operational transformation initiatives while maintaining a strong culture of regulatory compliance, accountability, and service excellence.</p><p>Ability to lead technology-enabled operational improvements, including system implementation, enhancement prioritization, and maintenance oversight to drive efficiency and reliability.</p><p>Ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p>Ability to make sound and timely decisions.</p><p>Ability to adapt to changing situations and adjust strategies accordingly.</p><p>Ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p>Exceptional interpersonal, verbal, and written communication skills, including executive communication with ability to produce audit-ready documentation.</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Registered Nurse (RN) - Active, current and unrestricted California License<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><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, Registered Nurse, Medicaid, Medicare, Fundraising, Healthcare, Nonprofit                                                    </p>

Senior Director and Grievance Officer, Appeals and Grievances

<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, Claims Administration, governs enterprise outcomes and risk controls, introducing a preventative orientation and regulatory accountability.&nbsp; This position is responsible for leading the end-to-end claims ecosystem, including claims adjudication, claims adjustments (escalations, disputes, general adjustments, and litigation-related requests), and strong focus on preventative controls through the Service Validation Unit (SVU). This role ensures timely, accurate, and complaint processing across all lines of business while strengthening upstream quality, embedding consistent control points, and reducing operational rework.&nbsp;</p><p>The Director has ownership of claims regulatory compliance and audit readiness.&nbsp; This position oversees daily production, inventory management, adjustment workflows, regulatory turnaround requirements, benefit and authorization interpretation, provide payment accuracy, and operational readiness for benefit, system, or regulatory changes. The role serves as an operational expert on managed care payment rules provider contracts, regulatory requirements, and claims operational dependencies.</p><p>The Director partners closely with cross functional teams to ensure end-to-end accuracy and operational integrity. This position fosters a culture of accountability, transparency, operational consistency, and continuous improvement.</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.&nbsp; Develops strategic plans, drives change and influences critical business outcomes.</p><h4>Duties</h4><h4>Translates organizational expectations into disciplined operational execution by creating predictable workflows, establishing strong preventative control environments, and ensuring that claims processing is accurate, timely, and complaint. &nbsp;Strengthens upstream quality, improves consistency through standardized processes, ensures rigorous adherence to regulatory and contractual requirements, and supports an operational model that aims to remove rework, prevents defects, and supports high-performing administrative operations.</h4><h4>Through ownership of regulatory compliance and audit readiness perspective, provides strategic and operational leadership for all aspects of claims adjudication across all lines of business.</h4><h4>Monitors daily, weekly, and monthly production performance to ensure accuracy, timeliness, and regulatory compliance.&nbsp; Oversees examiner productivity models, workload balancing, Quality Assurance performance, and inventory trending to ensure strong operational predictability.&nbsp; Ensures benefit, authorization, eligibility, and provider data issues are resolved quickly and consistently, with emphasis on preventing repeat defects.&nbsp; Supports enterprise initiatives requiring claims operational expertise.&nbsp; </h4><h4>Leads all adjustment workflows, including escalations, provider disputes, general adjustments, and litigation-related claims review.&nbsp; Ensures all regulatory turnaround times (TATs) and provider/member notice requirements are consistently met, documented, and monitored.&nbsp; Services and the operational escalation point for high-visibility or high-complexity claim issues, including those involving regulators, legal, provider groups, or executive leadership. Develops standardized adjustment pathways that improve cycle time and reduce manual rework.<br><br></h4><h4>Establishes and leads the Service Validation Unit (SVU) to function in a strategic, proactive and preventative manner by independently validate that billed services were authorized, medically supported, accurately represented, and provided/received prior to payment.