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<p><b>Salary Range:&nbsp;</b>&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Lead Financial Planning and Analysis &nbsp;is responsible for the overall completion of the annual budget and bi-annual forecast. The Lead oversee the day to day operations providing oversight of work assignments, schedules, provides performance feedback, mentors, handling escalated issues and oversees staff training. This is a key position to ensure the accuracy and integrity of our budgeting models and develop new systematic methodologies to address and align the budgeting models with L.A. Care's strategic goals. &nbsp;The Annual Budget Book is a critical document which is reviewed by the Chief Executive Officer (CEO) and Chief Finance Officer (CFO) before seeking the approvals from the Finance &amp; Budget Committee and Board of Governor. &nbsp;This position supports Divisional Chiefs and their staff on all budgeting and forecasting matters as well as monitoring the monthly divisional spending. &nbsp;Other duties include assistance with financial statement and administrative expense analysis, preparing reports for presentation, validating the budget for the RRB Ask and other ad hoc analysis and reports. This is a highly visible position and will interact with all departments at all levels in order to develop the annual budget, bi-annual forecast, monthly spending, and motion requests. &nbsp;</p><p>This position is responsible for the daily workflow and leading the work of assigned staff. &nbsp;This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff. &nbsp;This position serves as the backup to the &nbsp;manager.</p><h4>Duties</h4><p>Leads the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training and feedback on performance to department management. &nbsp;Oversees the daily office workflow, develops and recommends enhancements to process and procedures. &nbsp;</p><p>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</p><p>Plan, manage, and coordinate budget and forecast process with other team members and business owners. Timely follow-up with the stakeholders to ensure the Budget Book is ready for the review by the CEO and CFO prior to the Board of Governor (BoG) presentation and approval. &nbsp;</p><p>Develop budget/ forecast data models (for projecting membership, estimating revenue and cost of healthcare expense categories, and calculating administrative costs). Consolidate revenue, cost of healthcare and administrative expenses. Assist individual cost center owner in developing the budget and seek final approvals from business owners in order to hold them accountable for the budget. &nbsp;</p><p>Monitor and track forecast and budget versus actuals on a monthly basis. Develop or enhance variance reports to monitor budget versus actuals. Disseminate and communicate variance reports to internal departments for status of resource utilization.</p><p>Create, analyze, and disseminate variance reports to aid Senior Management with decision making. Support Division Chiefs and Directors on monitoring departmental spending and actual vs. budget variance analysis. &nbsp;Actively participate and lead assigned areas for the development of the budget, monthly and quarterly financial review, and long-range financial forecast based on expected operations and business conditions. Perform complex financial analysis of specific capital and extraordinary projects and make recommendations to management. Serve as a Finance liaison with other departments. Prepare and present staff reports and other necessary documents. Support and act as consultant to other departments and &nbsp;managers.&nbsp;</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Economics or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>At least 5 years of experience analyzing data in a financial context.</p><p>At least 3 years of leading process, program, or staff experience.</p><p>Experience with financial data modeling for Medi-Cal population.&nbsp; </p><p><b>Preferred:</b></p><p>Previous experience in accounting, budgeting and forecasting is a strong plus.</p><h4>Skills</h4><p><b>Required:</b><br>Excellent analytical skills and demonstrated ability to analyze complex issues and recommend solutions.</p><p>Must be proactive, resourceful, and able to collaborate and find alternative solutions to deliver results to upper management.</p><p>Highly proficient in Excel, Word and PowerPoint. &nbsp;Must have advanced skills in Excel on V-Lookup and pivot tables.</p><p>Excellent organizational skills with the ability to manage multiple priorities simultaneously.</p><p>Work independently and collaborate with other functional areas in order to achieve optimal results.</p><p>Strong verbal communication and presentation skills. &nbsp;</p><p>Strong knowledge of GAAP</p><p>Superior attention to detail</p><p>Proven ability to work effectively with others in a team-oriented environment.</p><p><b>Preferred:</b><br>SQL skills and budget system development skills.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Public Accountant (CPA)<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>                    Accounting, CPA, Financial, Finance                                                    </p>

