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<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Enterprise Data Analyst III serves as a Subject Matter Expert (SME) contributor responsible for leading complex analytic projects that link insights directly to enterprise goals, resource allocation, and performance improvement. This position leads the full analytic development process from business case definition and structured scoping through peer review, deployment, and post-implementation evaluation, ensuring high-quality, reproducible, and impactful outputs.</p><p>The Analyst III applies advanced analytic reasoning and strong business acumen to deliver analyses that inform both operational and financial decision making. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp; </p><h4>Duties</h4><p>Leads end-to-end analytic development, from structured business case definition and requirements gathering to delivery of validated, actionable insights.</p><p>Conducts advanced analyses evaluating drivers of quality, operational efficiency, and financial performance.</p><p>Coordinates with IT and product owners to ensure analytic outputs are integrated into enterprise systems and recurring workflows.</p><p>Develops, optimizes, and automates analytic assets (data models, dashboards, reports) following enterprise design and refresh standards.</p><p>Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.</p><p>Maintains awareness of data lineage and governance compliance throughout all analytic work.</p><p>Manages project planning, tracking, and post-implementation assessment for assigned deliverables.</p><p>Mentors and models adherence to analytic development best practices.</p><p>Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><p><b>Domain Specific Experience and Skills:</b></p><p><b>Domain Focus: Authorization &amp; Claims Operations Analytics</b></p><p><b>Required: </b>Experience with Utilization Management (UM) authorization workflows and prior authorization metrics. Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution. Knowledge of clinical and financial aspects of UM/claims and collaboration with operations or provider teams. Ability to analyze operational Key Performance Indicators (KPIs) (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights.</p><p><b>Domain Focus: Network Strategy Analytics</b></p><p><b>Required: </b>Experience supporting initiatives to optimize cost, access, and quality within provider networks. Experience analyzing provider networks, including contracting, credentialing, and panel optimization. Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.</p><p><b>Domain Focus: Risk Adjustment Analytics</b></p><p><b>Required:</b> Experience with risk adjustment methodologies, including Hierarchical Condition Category (HCC) coding, hierarchical models, and member risk scoring. Knowledge of diagnosis documentation, encounter data, and coding completeness to optimize plan revenue and quality scores. Knowledge of regulatory requirements impacting risk adjustment (e.g., Centers for Medicare and Medicaid Services (CMS) guidelines). Ability to assess encounter submission and processing operations, identifying trends, anomalies, or gaps in risk capture across provider or member populations.</p><p><b>Preferred Certification:</b> AAPC Certified Risk Adjustment Coder (CRC®); Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™); NAMAS Certified HCC Coder (CHCC™); AHIMA Certified Coding Specialist (CCS®)</p><p><b>Domain Focus: Medical Cost Driver Analytics</b></p><p><b>Required:</b> Experience analyzing medical cost drivers across populations, conditions, and service types. Experience developing dashboards or analytic tools to monitor and optimize medical spend. Knowledge of claims, provider, and condition level analyses to support financial and operational decision making. Ability to identify high-cost services, utilization patterns, and opportunities for cost containment.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 4 years of experience in analytics, with substantial exposure to healthcare operations, managed care, or population health.</p><p>Experience leading end-to-end analytic projects, including requirements gathering, data validation, analysis, and delivery of insights.</p><p>Experience analyzing multiple data sources and translate findings into actionable recommendations.</p><p><b>Preferred:</b></p><p>Experience with advanced analytics techniques, including multivariate analysis, regression, control charts, or predictive modeling.</p><p>Experience in domain specific operations, such as network strategy, risk adjustment, or medical cost driver analysis.</p><p>Experience mentoring junior analysts or providing guidance on analytic best practices.</p><h4>Skills</h4><p><b>Required</b></p><p>Expert in SQL for complex exploratory analysis, data modeling, and Extract, Transform, and Load (ETL) processes supporting enterprise dashboards, reports, and analytic deliverables.&nbsp;Advanced proficiency in Tableau (or equivalent BI tools) to design, optimize, and automate dashboards and visualizations for enterprise level insights.Strong statistical and analytical skills, including multivariate analyses, regression, and control charts to identify drivers of operational, clinical, and financial performance.Knowledge of version control (Git, GitHub) and collaborative development workflows, including peer review, continuous integration, and reproducible analytic practices.Ability to develop and maintain reusable analytic frameworks, templates, and processes that support recurring reporting and performance monitoring.&nbsp;Proficiency in data validation, reconciliation, and adherence to governance standards, including data lineage tracking and quality control.Ability to translate complex business problems into structured analytic requirements and actionable insights.&nbsp;Ability to interpret analytic results in the context of organizational performance, operational priorities, and enterprise goals.&nbsp;Ability to apply critical thinking to identify patterns, opportunities, and risks across multiple data domains.&nbsp;Ability to collaborate effectively with IT, operational teams, and business partners to operationalize analytic outputs.&nbsp;Demonstrated knowledge of healthcare concepts, such as quality measures, utilization patterns, and key operational drivers in a managed care environment.Ability to lead analytic projects end-to-end, including business case definition, requirements gathering, analysis, and post-implementation assessment.&nbsp;Ability to mentor junior analysts and promote adherence to analytic best practices.&nbsp;Ability to manage multiple projects simultaneously, prioritize tasks, and escalate issues appropriately.&nbsp;Ability to communicate findings effectively to both technical and non-technical stakeholders.&nbsp;</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Tableau Certified Data Analyst or Tableau Desktop SpecialistMicrosoft Certified: Power BI Data Analyst AssociateSnowflake SnowPro Core CertificationSnowPro® Specialty: Snowpark CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.<h4>Required Training</h4><p><b>General Skills Preferred</b>:Proficient with Process Improvement Methodology including defining and documenting workflow.