&nbsp; Ensures SVU findings translate into upstream, corrections, system or process improvements, and improved preventive controls.</h4><h4>Develops and leads initiatives to improve first-pass accuracy, reduce rework, shorten cycle time, and advance operational maturity.&nbsp; Participates in and partners through quality review processes to ensure adherence to regulatory and contractual processing standards.&nbsp; Oversees root-cause analysis of defects or variances, ensuring permanent corrective actions and improved upstream controls.&nbsp; Partners with stakeholder departments on regulatory reviews, corrective actions, and audit responses. Ensures the accuracy and timeliness of responses to regulators and external partners.</h4><h4>Duties Continued</h4><h4>Directs production, quality, and operational performance reporting, identifying trends, risks, and improvement opportunities.&nbsp; Ensures reporting supports proactive decision-making and enables early identification of potential inventory or compliance risks. Partners to establish/refine dashboards for visibility into accuracy, timeliness, adjustments, disputes, and SVU outcomes.</h4><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. Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Develops, and manages budgets, utilizing resources effectively.&nbsp;</p><p>Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals.&nbsp; Identifies and actualizes enhancements to support company vision.&nbsp;</p><p>Develops and maintains relationships with key stakeholders.&nbsp; Leads discussions on policy operationalization and oversees key policy perspective sharing.</p><h4>Ensures strong technical capability, a culture of accountability, and consistent performance.&nbsp; Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.</h4><h4>Performs additional duties as assigned.</h4><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 in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:<br></strong></p><p>At least 7 years of healthcare claims (Medicare, Medicaid, and Commercial) experience.</p><p>At least 5 years of experience leading, supervising and/or managing staff.</p><p>Experience in Medicaid, Medicare, and Commercial managed care lines of business.</p><p>Demonstrated experience leading claims adjudication, adjustments, disputes, escalations, and related functions.</p><p>Extensive experience interpreting provider contracts, payment methodologies, and managed care benefit structures</p><p>Experience handling complex claim review, root-cause evaluation, adhering to regulatory timeliness requirements, and ensuring accuracy.</p><p>Significant experience administering quality review programs and implementing sustainable operational improvements.</p><p>Experience supporting litigation, state or federal inquiries, and regulatory audits.</p><p>Demonstrated experience with high complexity claims review and RCA.</p><p><strong>Preferred:</strong></p><p>Experience leading a service validation or similar preventive quality/control unit.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong understanding of managed care contracts, benefit structures, payment methodologies, and authorization requirements.</p><p>Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.</p><p>Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.</p><p>Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies.<br>Deep study and understanding of managed care contracts and payment methodologies and provide contract interpretation.</p><p>Strong project leadership and management skills required; ability to manage multiple priorities, complex workflows, and high-volume environments.</p><p>Proficiency with Microsoft Office and data/reporting tools.</p><p>Exceptional presentation skills, written and verbal communication skills, including executive communication skills with the ability to produce audit-ready documentation.<br>Must be highly collaborative and maintain a consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas.</p><p>Must be able to present findings to various levels of management, across all organizations.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p>Demonstrated ability to make sound and timely decisions.</p><p>Demonstrated ability to adapt to changing situations and adjust strategies accordingly.</p><p>Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p>Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Professional Coder (CPC)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medical Coding, Claims, Medicare, Medicaid, Healthcare, Insurance                                                    </p>

Director, Claims Administration