L.A. Care Health Plan

Lead Financial Planning and Analysis

<p><b>Salary Range:&nbsp;</b>&nbsp;$77,265.00&nbsp;(Min.) -&nbsp;$100,445.00&nbsp;(Mid.) -&nbsp;$123,625.00&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 Systems Administrator II is responsible for day-to-day tasks and projects relating to the various operating systems, i.e. Windows 2008-12, Linux. This position works closely with System Administrators, DBAs, and Application groups in solving problems, and is responsible for managing business critical servers, and NetApp and Network Appliance Storage and subsystems, for a variety of applications in 99.9% up-time configurations. Ensure systems are performing at peak levels; implement tools to monitor system performance. Provide regular maintenance for Unix OS(s), MS-Windows, VMware, and Pick/Universe databases; routine administration, upgrades, design implementation, and documentation support.&nbsp;</p><h4>Duties</h4><p>Install, maintain, and upgrade software and O/S on EMC and Net-App devices, Tivoli Storage Manager and Net Backup.</p><p>Perform storage analysis, UNIX tuning, and Pick/Universe tuning functions on a regular basis.&nbsp;</p><p>Provide project plans to support seamless implementations. Organize work sessions with support groups to ensure well-planned implementations.</p><p>Develop and maintain security access levels for UNIX and windows servers systems.</p><p>Develop and maintain standards for all UNIX systems and windows systems.&nbsp;</p><p>Design and implement a disaster recovery plan for the core UNIX systems.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Information Systems or Related FieldIn 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 3 years of experience in managing large scale computing environment running multiple platforms (RS/6000 AIX 5.2, LINUX Apache/Tomcat), Vmware vSphere 5.1 - 5.5.&nbsp; </p><p>Experience in development and implementation of Integration solutions for business application across multiple platforms on Windows, UNIX O/S and Linux environments.</p><h4>Skills</h4><p><b>Required:</b></p><p>Knowledge of Windows servers, VMware,&nbsp;HP servers, Email Secure File Transfer, file share, and VDI.</p><p><b>Preferred:</b></p><p>Knowledge of Tivoli Storage Manager, EMC Subsystems (TimeFinder, Powerpath, BCV), IBM LTO. </p><p>Ability in Scripting (PowerShell), backup, and cloud (Azure and AWS).</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                                                </p>