&nbsp;Knowledge of program and project level planning, mobilization and management</p><p><b>Domain Specific Experience and Skills:</b><br><b>Domain Focus: Population Health Analytics</b></p><p><b>Required:</b> Experience analyzing community supports, care management, health education, Managed Long-Term Support Services (MLTSS), and intervention programs. Experience translating data into actionable insights to guide interventions, resource allocation, program improvements, and new ideas for member programs based on population needs. Knowledge of population health management frameworks and social determinants of health. Ability to evaluate population level outcomes and operational performance metrics.<br><b>Preferred:</b> Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM.<br><br><b>Domain Focus: Quality Improvement Analytics</b></p><p><b>Required:</b> Experience analyzing Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality measurement programs across both medical and pharmacy domains. Experience translating data into actionable insights to inform interventions, compliance, and performance improvement strategies. Knowledge of quality measurement frameworks, regulatory requirements, and reporting standards. Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives.</p><p><b>Preferred: </b>Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS).Experience supporting provider focused incentive program analytics. </p><p><b>Preferred Certification:</b> Certified Professional in Healthcare Quality (CPHQ)</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Domain Specific Experience and Skills:</b></p><p><b>Domain Focus: Access to Care Analytics</b></p><p><b>Required:</b> Experience analyzing appointment timeliness, access, and provider availability. Experience translating data into actionable insights to improve access, reduce barriers, and optimize provider scheduling. Experience supporting initiatives to improve network adequacy and member access, including operational interventions and performance monitoring. Knowledge access measurement frameworks and regulatory requirements. Ability to evaluate member access metrics, network capacity, and operational performance.<br></p><p><b>Domain Focus: Enterprise Support Analytics</b></p><p><b>Required:</b> Experience supporting enterprise level KPI maintenance, cross domain dashboards, and measure ROI analyses. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains. Experience translating data into actionable insights for strategic investments, operational decisions, and organizational performance monitoring. Knowledge of analytics frameworks, governance standards, and enterprise reporting processes.</p><p><b>Preferred: </b>Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.</p><p><b>Domain Focus: Member Experience Analytics</b></p><p><b>Required:</b> Experience analyzing call center operations, enrollment services, and appeals &amp; grievances. Experience translating data into actionable insights to improve member experience and member engagement operations. Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys or other member satisfaction measurement tools. Ability to assess member touchpoints, satisfaction metrics, and operational KPIs.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicaid, Medical Coding, Medicare, Pharmacy, Insurance, Healthcare                                                    </p>

L.A. Care Health Plan

Enterprise Data Analyst III

<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Development Program Manager II supports the Strategic Investment, Innovation and Partnership team to advance core strategic initiatives, achieve impact and network and collaborate with key stakeholders, including funders and other experts in field.&nbsp; This leads development opportunities to leverage resources and impact investments and partnerships at L.A. Care.&nbsp; The position primarily provides support with research and funding opportunities and in addition supports investment program management as needed.</p><p>The Program Manager (PM) II oversees one or more programs ensuring that the department management and key stakeholders define the program goals.&nbsp; This position is responsible for developing program assessment protocols for effectiveness and quality improvement. The PM II maintains the program standards of quality and performance.&nbsp; </p><h4>Duties</h4><h4>Work with key stakeholders on program implementation and facilitate communications with cross-functional departments on the status of ongoing activities, manage compliance to scope and reporting requirements.&nbsp; Obtain approvals from management.</h4><h4>Support new business/ program development including cost proposals, recruitment, collaborating, research/writing, coordinating activities.</h4><p>Responsible for research development opportunities. Research foundations and funders for opportunities to help leverage initiatives. Research other private and public stakeholders to support strategic relationships and partnership.</p><h4>Lead work to identify funding partners to leverage impact investments to support health care. Provide recommendations on financial management of assigned programs including developing, tracking, and updating budgets; monitoring monthly projections and actuals; obligated funds notifications; anticipate budget modifications and other financial matters. Review, edit, and contribute to technical deliverables and manage field assignments as required.</h4><h4>Provides program management support for strategic partnerships, relationships and investments (email, social and print) and membership. Contribute to L.A. Care’s investments, partnerships and giving culture.</h4><h4>Works as program manager for investment and partnership work from coordinating campaigns, production, timelines, mailing lists and website information. Develop and implement annual work plans; ensure timely and high-quality reviews and submissions of deliverables; Prepare scopes of work and monitoring service delivery. Participates and recommends in setting program goals and objectives. Ensure team members have the resources needed to meet their objectives.</h4><h4>Identify issues or potential risks, consult with the key stakeholders and management, and make informed decisions on how to address issues, communicating when appropriate with senior management.</h4><h4>Works with databases to track strategic investments across organization, partnerships. Monitors program operations for quality, efficiency and effectiveness.</h4><h4>Maintain an up-to-date internal database of key contacts for strategic investments and partnerships, including creating regular communication channels and opportunities for site visits of future partnerships and investments.</h4><h4>May work with vendors, consultants and government agencies that may include vendor management responsibilities.</h4><h4>Performs other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Business or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 4 years of experience in Project/Program Management.</p><p>Experience in managing complex initiative and multiple projects simultaneously.</p><p>Experience with working with grants. </p><p>Experience in building and maintaining relationships with cross-functional internal and external key stakeholders.