<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, Center of Excellence &amp; Quality Assurance is responsible for leading the quality, compliance, training, and continuous improvement functions that ensure L.A. Care’s Core Administrative Operations ecosystem operates with accuracy, integrity, and regulatory readiness. This role builds a disciplined quality framework that strengthens upstream and downstream controls, enhances first-pass accuracy, reduces defects, and ensures consistent, predictable outcomes across Claims Administration, Configuration, Payment Integrity, and related operational areas.</p><p>The Director oversees enterprise claims quality auditing, claims compliance oversight, issue detection and validation, corrective action planning, root-cause analysis, and enterprise reporting on quality performance. This role oversees enterprise quality for both operational claims processing and system configuration, ensuring the accuracy of benefit builds, provider reimbursement logic, system edits, pricing methodologies, and operational rules prior to deployment and ensures the organization meets federal, state, and contractual requirements by maintaining effective monitoring, quality review programs, compliance validation, and documentation standards. The Director also leads training and policy interpretation for claims-related operations, ensuring teams have the knowledge, tools, and guidance needed to maintain accuracy and adhere to changing regulatory requirements.</p><p>The Director creates a disciplined quality framework that strengthens upstream and downstream controls, enhances first-pass accuracy, reduces defects introduced through system changes, and ensures consistent execution across Core Administrative Operations service lines. The Director serves as the primary partner to operational leaders on quality and compliance matters, providing subject matter expertise on regulatory interpretation, operational risk, quality trends, and systemic improvements. This position builds a high-performing team and fosters a culture of quality, operational rigor, accountability, and continuous improvement.</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.&nbsp; Develops strategic plans, drives change and influences critical business outcomes.</p><h4>Duties</h4><p>Strengthens L.A. Care’s operational quality by creating a structured, disciplined approach to auditing, compliance, and process validation.&nbsp; Ensures quality is proactively managed, system and process changes are controlled, and risks are quickly identified and remediated. Through cross-functional collaboration, transparent reporting, and strong execution, that improves operational maturity, enhances accuracy, reduces rework, and supports sustainable performance across all core administrative operations.</p><p>Leads the continuous improvement and execution of the Core Administrative Operations quality audit program, including audit planning, sampling methodologies, examiner scorecards, and real-time quality monitoring, managing both examiner-level QA and configuration build validation.&nbsp; Ensures quality review processes measure end-to-end claims accuracy, including benefit interpretation, provider contract application, coding, pricing, and system logic.&nbsp; Oversees testing and validation of configuration changes, including benefit builds, reimbursement tables, pricing logic, clinical/non-clinical edits, and system enhancements.</p><p>Ensures robust pre-production testing (unit, peer, end-to-end, and regression testing) for all configuration changes.&nbsp; Implements quality gates and validation checkpoints to prevent configuration-related defects from reaching production.&nbsp; Builds and maintains quality dashboards and performance reports to provide transparency to leadership and operational teams.&nbsp; Oversees validation of operational improvements, new processes, and system changes to ensure sustained accuracy and alignment with expected outcomes.</p><p>Ensures compliance with all regulatory requirements, including the Department of Managed Health Care (DMHC), the California Department of Health Care Services (DHCS), the Centers for Medicare and Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and contractual obligations related to claims accuracy, turnaround times, interest payments, notices, and documentation.</p><p>Leads or supports internal and external audits, including preparation, documentation, sample reviews, responses, and corrective action plans.&nbsp; Monitors regulatory changes, interprets requirements, and ensures claims operations and related departments adopt compliant practices.&nbsp; Directs compliance monitoring of claims processing, Payment Integrity interventions, configuration changes, and related administrative controls.</p><p>Directs root-cause analysis of quality findings to identify systemic drivers of defects, inaccuracies, or compliance risks.&nbsp; Develops corrective action plans (CAPs) with clear ownership, timelines, and measurable outcomes; monitors implementation to ensure sustainable resolution.