Systems Administrator II

<p><b>Salary Range:&nbsp;</b>&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Customer Solution Center Quality Auditor (QA) II is responsible for monitoring and actively influencing the Customer Solution Call Center team’s quality performance, ensuring that the quality requirements in place are fulfilled and the goals are consistently achieved. This position will analyze quality results and performance in order to identify and optimize processes and support staff development, in partnership with the Quality Assurance Management. This position will identify processes, situations, and opportunities where improvement is needed and be responsible for creating performance reports and action plans. The position will maintain a high level of based knowledge on benefits for all product lines (Medi-Cal, CMC, PASC, Healthy Kids and Covered California) as well as serve and act as the department's SME (Subject Matter Expert). This position will assist in the development of tools and procedures established to audit each vertical under the Customer Solution Center. In addition, this position will make recommendations for individual and group training/retraining and process improvements. This position will assist in the development of training materials delivered to various internal departments and off site Call Center vendor to measure product knowledge. As needed, this position will be assisting and conducting training for new onboarding QA staff and assist and support trainers with academy classes. &nbsp;</p><h4>Duties</h4><p><br>Conduct audits to ensure that regulatory and quality requirements were met across all verticals under CSC. Conducts random member audits and surveys to ensure the member experience has a positive outcome. Responsible for monitoring call center, including Call Center Leads, Outbound and Outreach, Ansafone, Web Inquiries, M.R.U. (Member Relations Unit), and Appeals and Grievance, performance against key performance indicators and recognizes trends that require individual or group retraining. Conducts/reviews audits and analyzes the data and documentation and provides their input to management for review. Tracks and trends daily error reports, analyze results from Call Center, MRP, Medicare, M.R.U., Outbound and Outreach, and L.A. Care Covered scorecards and recommend quality improvements for the CSC Department. Create and assist in developing Desk Level Procedures (DLP) for all supporting units. (65%)</p><p>Performs and assist with weekly calibrations. Assists with new hire training (CSC and QA) and/or up training, assess class curriculum, Desk Level Procedures (DPL), and recommend changes as necessary. Compiles quality data on a daily/monthly basis to measure compliance with internal policies and procedures as well as regulatory requirements. Reviews quality reports, outcomes, recommends corrective action plans as needed and reports irregularities or vulnerabilities to appropriate parties as deemed necessary. &nbsp;Frequently compiles quality data to measure compliance as well as regulatory requirements. Review quality reports, outcomes, recommend corrective action plans as needed and report irregularities or vulnerabilities to appropriate parties as deemed necessary. &nbsp;(15%)</p><p>Provides 1:1 Coaching Assessments to all pertinent departments. Consistently participates in quality initiatives and special project task forces as deemed necessary. Works with unit managers to develop quality tools to monitor potential departmental vulnerabilities (Membership Accounting, Call Center Unit, Outbound and Outreach, and Member Relations Unit). Provides unit managers and departmental director with analysis on the error trends and provide recommendations for improvements. Serves as the subject matter expert for all Lines of Business (Medi-Cal, CMC, PASC/SEIU, Healthy Kids, L.A. Care Covered...); in addition to programs used at L.A. Care: MHC, MEIS, QNXT, QMEIS, IVR, NICE, MEDACCESS, TTY, SALESFORECE, MEDIASENSE, CISCO FINESSE, WEX CALLBACK and RETRO Process, AEVS, IHSS Website, and Provider Search Oracle. Reviews targeted audit text documentation (MIU, CC, MRP and Member Relations) and update quality screens via NICE/Access/MHC/MEIS/QMEIS software. The QA is also responsible for assisting Call Center with call intake as needed. (10%)</p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p><br><b>Required:</b></p><p>At least 2 years of quality assurance experience preferably in healthcare's Member Services or Quality Assurance. </p><p>Knowledge of and experience of Medi-Cal, Medicare, and Covered California.</p><h4>Skills</h4><p><br><b>Required:</b><br>Good oral and written communication skills.&nbsp;</p><p>Strong analytical skills, excellent technical skills and attention to detail.&nbsp;</p><p>Excellent technical skill.</p><p>Strong research skills.</p><p>Intermediate knowledge of MS Office.</p><p>Ability to coach and train employees.</p><p>Working knowledge of a CRM, AEVS, and other benefit eligibility programs.</p><p><br><b>Preferred:</b><br>Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>American Society for Quality - Certified Quality Auditor (ASQ - CQA) Certification<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>                    Medicare, Call Center, Audit, Healthcare, Customer Service, Finance                                                    </p>