</p><p>Experience leading professional staff and fostering accountability, collaboration, and results-oriented performance.</p><p><b>Preferred:</b></p><p>At least 2 years foundation or development experience or related experience.</p><p>Experience with Salesforce database products.</p><p>Experience within managed care, public health, or government-sponsored health insurance programs.</p><p>Experience in strategic portfolio management, governance, or organizational transformation within healthcare or public-sector environments.</p><h4>Skills</h4><p><b>Required:</b></p><p>Knowledge and understanding of the philanthropic, business and other key stakeholder’s communities.</p><p>Proficiency with Microsoft Office applications and an overall willingness to learn new applications. </p><p>Knowledge of Concur, QuickBooks, Square, website maintenance tools a plus.</p><p>Understanding of fundraising principles, techniques, and best practices. </p><p>Excellent interpersonal skills with commitment to customer service. </p><p>Exceptional communication skills both verbal and written. Must be a competent writer with editing strengths. </p><p>Highly organized, systems-oriented, strong analytical abilities. </p><p>Demonstrated ability to maintain a high degree of accuracy and confidentiality with financial and donor-related data. </p><p>Working knowledge of Project management techniques and tools.</p><p>Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.</p><p>Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.</p><p>Strong ability to make informed decisions.</p><p>Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.</p><p><b>Preferred:</b></p><p>Familiarity with California Medicaid (Medi-Cal) and regulatory entities such as Department of Health Care Service &nbsp;(DHCS), Centers for Medicare and Medicaid Services (CMS), or Department of Managed Health Care (DMHC).</p><p>Knowledge of health care operations or health care systems.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Professional in Healthcare Quality (CPHQ)Certificate in Program ManagementProgram Management Professional (PgMP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medicaid, Medicare, Philanthropic, Philanthropy, Public Health, Healthcare, Nonprofit                                                    </p>

Development Program Manager II

<p><b>Salary Range:&nbsp;</b>&nbsp;$171,925.00&nbsp;(Min.) -&nbsp;$232,100.00&nbsp;(Mid.) -&nbsp;$292,274.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Director of Artificial Intelligence (AI) and Impact Science is a senior leader, responsible for overseeing and advancing Applied AI and Casual Impact work. This position ensures that the team’s predictive, AI-driven, and causal analytics work is high-quality, reproducible, and aligned with the organization’s enterprise strategy and operational priorities.</p><p>This Director bridges advanced technical expertise, strategic foresight, and cross-functional collaboration. &nbsp;Provides leadership and mentorship to staff, ensuring compliance with analytic development standards, governance policies, and reproducibility requirements. Additionally, this position maintains close alignment with Enterprise Analytics leadership, including Directors and Managers of domain-aligned analyst teams, to integrate the team’s outputs into broader portfolio initiatives and operational workflows.</p><p>The Director scans the AI and emerging technology landscape to evaluate new solutions to guide build vs. buy decisions and ensure the organization continuously leverages innovative tools that provide incremental enterprise value. This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.</p><h4>Duties</h4><h4>Lead, mentor, and develop assigned team(s), fostering technical excellence, analytic rigor, and professional growth.</h4><h4>Ensure all analytic solutions follow standardized development practices, including version control, peer review, reproducible pipelines, and documentation protocols.</h4><h4>Serve as the primary liaison to other Enterprise Analytics leaders, integrating AI and causal science deliverables into domain-specific portfolios to maximize enterprise impact.</h4><h4>Guide cross-functional teams in translating AI and causal insights into actionable business recommendations, operational improvements, and strategic decision-making.</h4><h4>Oversee the design, implementation, and validation of predictive models, AI solutions, and causal impact studies, ensuring methodological rigor, scalability, and interpretability.</h4><h4>Establish and maintain technical standards, workflows, and governance policies for AI and causal impact analytics.</h4><h4>Continuously scan the AI, machine learning, and emerging technology landscape to identify tools, platforms, and frameworks that could enhance analytic capabilities, inform build vs. buy decisions, and deliver incremental value.</h4><h4>Assess new technologies and provide recommendations on integration strategies, feasibility, and potential Return on Investment (ROI) for adoption in enterprise workflows.</h4><h4>Promote the use of responsible AI principles, ensuring fairness, transparency, and explainability in all deployed solutions.</h4><h4>Duties Continued</h4><h4>Maintain oversight of resource allocation, project prioritization, and delivery timelines across the team.</h4><h4>Collaborate with key stakeholders to integrate predictive and causal insights, providing holistic, enterprise-level solutions.</h4><h4>Represent the AI &amp; Impact Science team to senior leadership and external stakeholders, communicating strategic value, project outcomes, and future opportunities.</h4><h4>Foster a culture of continuous learning, experimentation, and innovation within the team.</h4><h4>Proactively initiate, build and maintain effective relationships and communication with both internal and external key stakeholders.&nbsp; Communicate with senior leadership and executives, provide reports on performance and progress towards objectives. </h4><h4>Develop goals, objectives and action plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews, training, and disciplinary matters for direct reports.</h4><h4>Conduct strategic planning for resource management in order to meet current and future departmental and enterprise-wide goals. </h4><h4>Develops, and manages department budget, monitors expenditures and ensures financial sustainability. </h4><p>Perform other duties as assigned.</p><h4>Education Required</h4>Master's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Doctorate Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 7 years of progressive experience in advanced analytics, data science, or AI/ML.</p><p>At least 7 years of experience supervising/managing staff.</p><p>At least 3 years of professional experience working in a healthcare setting (e.g., Managed Care Organization, health system, hospital network, or health plan).</p><p>Demonstrated successful experience leading teams of technical practitioners (data scientists, analysts, or equivalent) in healthcare or complex enterprise environments.</p><p>Hands-on experience with AI/ML model development, causal inference, and enterprise-scale analytics projects.