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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;$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>

Solutions and Data Analyst III

<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, Enterprise Analytics provides strategic leadership and operational oversight for one of two primary analytic domains: Provider Performance &amp; Experience or Member Experience &amp; Outcomes. This position plays a pivotal role in enabling data-driven decision-making across the enterprise by translating complex data into actionable insights that inform strategy, improve performance, and advance organizational goals. As a key leader, the Director ensures that analytic strategy and execution are tightly aligned with other cross functional areas to drive L.A. Care’s enterprise transformation and strategic outcomes.</p><p>The Director oversees analytic teams in the design, development, and delivery of insights that span multiple operational and strategic workstreams. Ensures efficiency and effectiveness in work outcomes. &nbsp;This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports</p><h4>Duties</h4><p>Lead strategic planning and prioritization for analytics efforts within the assigned domain, ensuring alignment with organizational objectives and enterprise priorities.</p><p>Oversee and mentor leadership, fostering development of technical, operational, and leadership capabilities.</p><p>Ensure delivery of enterprise-level dashboards, reports, and analytic products that support business performance, regulatory compliance, member outcomes, and provider experience.</p><p>Partner with executives, strategic pillar leaders, cross-functional stakeholders, and partners to translate organizational priorities into analytics strategies, work plans, and actionable insights.</p><p>Support and enforce analytic governance, standardization, and methodology consistency across teams and domains.</p><p>Serve as the first point of engagement for domain analytics needs, providing expert guidance, strategic recommendations, and escalation support.</p><p>Track and monitor analytic initiatives, ensuring timely delivery, quality, and relevance to business objectives.</p><p>Advocate for data-driven decision-making, assuring they are embedded into strategic planning performance management and transformation initiatives across the enterprise and provide thought leadership on analytic strategy, capabilities, and innovation.</p><p>Collaborate with key stakeholders to ensure alignment of data architecture, availability, and quality with analytic needs.</p><p>Continuously assess enterprise and domain-level analytic capabilities, identifying opportunities for process improvement, automation, and innovation. Support and enforce the development, standardization, and governance of analytic processes and outputs across domains to ensure consistency, accuracy, and quality. </p><h4>Duties Continued</h4><p>Integrating development and outputs from the Applied AI and Causal Impact Data Science Team into the domain portfolio and roadmap, ensuring predictive and explainable models and program causal impact evaluations are operationalized, actionable, and aligned with business needs. Serving as a primary analytics liaison to stakeholders for the position’s focal analytic domain.</p><p>Develop goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews, training, and disciplinary matters for direct reports.</p><p>Conduct strategic planning for resource management in order to meet current and future departmental and enterprise-wide goals.</p><p>Develop, and manage department budget, monitor expenditures and ensures financial sustainability.</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<h4>Experience</h4><p><b>Required:</b><br>At least 9 years of progressively responsible experience in analytics.</p><p>At least 7 years of experience supervising/managing staff. </p><p>Experience leading teams, projects, initiatives, or cross-functional groups.</p><p>Experience with SQL, Python, and Tableau (or comparable BI/visualization tools) in a server-based analytics environment.</p><p>Experience integrating outputs from advanced analytics or data science models into operational analytic portfolios.</p><p><b>Preferred:</b><br>Experience with stakeholder engagement, executive reporting, and strategic initiative management.</p><p>Experience implementing and enforcing enterprise-level analytic standards and governance.</p><h4>Skills</h4><p><b>Required:</b></p><p>Ability to lead multiple Managers and analytic teams, set priorities, and align work with enterprise strategy.</p><p>Deep knowledge of healthcare operations, quality measurement, risk adjustment, provider networks, provider performance, population health and member experience.