&nbsp; Provides findings to operational leaders and supports development of upstream fixes that reduce rework and strengthen control points.&nbsp; Tracks and trends error patterns to proactively identify emerging risks and improvement opportunities.</p><h4>Duties Continued</h4><p>Establishes and maintains standard operating procedures, quality checkpoints, and control frameworks across related functions, ensuring consistency of processes, documentation, and quality standards.&nbsp; Ensures all system/benefit changes have proper impact assessments, approval workflows, and documented validations prior to production deployment.&nbsp; Strengthens alignment and consistency across teams by deploying standardized guidelines, documentation practices, and cross-functional workflows.</p><p>Ensures operational readiness for regulatory updates, benefit changes, system enhancements, and organizational initiatives by validating impacts on quality.&nbsp; Partners with Configuration and Claims Administration to ensure system logic and operational workflows support accurate processing.</p><p>Oversees development and delivery of training programs related to claims accuracy, policy interpretation, regulatory requirements, documentation standards, and quality expectations.&nbsp; Ensures training programs are aligned with audit findings, regulatory changes, and systemic improvement needs.&nbsp; Maintains updated knowledge repositories, training materials, and reference documentation to support consistent operational execution.&nbsp; Provides coaching to leaders and teams on quality standards, audit results, and improvement expectations.</p><p>Serves as a strategic advisor to operational, technical, and management teams on quality, compliance, and process improvement initiatives.&nbsp; Collaborates with cross-functional teams to address quality issues and implement sustainable solutions.&nbsp; Provides input on operational readiness for system changes, regulatory updates, and enterprise improvement work.&nbsp; Represents the quality and compliance perspective in governance forums, operational reviews, and cross-functional committees.</p><p>Develops and maintains dashboards, KPIs, and scorecards to monitor quality performance, compliance adherence, and systemic risks.&nbsp; Ensures leadership receives clear, actionable insights on trends, risks, and opportunities for improvement.&nbsp; Monitors the effectiveness of quality interventions and updates strategies based on performance data.</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. Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Develops, and manages budgets, utilizing resources effectively.&nbsp;</p><p>Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals.&nbsp; Identifies and actualizes enhancements to support company vision.&nbsp;</p><p>Develops and maintains relationships with key stakeholders.&nbsp; Leads discussions on policy operationalization and oversees key policy perspective sharing.</p><p>Leads, trains, develops, and manages a team of quality auditors, compliance analysts, training specialists, and process improvement staff.&nbsp; Develops specialized configuration QA capabilities (e.g., test scripts, regression suites, system scenario modeling).&nbsp; Oversees hiring, training, performance evaluations, coaching, and succession planning.&nbsp; Fosters a culture of integrity, accountability, operational rigor, and continuous improvement.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 7 years of deep experience in claims quality, claims compliance, auditing, or related managed care administrative functions.</p><p>At least 5 years of experience leading, supervising and/or managing staff.</p><p>Experience in Medicaid, Medicare, and Commercial managed care lines of business.</p><p>Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.</p><p>Demonstrated experience leading enterprise audit programs or quality assurance functions.</p><p>Experience interpreting regulatory requirements and applying them to operational workflows.</p><p>Experience overseeing corrective action implementation, issue remediation, or regulatory readiness activities.</p><p>Extensive experience supporting or preparing for regulatory audits ((Department of Managed Health Care (DMHC), California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS)), including corrective action planning.</p><p><strong>Preferred:</strong></p><p>Experience partnering with technical and configuration teams to validate system changes.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.</p><p>Extensive knowledge of claims adjudication, benefit structures, provider contracting, DoFR, pricing rules, and coding standards (Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS)/ International Classification of Diseases (ICD)/ Diagnosis Related Group (DRG)).