Customer Solution Center Quality Auditor II

<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><br>The Internal Auditor III prepares audit programs and conducts audit reviews of assigned areas, including performing various audit procedures and documents in findings in work papers in accordance with department standards. Identifies internal control weaknesses, develops audit recommendations and drafts written reports. Provides independent evaluations of operational and financial controls, policies, and procedures. Prepares audit report detailing findings and recommendations. Performs and coordinates follow-up audits to determine if management has taken action to mitigate risks identified. Participates in special reviews as necessary.Acts as a &nbsp;Subject Matter Expert, serves as a resource and mentor for other staff.&nbsp;</p><h4>Duties</h4><p>Develops audit programs and testing procedures relevant to risk and test objectives. Provides independent evaluations of operational and financial controls, regulatory compliance, policies, and procedures. Prepares work papers, observations and reports and related documents following department standards.</p><p>Prepares audit programs and conducts audit reviews of assigned areas, including performing various audit procedures and documenting findings on work papers. Obtains and reviews evidence ensuring audit conclusions are well-documented. </p><p>Identifies internal control weaknesses, non-adherence with regulatory requirements, develops audit recommendations and drafts written reports. Identifies and communicates issues raised, offering recommended solutions relevant to business and risk. Ensures audit conclusions are based on a complete understanding of the process, circumstances, and risk. </p><p>Performs and coordinates follow-up audits to determine if management has taken action to mitigate risks and findings identified.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Participates in special reviews as necessary.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Accounting or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong><br>At least 5 years of public or private accounting or audit experience, preferably in health care or other highly regulated industry.</p><h4>Skills</h4><p><br><b>Required:</b><br>Knowledge of finance, accounting and control principles, including GAAP and GAAS.</p><p>Excellent MS Office skills, including in Word, Excel and PowerPoint.</p><p>Ability to observe and understand business processes ensuring processes are documented completely and accurately.</p><p>Ability to apply audit standards through practical application.</p><p>Proactive in researching business best practice concepts in order to apply as appropriate.</p><p>Solid listening skills and ability to identify gaps in logic – inquisitive.</p><p>Strong organization and follow up skills including the ability to handle competing priorities and meet all deadlines and commitments.</p><p>Possess an appropriate combination of technical expertise in fields such as auditing, finance, technology, operations, or investigations.</p><p>Ability to flourish in a fast-paced, complex environment and willing to adapt to change.</p><p>Ability to give and follow instructions accurately and efficiently; proactive in asking clarifying questions to ensure work effort is directed wholly toward desired outcome.</p><p>Ability to recognize when learned theoretical concepts should be applied.</p><p>Solid understanding and ability to apply risk and control concepts</p><p>Ability to identify underlying cause of an issue raised.</p><p>Good awareness of other departments in the company with risk, control, and governance responsibilities and what is necessary for successful tactical collaboration and information sharing.</p><p>Good communication skills along with good or developing negotiation skills.</p><p>Ability to identify sensitive issues and facilitate communications in a proactive manner to avoid surprises.</p><p>Willingness and ability to adapt to new circumstances, information, and challenges.</p><p>Executes effective and thorough application of all internal audit standards within assigned responsibility.</p><p><b>Preferred:</b><br>Knowledge of Sarbanes-Oxley and COSO guidelines and requirements.</p><p>Risk assessment practices.</p><h4>Licenses/Certifications Required</h4>Certified Public Account (CPA) or Certified Internal Auditor (CIA) or Cerfitified Fraud Examiner (CFE) or Certified Information Systems Auditor (CISA)<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>                    Internal Audit, Risk Management, Accounting, CPA, Audit, Finance                                                    </p>

Internal Auditor III

<p><b>Salary Range:&nbsp;</b>&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Provider Data Quality Auditor II is responsible for the timely and accurate uploading of L.A. Care's provider network data, including identification and remediation of provider data errors. The Provider Data Quality Auditor must foster positive working relationships with both internal and external business partners, including L.A. Care's contracted independent Practice Association (IPAs), Medical Groups and Plan Partners. This position must make independent decisions to ensure data quality measures, timelines and organizational policies are met related to provider network data. The position is responsible to conduct ongoing data quality auditing of L.A. Care's provider network data, including working with their assigned provider network accounts to remediate provider data errors.</p><h4>Duties</h4><p>Work in a metric driven environment and is expected to understand and work in accordance with all department and company provider data metrics. Work with contracted partners to ensure timely, accurate and successful submissions of all required provider data elements via the Sender Policy Framework (SPF)/Provider Add Change Delete Workflow (PCDW) tasks by continuous provider network data quality oversight and auditing activities. Must work to identify and triage all provider data quality issues. Responsible to ensure that Senate Bill 137 requirements are met, by meeting mandated update periods for the provider’s name, practice location or locations, and contact information. Responsible to manage and oversee all Data Fallout reporting as a result of SPF submissions from L.A. Care’s contracted entities (IPAs, Medical Groups, Plan Partners, and Vendors). Knowledgeable of reporting formats for use in continuous data auditing, independent analysis of audit results, including root-cause analysis. &nbsp;Must be well-versed in written and verbal communications and is responsible for interacting with contracted partners and provide training and coaching activities to improve overall compliance with the SPF submission. (35%)</p><p>Responsible for fostering and maintaining positive working relationships with contracted partners and providing training and coaching activities to improve overall data accuracy. Must work collaboratively with Contracting and Relationship Management Account Managers to ensure that all provider data standards are met in accordance with contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures, including IPA and Medical Group terminations. (15%)</p><p>Responsible to follow and execute appropriate procedures when administering provider data system overrides. Responsible to manage provider data quality issues for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. Responsible for understanding all data related contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures and responsible to assist and train contracted partners about this information on an as needed basis. (20%)</p><p>Must have a strong knowledge of Provider Relations and a understanding of how Independent Practice or Physician Association (IPA) and Medical Groups operate. Manage data quality information for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. (15%)</p><p>Manage and oversee all provider data fallout, including reporting of root-cause and resolution. &nbsp; (5%)</p><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p><b>Required:</b></p><p>Minimum of at least 2 years of work experience in healthcare or related industry.</p><p>At least 2 years working with data.</p><p>Provider Network interaction experience.</p><p><b>Preferred: &nbsp;</b><br>Provider Relations, management or sales experience.</p><p>Policy and procedure and desktop manual development experience.</p><h4>Skills</h4><p><strong>Required:</strong><br>Excellent communication skills, strong analytical skills, and ability to build strong customer relationships, including the ability to work effectively with diverse team members.</p><p>Ability to perform root-cause analyses and recommend effective alternative solutions to handle Provider and Member inquiries, and to provide optimal customer service for internal and external customers.</p><p>Ability to multitask in a face-paced work environment and recommend process improvement measures for day to day operations, wherever possible.</p><p>Strong PC skills (Word, Excel, Project, etc.)</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>                    Relationship Manager, Audit, Customer Service, Finance                                                    </p>