</p><p>Demonstrated ability to set enterprise analytic priorities, translate strategy into execution, and deliver actionable insights to executive leadership.</p><p>Knowledge of managed care, Medicare Advantage, Medi-Cal, commercial insurance operations, and compliance reporting</p><p>Knowledge of prescriptive analytics, predictive risk modeling, or causal impact modeling.</p><p>Ability to support and enforce the development, standardization, and governance of enterprise analytics outputs.</p><p>Ability to synthesize complex findings into actionable recommendations and communicate effectively with senior leaders.</p><p>Ability to provide oversight of multiple complex analytic initiatives, ensuring on-time and high-quality delivery.</p><p>Ability to partner effectively across Information Technology (IT), Data Governance, operational and clinical teams, and business stakeholders.</p><p>Ability to mentor Senior Managers, Managers, and analytic leaders, building enterprise analytic capability. </p><p>Excellent written and verbal communication skills. Strong negotiation and interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.</p><p>Strong strategic and operational acumen, with the ability to collaborate across business areas, anticipate analytic needs, and ensure alignment with enterprise priorities and transformation initiatives. Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.</p><p><b>Preferred:</b></p><p>Advanced knowledge of visualization design, executive dashboards, and Key Performance Indicators (KPI) frameworks.</p><p>Strategic planning skills for enterprise analytic initiatives.</p><p>Change management expert knowledge to drive adoption of standardized processes and tools.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Professional in Healthcare Quality (CPHQ)Project Management Professional (PMP)Tableau Desktop or Tableau Server CertificationSnowflake SnowPro Core CertificationOther analytics or data-focused certifications (e.g., Microsoft Certified: Data Analyst Associate, Python for Data Science certifications)<h4>Required Training</h4><p><b>Preferred:</b></p><p>Snowflake or SnowPro training</p><p>Healthcare analytics training (e.g., HEDIS, Risk Adjustment, MLTSS)</p><p>Executive leadership or strategic analytics training</p><p>Training in data governance, reproducibility, and analytic methodology best practices</p><p>Familiarity with predictive modeling, prescriptive analytics, and causal inference methods</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Domain Specific Experience and Skills: </b></p><p><b>Domain Focus: Provider Performance &amp; Experience Analytics<br>Required:</b></p><p>Proven experience leading and executing analytics strategy across at least one of the following managed care domains: Authorizations, Claims and Medical Cost Driver Analytics, Provider Network Strategy Analytics, or Risk Adjustment and Encounter Analytics.</p><p>Demonstrated ability to align operational, financial, and clinical analytics to improve provider performance, experience, and value-based outcomes.</p><p>Experience integrating analytic insights into provider engagement, performance improvement, and contracting strategies.</p><p><b>Preferred: </b><br>Experience with predictive modeling, cost driver analytics, and provider performance dashboards to support strategic decision-making.</p><p>Deep understanding of provider network contracting, credentialing, utilization management, and claims operations.</p><p>Knowledge of managed care regulations, compliance requirements, and operational reporting standard.</p><p><b>Domain Focus: Member Experience &amp; Outcomes Analytics</b></p><p><b>Required:</b></p><p>Experience leading and executing analytics strategy across Member Experience, Quality, Population Health, and Access to Care domains.</p><p>Knowledge of population health frameworks, risk stratification methodologies, and social determinants of health analytics.</p><p>Proven ability to align analytics to drive measurable improvements in member satisfaction, clinical quality outcomes, care access, and population health performance.</p><p>Demonstrated success in developing and operationalizing analytics that inform strategic decision-making, program evaluation, and performance improvement initiatives.<br><b>Preferred:</b></p><p>Experience with Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS), Stars, and other quality and satisfaction measurement programs.</p><p>Experience incorporating predictive, explainable, and causal impact models into analytics solutions to enhance member insights and guide strategic interventions.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicare, Performance Management, Insurance, Healthcare, Human Resources                                                    </p>