</p><p>Strong understanding of regulatory requirements and compliance frameworks.</p><p>Advanced analytical, problem-solving, and root-cause analysis skills.</p><p>Strong project leadership and organizational skills; able to manage multiple priorities simultaneously.</p><p>Exceptional interpersonal, verbal, and written communication skills, including executive communication with ability to produce audit-ready documentation.</p><p>Ability to work collaboratively across diverse teams and influence without direct authority.</p><p>Proficiency with Microsoft Office and data reporting tools.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p>Demonstrated ability to make sound and timely decisions.</p><p>Demonstrated ability to adapt to changing situations and adjust strategies accordingly</p><p>Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p>Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicaid, Medicare, Insurance, Healthcare                                                    </p>

Director, Center of Excellence and Quality Assurance

<p><b>It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! </b></p><p><b>When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!</b></p>Role:  <br>The Revenue Cycle Director provides operational leadership for Billing and Collections, and Insurance Verification and Authorization.<p><b>Qualifications:</b></p><ul><li>Bachelor’s degree in Healthcare Administration, Finance or Business or an equivalent combination of education and experience</li><li>Minimum of eight (8) years in healthcare revenue cycle and systems technical experience </li><li>Minimum of five (5) years of management experience</li><li>Knowledge of clinical and billing application interfacing</li><li>Experience in System Administrator functions as related to revenue cycle</li><li>Knowledge in claims processing and Third Party Administrator claims processing</li><li>Demonstrated expertise and knowledge with third party payor’s to include Medicaid, Medicare and their state and federal regulations for both Acute and Professional billing and collections rules and regulations</li><li>Ability to manage in a fast pace environment, remaining proactive, detailed oriented, resourceful and efficient, with a high level of professionalism</li><li>Proven successful experience leading, coaching, and mentoring management and subordinates </li><li>Excellent critical thinking and time management skills, self-starter, and ability to manage staff on-site and remotely</li><li>Excellent communication (written and verbal) and interpersonal skills</li><li>PC proficient (Word, Excel, Access, PowerPoint, Outlook, Project, Visio, etc.) and multi-system applications</li></ul><p><b>Competencies:</b></p><ul><li>Satisfactorily complete competency requirements for this position.</li></ul><p><b>Responsibilities of all employees:</b></p><ul><li>Represent the Company professionally at all times through care delivered and/or services provided to all clients.</li><li>Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse. </li><li>Comply with Company policies, procedures and standard practices.</li><li>Observe the Company's health, safety and security practices.</li><li>Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.</li><li>Use resources in a fiscally responsible manner.</li><li>Promote the Company through participation in community and professional organizations.</li><li>Participate proactively in improving performance at the, departmental and individual levels.</li><li>Improve own professional knowledge and skill level.</li><li>Advance electronic media skills.</li><li>Support Company research and educational activities.</li><li>Share expertise with co-workers both formally and informally.</li><li>Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.</li></ul><p><b>Leadership Success Factors: </b></p><ul><li>Communication.&nbsp; Express thoughts and ideas clearly.&nbsp; Adapt communication style to fit audience.</li><li>Initiative.&nbsp; Originate action to achieve goals.</li><li>Management Identification.&nbsp; Identify with and accept the problems and responsibilities of management. </li><li>Judgment.&nbsp; Make realistic decisions based on logical assumptions which reflect factual information and consideration of organizational resources.</li><li>Planning, Organizing and Controlling.&nbsp; Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources.&nbsp; Monitors results.</li><li>Leadership.&nbsp; Use appropriate interpersonal styles and methods in guiding others toward task accomplishment. </li><li>Work Standards.&nbsp; Set high goals or standards of performance for self and others.&nbsp; Compel others to perform</li><li>Tolerance for Stress. Maintain stability of performance under pressure and/or opposition.</li><li>Innovativeness.