</p><p>Experience managing multiple projects and prioritizing resources in a dynamic environment.</p><p>Experience evaluating emerging AI and analytics technologies and guiding build vs. buy decisions.</p><p>Prior experience setting standards for reproducibility, governance, and responsible AI practices.</p><p><b>Preferred:</b><br>Experience in a Managed Care Organization (Medicaid, Medicare, ACA Exchange).</p><p>Experience with health equity analytics and population segmentation for targeted interventions.</p><h4>Skills</h4><p><b>Required:</b></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 written and verbal communication, negotiation, and interpersonal skills.</p><p>Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.<br>Demonstrated ability to lead and mentorship of technical teams in AI, data science, or analytics.</p><p>Ability to operationalize analytics and AI outputs into business workflows and enterprise decision-making.</p><p>Advanced understanding of predictive modeling, AI/ML methods, causal inference, and analytic pipeline design.</p><p>Strong project management and prioritization skills, including using Jira or equivalent workflow tools.</p><p>Expertise with collaboration and documentation tools such as GitHub and Confluence.</p><p>Exceptional communication and stakeholder engagement skills for technical and non-technical audiences.</p><p>Proven ability to collaborate across multiple business domains, integrating analytics into strategic decision-making and operational workflows.</p><p>Strong communication skills with the ability to translate complex technical topics for senior leadership and non-technical stakeholders.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Health Data Analyst (CHDA)Certified Analytics Professional (CAP)Snowflake SnowPro Core CertificationSnowPro Specialty: Data Engineering or SnowparkHealth Economics and Outcomes Research (HEOR) Certification or Graduate CertificateAdvanced AI/ML or Data Science certifications (e.g., Microsoft DP-100, MITx MicroMasters in AI, or similar)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Additional Skills:</b></p><p><b>Preferred:</b><br>Expertise in responsible AI principles, including fairness, transparency, and explainability.</p><p>Ability to evaluate emerging AI technologies and integrate them strategically into enterprise analytics capabilities.</p><p>Knowledge of Shiny, Streamlit, or other visualization and analytic tool deployment platforms.</p><p>Knowledge of healthcare administrative datasets (claims, encounters, eligibility, provider networks, quality measures).</p><p>Knowledge of Snowflake/Snowpark, cloud-based analytics, and large-scale distributed computing environments</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>                    Medicaid, Medicare, Defense, Claims, Equity, Healthcare, Government, Insurance, Finance                                                    </p>

Director, Artificial Intelligence and Impact Science

<p><b>Salary Range:&nbsp;</b>&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Solutions and Data Analyst III serves as a Subject Matter expert (SME), technical and analytic integrator, responsible for designing, developing, and operationalizing advanced analytic solutions that drive strategic insight and organizational performance. This position combines strong data engineering fluency with analytical acumen transforming complex, multi-domain data (membership, encounters, providers, claims, quality metrics) into interpretable and actionable insights used by leaders across the health plan.</p><p>This position emphasizes the development of insight rich, production ready analytic assets, delivering repeatable, governed analyses that illuminate key drivers of care quality, efficiency, and financial outcomes.&nbsp;Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp;&nbsp; </p><h4>Duties</h4><p>Designs and maintains reusable analytic data models and Extract, Transform, and Load (ETL) pipelines that support recurring insight generation and performance monitoring.</p><p>Leads development of advanced dashboards, reports, and analytic tools that surface trends, correlations, and performances opportunities across enterprise domains.</p><p>Partners with analysts, data scientists, and operational stakeholders to embed insights directly into workflows and decision processes.</p><p>Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.</p><p>Ensures adherence to data lineage, governance, and reproducibility standards across all analytic products.</p><p>Supports enterprise level measure refresh cycles and ensures alignment with standardized data abstraction layers.</p><p>Drives continuous enhancement of the analytic ecosystem by integrating new data sources, improving data structures, and optimizing performance.</p><p>Translates analytic findings into business relevant narratives and partners with stakeholders to act on insights.</p><p>Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><p><b>Domain Specific Experience and Skills: </b></p><p><b>Domain Focus: Authorization &amp; Claims Operations Analytics<br>Required: </b>Experience with Utilization Management (UM) authorization workflows and prior authorization metrics.Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution.Knowledge of clinical and financial aspects of UM/claims and collaboration with operations or provider teams.Ability to analyze operational KPIs (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights.</p><p><b>Domain Focus: Network Strategy Analytics</b></p><p><b>Required: </b>Experience supporting initiatives to optimize cost, access, and quality within provider networks.Experience analyzing provider networks, including contracting, credentialing, and panel optimization.Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.</p><p><b>Domain Focus: Risk Adjustment Analytics</b></p><p><b>Required: </b>Experience with risk adjustment methodologies, including Hierarchical Condition Category (HCC) coding, hierarchical models, and member risk scoring.Knowledge of diagnosis documentation, encounter data, and coding completeness to optimize plan revenue and quality scores.Knowledge of regulatory requirements impacting risk adjustment (e.g., Centers for Medicare and Medicaid Services (CMS) guidelines).Ability to assess encounter submission and processing operations, identifying trends, anomalies, or gaps in risk capture across provider or member populations.</p><p><b>Preferred Certifications: </b>AAPC Certified Risk Adjustment Coder (CRC®)<b>, </b>Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™)<b>, </b>NAMAS Certified HCC Coder (CHCC™)<b>, </b>AHIMA Certified Coding Specialist (CCS®).<br><b>Domain Focus: Medical Cost Driver Analytics</b></p><p><b>Required: </b>Experience analyzing medical cost drivers across populations, conditions, and service types.Experience developing dashboards or analytic tools to monitor and optimize medical spend. Knowledge of claims, provider, and condition level analyses to support financial and operational decision making.Ability to identify high-cost services, utilization patterns, and opportunities for cost containment.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 5 years of progressive analytics experience in healthcare, managed care, or related industries.