Director, Enterprise Analytics

<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 Senior Manager of Emerging Technologies and Artificial Intelligence (AI) leads L.A. Care’s advancement into innovative digital health solutions, focusing on the adoption and integration of artificial intelligence and other disruptive technologies. This position crafts a forward-thinking technology vision to propel L.A. Care’s service delivery, member engagement, and operational efficiency. Acting as both strategist and champion, the role evaluates next-generation tools, fosters experimentation, and ensures responsible implementation that meets legal and ethical standards positioning L.A. Care as a tech-enabled health plan prepared for the future of healthcare.&nbsp; The position leads L.A. Care’s governance, program management of adoption and implementation of AI in partnership with IT, analytics and project management.</p><p>The Senior Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.&nbsp; Responsible for driving performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.&nbsp; Oversees the development, implementation, administration, and maintenance of the department's programs, policies, and procedures. Responsible for driving management and performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.</p><h4>Duties</h4><h4>Manages staff and the day-to-day activities in the department. Participates in the department budgeting process.&nbsp; Responsible for scheduling, training, performance, corrective actions, mentoring, developing of the team(s). Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentors and develops staff, building technical and problem-solving skills across the team.</h4><p>Shape digital innovation strategy, prioritizing high-impact tech investments for L.A. Care.</p><p>Serve as a thought leader on emerging tech, guiding adoption in clinical and administrative domains.</p><p>Anticipate industry trends and regulatory shifts to maintain competitive edge.</p><p>Lead end-to-end delivery of AI and technology pilot and production solutions.</p><p>Manage vendor and partner relationships; oversee tech evaluation and integration.</p><p>Collaborate with IT on data governance and ensure regulatory and ethical compliance in tech use.</p><p>Mentor multidisciplinary teams</p><p>Cultivate innovative thinking and continuous learning within the team.</p><p>Educate and develop training modules for L.A. Care’s workforce and members on AI</p><p>Partner with coalitions and other associations to keep up to date on the latest market trends, developments in industry</p><h4>Duties Continued</h4><p>Lead and implement an AI intake process for vendor management in close partnership with IT</p><p>Encourage collaboration across IT, business, and clinical functions.</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><h4>Implements and provides guidance to the departmental and organizational processes and policies and works with senior and/ or executive management to define, prioritize, and develop projects and programs.</h4><h4>Responsible for Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.</h4><h4>Responsible for overseeing and managing the budgets of their respective departments.</h4><h4>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</h4><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.</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><b>Required:</b></p><p>At least 7 years of experience doing problem solving, policy, and/or project implementation in a health care or a related field.</p><p>At least 5 years of leading staff or supervisory/management experience.</p><p>At least 5 years of experience in leading project teams.</p><p>Experience building relationships with organizations and business partners.</p><h4>Skills</h4><p><b>Required:</b></p><p>Demonstrated critical thinking, problem solving, and project planning and implementation skills.</p><p>Demonstrated strong writing and communication skills.</p><p>Ability to implement pilots, integrate AI systems, and address cybersecurity/data governance.</p><p>Ability to apply AI and analytics to clinical workflow transformation and care management improvement.</p><p>Ability to ensure AI usage meets regulatory, privacy, and ethical standards.</p><p>Ability to align AI roadmap and emerging tech initiatives with broader organizational goals.</p><p>Ability to evaluate new tools, support solution development, and stay ahead of industry advancements.</p><p>Strategic planning skills in technology</p><p>Strong collaboration skills </p><p>Strong data-driven decision-making skills.</p><p>Advanced knowledge of AI, analytics, and emerging technology</p><p>Strong project and vendor management skills</p><p>Knowledge of regulatory and risk management for health tech.</p><p>Demonstrated ability to synthesize and analyze qualitative and/or quantitative data.</p><p>Knowledge of health care operations or health care systems.</p><p>Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.</p><p>Skilled in mediating disputes and resolving conflicts in a fair and constructive manner. </p><p>Must have a deep understanding of financial principles.&nbsp; Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.</p><p>Deep knowledge of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.</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>                    Public Health, Defense, Risk Management, Healthcare, Government, Finance                                                    </p>