&nbsp; Generates and/or recognizes imaginative, creative solutions in work related situations.</li><li>Delegation.&nbsp; Allocate decision making and other responsibilities effectively and appropriately.</li><li>Staff Development.&nbsp; Develop the skills &amp; competencies of subordinates.</li><li>Organizational Sensitivity.&nbsp; Perceive the impact and the implications of decisions on other components of the organization.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </li><li>Ethics. Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.</li><li>Regulatory Compliance: Educate and monitor staff regarding their own and the organization's responsibilities for regulatory compliance.</li></ul><p><b>Job Responsibilities:</b></p><ul><li>Identifies and implements operational and strategic goals and objectives. </li><li>Oversees Revenue Cycle Leadership team.</li><li>Acts as a liaison with other departments or stakeholders.</li><li>Partners with Corporate Compliance. </li><li>Monitors revenue cycle management’s key performance indicators; identifies and resolves negative performance trends.</li><li>Responsible for identifying and implementing solutions that support more efficient and effective work performance. </li><li>Responsible for monitoring, identifying and working with the vendor to resolve EHR technical issues that negatively affect Revenue Cycle performance.</li><li>Oversees the quality assurance (QA) process assuring that performance issues are identified and rectified in a timely manner.</li><li>Responsible for overseeing all month-end close processes and for providing end of month close reporting to appropriate departments and stakeholders.</li><li>Performs other duties as assigned.</li></ul><p><b>Compensation Pay Range: </b></p>$92,720.60 - $139,080.90<p><b>This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.</b></p><p><b>All Chapters Health System employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse to verify eligibility after a conditional offer of employment is made as well as ongoing eligibility. For more information, please visit </b><b><a href="https://info.flclearinghouse.com/" target="_blank">https://info.flclearinghouse.com/</a></b><b>.</b></p>

Chapters Health System

Director Revenue Cycle, Front End

<br><b>Description</b><br><br>The Idaho National Laboratory (INL), in collaboration with the U.S. Department of Energy (DOE), is seeking a seasoned and visionary leader to serve as the Director of the Center for Used Fuel Research. This role offers a unique opportunity to shape the future of global nuclear waste research and policy through technical, regulatory, and diplomatic engagement. Our team works a 9x80 schedule located out of our REC facility with every other Friday off.<br><br>The Director will serve as the Center’s top executive, responsible for the strategic direction, international leadership, and operational management of this flagship institution. This position demands exceptional communication, leadership, and organizational skills—attributes that are considered more critical to success than academic credentials alone. Executive experience in complex, multi-stakeholder environments may be considered in lieu of advanced academic degrees.<br><br><strong>Responsibilities Include:</strong><br><br><ul><li>Lead the Center’s mission to support the safe and scientifically defensible management of used nuclear fuel and high-level radioactive waste worldwide.</li><li>Serve as the principal representative to DOE, INL, the Center Oversight Council, international partners, and industry stakeholders.</li><li>Oversee a diverse executive team and guide the execution of applied research and development (R&amp;D) focused on storage, disposal, transport, and regulatory tools.</li><li>Communicate complex technical and policy matters with clarity to regulators, policymakers, and global technical organizations.</li><li>Build and sustain partnerships with international waste management authorities (e.g., Posiva Oy, SKB), multinational bodies (e.g., OECD NEA, WNA), and private sector collaborators.</li><li>Ensure Center activities comply with DOE Orders, NRC regulations, FAR/DEAR, and applicable international legal agreements.</li><li>Cultivate an organizational culture of excellence, transparency, and continuous improvement.</li><li>Coordinate future applied R&amp;D activities directly with DOE leadership and leaders from industry, national laboratories, and universities.</li><li>Be the spokesperson addressing the back-end of the nuclear fuel cycle to help to better position the nuclear industry for success.</li></ul><b>Qualifications</b><br><br><strong>Minimum Requirements:&nbsp;</strong><br><br><ul><li>Baccalaureate degree in scientific or other technical field from an accredited institution, 10 years of relevant experience,&nbsp;and a minimum of 5 years of progressive leadership experience in government, industry, or international nuclear policy.