</p><p>Proven experience designing, developing, and operationalizing analytic solutions across multiple domains.</p><p>Ability to operate with high autonomy, manage complex or ambiguous projects, and influence operational or strategic decisions.</p><p>Experience translating multi-domain analytics into actionable insights for leadership and enterprise-wide initiatives.</p><p>Demonstrated successful experience in communicating insights effectively to senior leadership and executives.</p><p><b>Preferred:</b></p><p>Experience with enterprise level initiatives, such as Key Performance Indicator (KPI) maintenance, cross-domain dashboards, measure ROI, or strategic investment analytics.</p><p>Strong experience managing care operations, including capitation, provider networks, risk adjustment, or quality incentive programs.</p><h4>Skills</h4><p><b>Required:</b></p><p>Expertise in designing, building, and maintaining complex ETL pipelines and analytic data models that support enterprise reporting, dashboards, and predictive insights. Advanced experience with BI tools (Tableau, Power BI) to design insight rich, production ready dashboards and analytic products. Proficiency with SQL and/or Python/R for large-scale data manipulation, advanced analyses, and operationalization of analytic workflows. Strong knowledge of version control (Git/GitHub) and CI/CD processes for analytic code and pipelines. Ability to integrate, optimize, and enhance multiple data sources for performance, governance, and reproducibility. </p><p>Ability to apply advanced statistical, predictive, and diagnostic methods to uncover drivers of quality, efficiency, and financial outcomes. Deep understanding of managed care operations, such as capitation models, provider networks, utilization management, and quality incentive programs. Ability to translate multi-domain data into actionable insights that directly inform strategic and operational decisions. Ability to conduct root-cause analyses, scenario modeling, and complex problem solving with minimal guidance.</p><p>Ability to operate with high autonomy, independently defining priorities and managing complex, ambiguous analytic projects. Ability to communicate complex analytic findings effectively to senior leadership, executives, and external stakeholders. Ability to translate insights into actionable recommendations and strategic narratives that influence enterprise decision making. Ability to mentor and guide other analysts, promoting analytic best practices across teams. Ability to drive continuous improvement of analytic tools, data structures, and reporting ecosystems, proactively identifying opportunities to enhance organizational performance.&nbsp;</p><p><b>Preferred:</b></p><p>Proficient with Process Improvement Methodology including defining and documenting workflow. Knowledge of program and project level planning, mobilization and management.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Tableau Certified Data Analyst or Tableau Desktop SpecialistSnowflake SnowPro Core CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Python Institute PCEP™ or PCAP™ (Python Programming)SnowPro® Specialty: Snowpark CertificationDataCamp Certified Data Analyst (Python or R)HarvardX or Johns Hopkins Data Science Certificate (R)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.Certified Analytics Professional (CAP)or related<h4>Required Training</h4><p><b>Domain Specific Experience and Skills: </b></p><p><b>Domain Focus: Member Experience Analytics</b></p><p><b>Required: </b>Experience analyzing call center operations, enrollment services, and appeals &amp; grievances.Experience translating data into actionable insights to improve member experience and member engagement operations.Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys or other member satisfaction measurement tools. Ability to assess member touchpoints, satisfaction metrics, and operational KPIs.</p><p><br><b>Domain Focus: Population Health Analytics</b></p><p><b>Required: </b>Experience analyzing community supports, care management, health education, Managed Long Term Support Services (MLTSS), and intervention programs.Experience translating data into actionable insights to guide interventions, resource allocation, program improvements, and new ideas for member programs based on population needs.Knowledge of population health management frameworks and social determinants of health. &nbsp;Ability to evaluate population level outcomes and operational performance metrics.</p><p><b>Preferred:</b> Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM.<br></p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Domain Specific Experience and Skills:</b><br><b>Domain Focus: Quality Improvement Analytics</b></p><p><b>Required: </b>Experience analyzing Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality measurement programs across both medical and pharmacy domains.Experience translating data into actionable insights to inform interventions, compliance, and performance improvement strategies.Knowledge of quality measurement frameworks, regulatory requirements, and reporting standards.</p><p><b>Preferred: &nbsp;</b>Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS). Experience supporting provider focused incentive program analytics. Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives.</p><p><b>Preferred Certification: </b>Certified Professional in Healthcare Quality (CPHQ)<br><b>Domain Focus: Access to Care Analytics</b></p><p><b>Required: </b>Experience analyzing appointment timeliness, access, and provider availability.Experience translating data into actionable insights to improve access, reduce barriers, and optimize provider scheduling. Experience supporting initiatives to improve network adequacy and member access, including operational interventions and performance monitoring. Knowledge of access measurement frameworks and regulatory requirements.Ability to evaluate member access metrics, network capacity, and operational performance.<br><b>Domain Focus: Enterprise Support Analytics</b></p><p><b>Required: </b>Experience supporting enterprise level KPI maintenance, cross-domain dashboards, and measure ROI analyses.Experience translating data into actionable insights for strategic investments, operational decisions, and organizational performance monitoring.Knowledge of analytics frameworks, governance standards, and enterprise reporting processes. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains.</p><p><b>Preferred: &nbsp;</b>Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicaid, Medical Coding, Medicare, Pharmacy, Insurance, Healthcare                                                    </p>

Solutions and Data Analyst III