Senior Manager, Emerging Technologies and Artificial Intelligence

<p><b>Salary Range:&nbsp;</b>&nbsp;$47,840.00&nbsp;(Min.) -&nbsp;$57,062.00&nbsp;(Mid.) -&nbsp;$68,474.00&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 Medical Document Management Specialist II is responsible for the secure, accurate and efficient management of medical records and any other documentation for the Enterprise Risk Adjustment (ERA) department in compliance with all healthcare regulatory agencies and organizational standards. This position utilizes the most current technology for faxing, emailing, scanning, secure file transfer protocol (SFTP) and various technological platforms/application softwares in the management of medical documents.</p><h4>Duties</h4><p>Document Management: Manages the collection, processing, organizing, storing of all medical documents while ensuring completeness, accuracy, and compliance with all regulatory, legal, and organizational standards. (50%)</p><p>Compliance and Quality Assurance: Ensures all medical documents meet compliance and quality standards per organizational policies and procedures, Health Insurance Portability and Accountability Act (HIPPA), legal and regulatory requirements. (10%)</p><p>Audit and Review: Performs routine audits of medical documents to ensure proper categorization, quality standards, completeness and compliance with organizational policies and procedures and regulatory requirements. (15%)</p><p>Record Retention: Ensures proper organization of all medical documents, storage, retention, and destruction of in accordance with organizational policies and procedures and regulatory requirements. (5%)</p><p>Document Retrieval &amp; Distribution: Manages the retrieval, copying and distribution of medical documents as requested from internal and/or external partners. (5%)</p><p>Collaboration: Works with internal and external partners to ensure seamless integration document processes and data management across various technological platforms/application software. (5%)</p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>Minimum of 1 year of experience in medical document management or health information management.</p><p>Experience working with Microsoft Office Suite, copying, faxing, scanning, and uploading documents to various technological platforms/applications.</p><h4>Skills</h4><p><b>Required:</b></p><p>Proficient with medical terminology and medical document management standards.</p><p>Excellent communication and interpersonal skills.</p><p>Knowledge of HIPAA regulations and privacy standards.</p><p>Excellent organizational, and problem-solving skills, with attention to detail and the ability to manage multiple tasks simultaneously.</p><p>Ability to collaborate with cross-functional teams.</p><p>Ability to maintain confidentiality with sensitive information.</p><h4>Licenses/Certifications Required</h4>Medical Terminology Certificate within 180 days of hire<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>                    Medical, Healthcare                                                    </p>

Medical Document Management Specialist II

<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 Process Improvement Engineer II is responsible for identifying, analyzing, and implementing solutions to improve operational efficiency, quality, and effectiveness across the organization. This position partners with cross-functional teams to evaluate current processes, eliminate waste, and streamline workflows using continuous improvement methodologies such as Lean, Six Sigma, and Kaizen. </p><h4>Duties</h4><p>Analyze business processes, workflows, and performance data to identify inefficiencies and areas for improvement.</p><p>Perform root cause analyses and develop solutions that address quality, cost, and productivity challenges.</p><p>Design, test, and implement process improvement initiatives across departments.</p><p>Partner with leadership and frontline staff to ensure alignment of improvement efforts with organizational goals.</p><p>Facilitate workshops, Kaizen events, and process mapping sessions.</p><p>Establish, monitor, and report on performance metrics and key performance indicators (KPIs).</p><p>Document new processes, create standard operating procedures (SOPs), and ensure sustainability of improvements.</p><p>Support change management and training to build a culture of continuous improvement.</p><p>Collaborate with Information Technology (IT), Operations, Finance, and other stakeholders to implement process automation and system enhancements.</p><h4>Stay current on industry best practices, tools, and methodologies related to process improvement.</h4><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Industrial Engineering or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 5 years of experience in process improvement, industrial engineering, operations, or related experience.</p><p>Experience leading Lean Six Sigma, or continuous improvement initiatives with measurable outcomes.</p><p>Experience with data collection, statistical analysis, and process modeling tools.</p><p><strong>Preferred:</strong></p><p>Experience in a manufacturing, healthcare, technology, or service environment.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Strong analytical, problem-solving, and change management skills to drive measurable improvements in performance, cost reduction, and customer satisfaction.</p><p>Proficient skills with process improvement tools (process mapping, root cause analysis, value stream mapping).</p><p>Proficient skills with data analysis software (Excel, Minitab, SQL, Power BI, Tableau).</p><p>Strong project management and organizational skills with the ability to manage multiple priorities.</p><p>Strong communication, facilitation, and interpersonal skills to work effectively across teams.</p><p>Ability to influence employees at all levels of the organization.</p><p>Ability to adapt and lead organizational change in dynamic and complex settings.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Lean Six Sigma Green Belt or Master Black Belt or related certification Project Management Professional (PMP) certification.Certified Quality Engineer (CQE)Certified Process Improvement Specialist (CPIS)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Experience in high stakes process improvement in health care maybe substitutes for professional license/certification.</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>                    Medical Technology, Healthcare                                                    </p>