</li><li>Demonstrated success leading large, multidisciplinary programs or organizations, particularly within highly regulated environments.</li><li>Outstanding written and verbal communication skills, including experience engaging with senior government officials, international delegates, and technical staff.</li><li>Deep understanding of regulatory, policy, or operational issues related to nuclear fuel cycle management, waste disposition, or national laboratory operations.</li><li>This position requires the ability to obtain and maintain a Department of Energy "Q" clearance, which requires US Citizenship.&nbsp;</li></ul><br><br><strong>The ideal candidate will possess:&nbsp;</strong><br><br><ul><li>Executive or senior leadership experience at a DOE national laboratory, NRC, multinational nuclear organization, or commercial waste management entity.</li><li>Experience navigating DOE Orders, regulations, and international agreements.</li><li>Background in negotiating CRADAs, MOUs, and User Agreements for public-private or international collaboration.</li><li>Familiarity with export control regimes (10 CFR Part 810, EAR, ITAR) and foreign national engagement requirements.</li></ul><br><br><strong>Job Information:&nbsp;</strong><br><br><ul><li>The target pay range for this position is $159,054 - $230,070 annually. The full pay range is $127,596 - $331,752. At Idaho National Laboratory compensation decisions are determined using factors such as education, relevant experience, and other credentials.&nbsp;</li><li>TDP: This is a testing designated position; you will be required to submit to a pre-employment drug screen and periodic drug testing throughout the term of your employment.&nbsp;</li></ul><br><br><strong>Physical Requirements</strong><br><br>While performing the duties of this classification, the employee is frequently required to stand, walk, sit, stoop, kneel,&nbsp;bend, and work in an office and field/laboratory environment. The job requires hand/finger dexterity to keyboard or type,&nbsp;handle materials, manipulate tools, and reach with hands and arms. The job requires operation of job-related equipment&nbsp;and driving a vehicle. The employee must occasionally lift and/or move up to 35 pounds. Sufficient visual acuity and&nbsp;hearing capacity to perform the essential functions and interact with the public is required. Reasonable accommodations&nbsp;may be made to enable individuals with disabilities to perform the essential functions.<br><br><strong>Benefits and Relocation</strong><br><br><ul><li>Medical, Dental, Vision, and Flexible Spending Accounts</li><li>401(k) with a 4.2% employer contribution and up to 4.8% match</li><li>Paid time off (personal leave)</li><li>Employee Education Program (tuition assistance)</li><li>Comprehensive Relocation Package</li><li>Benefit eligibility subject multiple factors, including employment status and position classification.</li></ul><br><br><strong>At this time, BEA will not sponsor any H1-B visas obtained outside of the United States of America (U.S.A.), including consular visas.</strong><br><br><i>INL is a science-based, applied engineering national laboratory dedicated to supporting the U.S. Department of Energy’s mission in nuclear energy research, science, and national defense. With more than 6,300 scientists, researchers, and support staff, the laboratory works with national and international governments, universities and industry partners to change the world’s energy future and secure our nation’s critical infrastructure.</i><br><strong>INL Mission</strong><br>Our mission is to discover, demonstrate and secure innovative nuclear energy solutions, other clean energy options and critical infrastructure.<br><br><strong>INL Vision</strong><br>Our vision is to change the world’s energy future and secure our nation’s critical infrastructure.<br><br><strong>Selective Service Requirements</strong><br>To be eligible for employment at INL males born after December 31, 1959 must have registered with the Selective Service System (SSS). For more information see <a href="http://www.sss.gov" target="_blank">www.sss.gov</a>.<br><br><strong>Equal Employment Opportunity</strong><br>Idaho National Laboratory (INL) is an Equal Employment Opportunity (EEO) employer. It is the policy of INL to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.&nbsp;<br><br><strong>Reasonable Accommodation</strong><br>We will ensure 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 accommodation.<br><br><strong>Other Information</strong><br>When applying to positions please provide a resume and answer all questions on the following screens. Applicants, who fail to provide a resume or answer the questions, may be deemed ineligible for consideration.<br><br>INL does not accept resumes from third party vendors unsolicited.<br>