<p><b>Salary Range:&nbsp;</b>&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Enterprise Planner III is responsible for designing and shaping the frameworks, methodologies, and structures that guide organizational planning within L.A. Care. This position supports enterprise-level strategy, program design, and business transformation by aligning planning processes with organizational goals and regulatory requirements. The Enterprise Planner III serves as a bridge between strategy and execution, ensuring strategic initiatives are structured, resourced, and monitored in a way that delivers measurable outcomes. The Enterprise Planner III collaborates with executive leadership and cross-functional teams to develop and implement standards, tools, and models that strengthen the health plan’s ability to adapt to change, optimize resources, and fulfill its mission of delivering high-quality, accessible, and equitable care. </p><p>Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Design, develop, and implement enterprise planning frameworks, methodologies, and governance models that align with organizational strategy. Develop planning tools, templates, and dashboards that standardize approaches and enable real-time tracking of strategic progress.</p><p>Partner with analytics teams to define metrics, reporting cadences, and visualization.</p><p>Facilitate cross-functional planning sessions to ensure integration and alignment across business units throughout the enterprise.</p><p>Support the planning cycle by coordinating data, collection, validation, and synthesis across business units.</p><p>Provide analytical support for prioritizing projects and allocating resources based on organizational goals, risk, and impact.</p><p>Monitor the execution of strategic and operational plans, identifying barriers and recommending corrective actions.</p><p>Ensure planning processes comply with regulatory and accreditation requirements within the organization.</p><p>Prepare presentations, reports, and briefings for senior leadership, board members, and external stakeholders.</p><p>Foster a culture of continuous improvement in organizational planning practices.</p><p>Translate business strategies into structured planning frameworks and data models.</p><h4>Support the development of enterprise performance dashboards and reporting structures to measure progress toward the strategic plan and related roadmaps in priorities and projects.</h4><h4>Duties Continued</h4><p>Apply subject expertise in evaluating business operations and processes. Identify areas where technical solutions would improve business performance. Consult across business operations, provide mentorship, and contribute specialized knowledge. Ensure that the facts and details are correct so that the project’s/program's&nbsp;</p><p>deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provide training, recommend process improvements, and mentor junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Business Administration or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 6 years of experience in strategic planning, business planning, or enterprise planning within a healthcare or managed care organization.</p><p>Experience designing or managing organizational planning frameworks, governance structures, or transformation initiatives.</p><p>Experience working with cross-functional teams and influencing senior leadership in complex organizations.</p><h4>Skills</h4><p><b>Required:</b></p><p>Strong knowledge of planning methodologies and enterprise performance management.</p><p>Advanced analytical skills with ability to synthesize complex information and translate into actionable insights.</p><p>Proficiency in planning and project management tools (e.g., MS Project, Smartsheet, Power BI, Tableau).</p><p>Strong written and verbal communication skills, with ability to prepare executive-level materials.</p><p>Excellent facilitation, negotiation, and interpersonal skills to align diverse stakeholders.</p><p>Ability to manage multiple priorities in a fast-paced, highly regulated environment.</p><p>Knowledge of managed care operations, regulatory requirements, and healthcare performance metrics.</p><p><b>Preferred:</b></p><p>Change management and organizational design capabilities a plus.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Strategy Planning Professional (SPP)Strategy Management Professional (SMP)Certified Strategy and Business Planning ProfessionalCertified Strategic PlannerCertified Performance Improvement Professional (CPIP)Lean Six Sigma<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>                    Performance Management, Human Resources                                                    </p>

Enterprise Planner III

<p><b>Salary Range:&nbsp;</b>&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Strategic Investments Program Manager III team is responsible for strategic investment, and partnership projects to address strategic priorities and community needs, including, but not limited to: workforce gaps, innovation and technological supports for providers, provider infrastructure and capacity building, member care management and community health—aligned with the business needs. The position works on projects from start to finish. This position works with internal and external key stakeholders and senior management, analytics, finance and other teams across L.A. Care to develop and manage investment planning, prioritization, timelines, performance metrics, budgets, outcomes analysis, and investment agreements for various priority initiatives. </p><p>This position oversees multiple complex programs in the department. This position designs and manages the implementation, operations, and the evaluation of strategic programs or functions of the assigned program of responsibility. Acts as a Subject Matter Expert, (SME) serves as a resource and mentor for other staff.&nbsp; </p><h4>Duties</h4><p>Develops, designs and implements investments in alignment with the strategic investment plan and priorities to support local workforce needs, innovation and technological supports for providers, community health, provider infrastructure and capacity gaps, member health outcomes, among other areas, while managing the program from start to finish for the investments and partnership projects. </p><p>Responsible for managing program execution, budget, and expenditures. Plans, develops, and implements strategies for generating funding and/or resource opportunities for program activities.&nbsp; Develops strategic partnerships with key stakeholders aligned with strategic investment plan and priorities to support quality care aligned with the needs of the business.</p><p>Promotes and participates in internal planning to identify key investment opportunities. Identifies key contributors, strategy partners, and overall resources required for investment execution and evaluation. Recognizes risks and recommends solutions to mitigate impact on operations and maximize benefit to investment recipients.</p><p>Conducts need assessment of investment requirements, scope, budget and timeline for cross-functional department participation and execution. Identifies opportunities for efficiency in scope and ensure program objectives and deliverables are in alignment with department and L.A. Care goals. Drafts agreements, work plans and budgets based on approved funding decisions and desired outcomes. </p><p>Contributes to annual strategic investment planning in partnership with internal and external stakeholders, including senior leadership. Develops materials to summarize investment plans, partnerships, general updates, areas of concerns and proposed solutions to advance priority outcomes.&nbsp; </p><p>Monitors inter-connected programs/project work product, outcome and interplay to be able to make necessary enhancements or modifications as appropriate to ensure alignment with department objectives. Coordinates cross-program/project activities as necessary.