Process Improvement Engineer II

<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 Project Manager III is responsible for managing high priority and complex projects across the enterprise.&nbsp; The position is responsible for managing projects across the strategic priorities as well as programs across the business. This position integrates advanced project management practices with high-level analytical capabilities to ensure that initiatives are delivered on time, within scope and budget, and with measurable impact. </p><p>The Project Manager III interfaces with all areas affected by the project, including end users, distributors, and vendors. &nbsp;This position partners with leadership and cross-functional teams to plan, execute, and evaluate projects to improve operational efficiency, regulatory compliance, and organizational performance. </p><p>The Project Manager III applies both strategic insight and tactical execution skills to drive data-informed decision-making and deliver organizational value. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Manage the planning, execution, and delivery of projects across diverse business areas, including operational, clinical, strategic, and technology initiatives.</p><p>Define project scope, goals, deliverables, timelines, and success metrics in collaboration with sponsors and stakeholders.</p><p>Conduct high-level data and process analysis to inform project design, evaluate outcomes, and identify opportunities for improvement.</p><p>Develop detailed project plans, schedules, budgets, and resource allocations.</p><p>Monitor progress against milestones, manage risks, issues, and dependencies, and implement mitigation strategies.</p><p>Prepare and present project updates, dashboards, and analytical reports to leadership and governance bodies.</p><p>Facilitate cross-functional collaboration to ensure alignment and communication across departments.</p><p>Ensure project compliance with legislation and organizational policies, procedures, and managed care regulatory requirements.</p><p>Support post-implementation evaluation, including benefits realization, lessons learned, and continuous improvement.</p><p>Mentor and guide project teams and business partners in project management and analytical best practices.</p><p>Track maintenance of business needs and requirements.</p><p>Develop detailed project plans, schedules, budgets, and resource allocations. </p><h4>Duties Continued</h4><p>Facilitate project meetings, status reports, and communications with cross-functional teams. Distribute project communication artifacts such as charter, budgets routinely to management, project team members, and other key stakeholders, actively soliciting and addresses feedback.</p><p>Partner with key stakeholders to monitor budgets, forecast resource needs, and track key performance indicators.</p><p>Ensure project documentation is maintained according to Project Management Office (PMO) standards and audit requirements.</p><p>Collaborate with key stakeholders to coordinate implementation and sustainment activities. </p><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 projects meets the needs of the department, organization and legislation's policies, standards, and best practices. Provide training, recommend process improvements, and mentor junior level staff, department interns, etc. as needed.</p><p>Performs 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 5 years of progressive experience in project management, business analysis, or operations management within a healthcare or managed care organization.</p><p>At least 4 years of moderate to complex project management experience. </p><p>Experience working simultaneously on multiple projects.</p><p>Experience and knowledge with different project management frameworks, including waterfall and agile.</p><p>Proven experience leading complex, cross-functional projects involving multiple stakeholders.</p><p>Strong experience in data and process analysis, performance measurement, and reporting.</p><p><b>Preferred:</b></p><p>Experience in regulatory compliance</p><p>Experience managing project budgets.</p><h4>Skills</h4><p><b>Required:</b></p><p>Advanced project management skills, including knowledge of Agile, Waterfall, and hybrid methodologies.</p><p>Ability to build strong relationships and communicate effectively with internal and external stakeholders.</p><p>Strong grasp of current communication, project tracking, and budget management technologies.</p><p>Excellent facilitation skills, with proven knowledge of how to foster attendee participation and collaboration in small and large groups.</p><p>Solid technical understanding and ability to define and refine requirements through a project lifecycle.</p><p>Strong problem-solving skills to manage shifting priorities, demands and timelines.</p><p>Strong analytical and critical thinking skills, with ability to interpret complex data and translate insights into actionable recommendations.</p><p>Proficiency in project management and analytics tools (e.g., MS Project, Smartsheet, Jira, Power BI, Tableau, Excel).</p><p>Excellent written and verbal communication skills, including executive-level reporting and presentations.</p><p>Strong organizational, facilitation, and stakeholder management skills.</p><p>Ability to build relationships and influence cross-functional teams and leadership.</p><p>Deep understanding of managed care operations, quality improvement, and regulatory compliance.</p><p>Adaptability and resilience in managing complex, fast-paced initiatives.</p><p>Demonstrated ability to manage competing priorities and deliver results in a matrixed environment.</p><p><b>Preferred:</b></p><p>Knowledge of vendor management.</p><p>Ability to understand healthcare or managed care landscape.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Agile or Scrum certification (e.g., Certified ScrumMaster)Lean Six Sigma Green BeltProject Management CertificateProject Management Professional (PMP)Program Management Professional (PgMP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

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