Idaho National Laboratory

Director, Center for Used Fuel Research

<h4><b>Summary of Position</b></h4><p>Lionsgate has an immediate opening for a Director, Finance – SAP ERP &amp; Process Improvement &amp; Governance. This person will lead finance process design and governance in SAP S/4HANA, including Procure-to-Pay (P2P), Master Data Governance (MDG), and Intercompany Matching &amp; Reconciliation (ICMR). The role ensures timely quarter closes, accurate SEC reporting, robust SOX controls, and successful external audits.</p><p>This person will also be a key leader on finance and accounting projects for senior management, including M&amp;A activities, due diligence and integration, capital and debt offerings, process improvement, and system implementations. The role will act as business owner for SAP finance capabilities and drive continuous improvement.</p><h4><b>Responsibilities</b></h4><ul><li>Key GL owner for SAP S/4HANA finance landscape (FI/CO) and integration with P2P/MM and AP processes.</li><li>Lead Procure-to-Pay process improvements and automation utilizing best in class tools and practices.</li><li>Establish SAP Master Data Governance (MDG) for Business Partners, GL accounts, cost/profit centers; internal orders, project systems, title master and enforce data standards and workflows.</li><li>Manage intercompany processes using SAP ICMR: configure matching rules, variance workflows, and auto postings to accelerate close.</li><li>Enable Group Reporting integration for consolidations and intercompany eliminations.</li><li>Implement SOX and internal controls in SAP: user access, segregation of duties, and audit dashboards using SAP GRC.</li><li>Serve as product owner for SAP finance enhancements: requirements, testing, cutover, training, and hypercare.</li><li>Drive continuous improvement using SAP Signavio for process mining and KPI tracking.</li><li>Oversee accounting for joint ventures and subsidiaries with unique reporting requirements.</li><li>Coordinate quarterly close readiness and ensure timely SEC filings and successful audits.</li><li>Partner with FP&amp;A and Tax for accurate intercompany and royalty accounting.</li><li>Act as signatory on designated bank accounts and align bank integrations with SAP payment processes.</li></ul><h4><b>Qualifications and Skills</b></h4><ul><li>Bachelor’s degree in Accounting, Finance, or Information Systems; CPA preferred.</li><li>5+ years of relevant experience.</li><li>Expertise in SAP ECC, SAP S/4HANA Finance (FI/CO) and integration with P2P/MM and AP.</li><li>Experience implementing SAP MDG and Business Partner governance.</li><li>Knowledge of SAP ICMR and Group Reporting for intercompany and consolidation.</li><li>Strong understanding of SOX controls and SAP GRC Access Control.</li><li>Systems design and implementation experience, including testing, conversions and change management.</li><li>Strong US GAAP knowledge and advanced Excel skills.</li><li>Excellent communication and collaboration skills; ability to work under tight deadlines.</li><li>Advanced SAP reporting skills across ECC and BW and Report Painter.</li><li>Ability to navigate and work in a fast pace environment, multitasking on many initiatives across global locations.&nbsp;</li><li>Proven track record for implementing process improvements and technology across global organizations.</li><li>International accounting and Media and Entertainment experience preferred.</li></ul><h4><b>Nice to Haves</b></h4><ul><li>Experience with Central Finance and multi-ERP integration.</li><li>Public accounting experience.</li></ul><h4><b>About Lionsgate</b></h4><p>Lionsgate (NYSE: LION) is one of the world’s leading standalone, pure play, publicly traded content companies. It brings together diversified motion picture and television production and distribution businesses, a world-class portfolio of valuable brands and franchises, a talent management and production powerhouse and a more than 20,000-title film and television library, all driven by the studio’s bold and entrepreneurial culture.</p><h4><b>Our Benefits</b></h4><ul><li>Full Coverage – Medical, Vision, and Dental</li><li>Work/Life Balance – generous sick days, vacation days, holidays, and Impact Day</li><li>401(k) company matching</li></ul><h4><b>Compensation</b></h4><p>$140,000 – $150,000</p><h4>EEO Statement</h4><p><em>Lionsgate is an equal employment opportunity employer. All employees and applicants are evaluated on the basis of their qualifications, consistent with applicable state and federal laws. In addition, Lionsgate will provide reasonable accommodations for qualified individuals with disabilities. Lionsgate will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable state and federal law. &nbsp;</em></p>

379 Leadership / Executive Board Jobs