</p><p>Designs and orchestrates the delivery of applicable communication to staff and management to establish goals and strategies related to the program.</p><p>Responsible for defining the metrics, quality standards, and documentation required for consistent program management and execution across the business. </p><h4>Duties Continued</h4><p>Serves as SME for all programmatic processes and procedures.&nbsp; Provides strategic direction to program start-up and closeout activities including development, and refinement of program management tools, resources, and processes.</p><p>Maintains up to date knowledge of compliance requirements and supports with regulatory body reporting, as requested. Works with analytic teams to properly assess program performance and build in maximize return on investment (ROI) or health, utilizes change management strategies to implement enhancements and process improvements as necessary. Prepares reports as needed for key stakeholders.</p><p>Performs other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Public Health or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Public Health or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 6 years of work experience doing problem solving, policy, and/or project implementation in a health care or a related field.</p><p>Experience building relationships with organizations and business partners.</p><p>At least 2 years of experience in leading project teams.</p><h4>Skills</h4><p><b>Required:</b></p><p>Strong critical thinking, problem solving, and project planning and implementation skills.</p><p>Excellent writing and communication skills.</p><p>Strong ability to synthesize and analyze qualitative and/or quantitative data.</p><p>Knowledge of health care operations or health care systems.</p><p>Strong ability to build strong relationship management with a diverse set of partners</p><p>Strong skills in strategic thinking.</p><p>Ability to lead and motivate cross-functional teams, manage resources, and drive strategy.</p><p>Capability to align goals with the organization strategic objectives and make strategic decisions.</p><p>Proficiency in budget management, resource planning and financial analysis for program budgets.</p><p>Ability to navigate and adapt to dynamic and changing environments.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Program Management Professional (PgMP)Lean Six SigmaManaging Successful Programmes (MSP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Public Health, Relationship Manager, Healthcare, Customer Service                                                    </p>

Strategic Investments Program Manager III

<p><b>Salary Range:&nbsp;</b>&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Solutions and Data Analyst III serves as a Subject Matter expert (SME), technical and analytic integrator, responsible for designing, developing, and operationalizing advanced analytic solutions that drive strategic insight and organizational performance. This position combines strong data engineering fluency with analytical acumen transforming complex, multi-domain data (membership, encounters, providers, claims, quality metrics) into interpretable and actionable insights used by leaders across the health plan.</p><p>This position emphasizes the development of insight rich, production ready analytic assets, delivering repeatable, governed analyses that illuminate key drivers of care quality, efficiency, and financial outcomes.&nbsp;Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.&nbsp;&nbsp; </p><h4>Duties</h4><p>Designs and maintains reusable analytic data models and Extract, Transform, and Load (ETL) pipelines that support recurring insight generation and performance monitoring.</p><p>Leads development of advanced dashboards, reports, and analytic tools that surface trends, correlations, and performances opportunities across enterprise domains.</p><p>Partners with analysts, data scientists, and operational stakeholders to embed insights directly into workflows and decision processes.</p><p>Implements and maintains version control, peer review (pull request), and continuous integration practices for analytic codebases.</p><p>Ensures adherence to data lineage, governance, and reproducibility standards across all analytic products.</p><p>Supports enterprise level measure refresh cycles and ensures alignment with standardized data abstraction layers.</p><p>Drives continuous enhancement of the analytic ecosystem by integrating new data sources, improving data structures, and optimizing performance.</p><p>Translates analytic findings into business relevant narratives and partners with stakeholders to act on insights.</p><p>Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><p><b>Domain Specific Experience and Skills: </b></p><p><b>Domain Focus: Authorization &amp; Claims Operations Analytics<br>Required: </b>Experience with Utilization Management (UM) authorization workflows and prior authorization metrics.Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution.Knowledge of clinical and financial aspects of UM/claims and collaboration with operations or provider teams.Ability to analyze operational KPIs (e.g., turnaround times, denial rates, appeals outcomes) and translate data into actionable insights.</p><p><b>Domain Focus: Network Strategy Analytics</b></p><p><b>Required: </b>Experience supporting initiatives to optimize cost, access, and quality within provider networks.Experience analyzing provider networks, including contracting, credentialing, and panel optimization.Ability to evaluate network performance metrics and translate findings into actionable insights for strategy and business planning.</p><p><b>Domain Focus: Risk Adjustment Analytics</b></p><p><b>Required: </b>Experience with risk adjustment methodologies, including Hierarchical Condition Category (HCC) coding, hierarchical models, and member risk scoring.Knowledge of diagnosis documentation, encounter data, and coding completeness to optimize plan revenue and quality scores.Knowledge of regulatory requirements impacting risk adjustment (e.g., Centers for Medicare and Medicaid Services (CMS) guidelines).Ability to assess encounter submission and processing operations, identifying trends, anomalies, or gaps in risk capture across provider or member populations.</p><p><b>Preferred Certifications: </b>AAPC Certified Risk Adjustment Coder (CRC®)<b>, </b>Practice Management Institute Certified Risk Adjustment and HCC Coder (CRA-HCC™)<b>, </b>NAMAS Certified HCC Coder (CHCC™)<b>, </b>AHIMA Certified Coding Specialist (CCS®).<br><b>Domain Focus: Medical Cost Driver Analytics</b></p><p><b>Required: </b>Experience analyzing medical cost drivers across populations, conditions, and service types.Experience developing dashboards or analytic tools to monitor and optimize medical spend. Knowledge of claims, provider, and condition level analyses to support financial and operational decision making.Ability to identify high-cost services, utilization patterns, and opportunities for cost containment.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 5 years of progressive analytics experience in healthcare, managed care, or related industries.</p><p>Proven experience designing, developing, and operationalizing analytic solutions across multiple domains.</p><p>Ability to operate with high autonomy, manage complex or ambiguous projects, and influence operational or strategic decisions.</p><p>Experience translating multi-domain analytics into actionable insights for leadership and enterprise-wide initiatives.</p><p>Demonstrated successful experience in communicating insights effectively to senior leadership and executives.</p><p><b>Preferred:</b></p><p>Experience with enterprise level initiatives, such as Key Performance Indicator (KPI) maintenance, cross-domain dashboards, measure ROI, or strategic investment analytics.</p><p>Strong experience managing care operations, including capitation, provider networks, risk adjustment, or quality incentive programs.</p><h4>Skills</h4><p><b>Required:</b></p><p>Expertise in designing, building, and maintaining complex ETL pipelines and analytic data models that support enterprise reporting, dashboards, and predictive insights. Advanced experience with BI tools (Tableau, Power BI) to design insight rich, production ready dashboards and analytic products. Proficiency with SQL and/or Python/R for large-scale data manipulation, advanced analyses, and operationalization of analytic workflows. Strong knowledge of version control (Git/GitHub) and CI/CD processes for analytic code and pipelines. Ability to integrate, optimize, and enhance multiple data sources for performance, governance, and reproducibility. </p><p>Ability to apply advanced statistical, predictive, and diagnostic methods to uncover drivers of quality, efficiency, and financial outcomes. Deep understanding of managed care operations, such as capitation models, provider networks, utilization management, and quality incentive programs. Ability to translate multi-domain data into actionable insights that directly inform strategic and operational decisions. Ability to conduct root-cause analyses, scenario modeling, and complex problem solving with minimal guidance.</p><p>Ability to operate with high autonomy, independently defining priorities and managing complex, ambiguous analytic projects. Ability to communicate complex analytic findings effectively to senior leadership, executives, and external stakeholders. Ability to translate insights into actionable recommendations and strategic narratives that influence enterprise decision making. Ability to mentor and guide other analysts, promoting analytic best practices across teams. Ability to drive continuous improvement of analytic tools, data structures, and reporting ecosystems, proactively identifying opportunities to enhance organizational performance.&nbsp;</p><p><b>Preferred:</b></p><p>Proficient with Process Improvement Methodology including defining and documenting workflow. Knowledge of program and project level planning, mobilization and management.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Tableau Certified Data Analyst or Tableau Desktop SpecialistSnowflake SnowPro Core CertificationSQL Certification (e.g., DataCamp SQL Associate Certificate, Codecademy SQL Professional Certification, W3Schools SQL Certification)Python Institute PCEP™ or PCAP™ (Python Programming)SnowPro® Specialty: Snowpark CertificationDataCamp Certified Data Analyst (Python or R)HarvardX or Johns Hopkins Data Science Certificate (R)Certified Health Data Analyst (CHDA)Managed Care Professional (MCP) or relevant certification.Certified Analytics Professional (CAP)or related<h4>Required Training</h4><p><b>Domain Specific Experience and Skills: </b></p><p><b>Domain Focus: Member Experience Analytics</b></p><p><b>Required: </b>Experience analyzing call center operations, enrollment services, and appeals &amp; grievances.Experience translating data into actionable insights to improve member experience and member engagement operations.Knowledge of Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys or other member satisfaction measurement tools. Ability to assess member touchpoints, satisfaction metrics, and operational KPIs.</p><p><br><b>Domain Focus: Population Health Analytics</b></p><p><b>Required: </b>Experience analyzing community supports, care management, health education, Managed Long Term Support Services (MLTSS), and intervention programs.Experience translating data into actionable insights to guide interventions, resource allocation, program improvements, and new ideas for member programs based on population needs.Knowledge of population health management frameworks and social determinants of health. &nbsp;Ability to evaluate population level outcomes and operational performance metrics.</p><p><b>Preferred:</b> Experience understanding and responding to ongoing California Department of Health Care Services (DHCS) requirements for various programs, such as CalAIM.<br></p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Domain Specific Experience and Skills:</b><br><b>Domain Focus: Quality Improvement Analytics</b></p><p><b>Required: </b>Experience analyzing Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality measurement programs across both medical and pharmacy domains.Experience translating data into actionable insights to inform interventions, compliance, and performance improvement strategies.Knowledge of quality measurement frameworks, regulatory requirements, and reporting standards.</p><p><b>Preferred: &nbsp;</b>Experience supporting quality reporting requirements and initiatives for regulatory or accreditation programs (e.g., CMS, DHCS). Experience supporting provider focused incentive program analytics. Ability to evaluate performance metrics, trends, and gaps to support quality improvement initiatives.</p><p><b>Preferred Certification: </b>Certified Professional in Healthcare Quality (CPHQ)<br><b>Domain Focus: Access to Care Analytics</b></p><p><b>Required: </b>Experience analyzing appointment timeliness, access, and provider availability.Experience translating data into actionable insights to improve access, reduce barriers, and optimize provider scheduling. Experience supporting initiatives to improve network adequacy and member access, including operational interventions and performance monitoring. Knowledge of access measurement frameworks and regulatory requirements.Ability to evaluate member access metrics, network capacity, and operational performance.<br><b>Domain Focus: Enterprise Support Analytics</b></p><p><b>Required: </b>Experience supporting enterprise level KPI maintenance, cross-domain dashboards, and measure ROI analyses.Experience translating data into actionable insights for strategic investments, operational decisions, and organizational performance monitoring.Knowledge of analytics frameworks, governance standards, and enterprise reporting processes. Ability to develop analytic tools and dashboards that consolidate insights across multiple domains.</p><p><b>Preferred: &nbsp;</b>Experience supporting talent development analytics or enterprise-wide strategic initiative evaluation.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicaid, Medical Coding, Pharmacy, Call Center, Insurance, Healthcare, Customer Service                                                    </p>

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