Provider Data Quality Auditor II

<p><b>Salary Range:&nbsp;</b>&nbsp;$105,267.00&nbsp;(Min.) -&nbsp;$139,478.00&nbsp;(Mid.) -&nbsp;$173,689.00&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 Technical Analyst III serves as the requirements project lead, working with the solutions architects, developers, business owners and stakeholders on all domains. The position is responsible for providing key client relationship management of projects and is accountable for consulting with the businesses to understand their business goals and objectives, processes, and requirements. Additionally, the incumbent leads small to medium projects, mentors other Technical Analysts, represents the department manager, coordinates design sessions, creating process/data flow diagrams and documenting project efforts. The Technical Analyst III functions as a liaison between the developmental team and business owners as they collect, clarify, and translate business requirements into documentation and conceptual design, from which applications and solutions are developed. In addition to developing functional requirements and specifications, the Technical Analyst III is also responsible for providing guidance on the day to day activities of the other Technical Analysts, both staff and contractors. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Lead, plan and coordinate Technical Analyst activities within the department.</p><p>Support large complex projects and /or multiple smaller projects.</p><p>Liaison between I.S. Business Solutions developmental team and business clients gathering and defining requirements.</p><p>Facilitate requirements gathering sessions, including leading discussions, managing group dynamics, and maintaining group focus, to work towards accomplishing goals and objectives.</p><p>Coordinate JAD (design) sessions with business units, I.T. developers and QA resources.</p><p>Mentor, coach, and develop staff to meet and exceed performance expectations.</p><p>Create and modify analytical documents to support the engineering team including flow charts and functional decompositions.</p><p>Provide clarification of requirements to other project team members to assist in the creation of specific project deliverables.</p><p>Provide analytical support to drive project decisions and production support as needed. </p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned. </p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Computer Science or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b><br>Minimum of 5 years of Analyst experience.</p><p>Prior healthcare insurance payer experience.&nbsp;</p><p>Hands on experience working with enterprise warehouse and OLTP databases.</p><p><b>Preferred: &nbsp;</b><br>Minimum of 7 years of Analyst experience working in mixed AGILE and traditional environment I.T. environment.</p><h4>Skills</h4><p><b>Required:</b><br>Strong teamwork and interpersonal skills to work well on cross-functional project teams in a leadership role.</p><p>Strong communications skills, written, verbal, listening and responding.</p><p>Ability to quickly understand and assess business needs in addition to strong data evaluation and data mapping skills.</p><p>Strong demonstrated problem solving skills.</p><p>Strong Data Analytical skills, working with SQL Server.</p><p>Demonstrated ability to create succinct flowcharts.</p><p>Ability to facilitate business and technical design sessions.&nbsp;</p><p>Strong ability to work with minimal supervision. &nbsp; &nbsp; &nbsp;&nbsp;</p><p>Demonstrated ability to lead successfully and motivate a team.</p><p>Ability to build good relationships with clients/operational leadership and colleagues.</p><p>Ability to gather and assimilate information.</p><p>Current knowledge of technical applications.</p><p>Good knowledge of quality standards, legislation and best practices.</p><p>Ability to adapt and prioritize.</p><p>Demonstrated ability to work under pressure and meet deadlines.</p><p>Ability to think ahead, anticipate issues and provide solutions.</p><p>Ability to quickly learn new tools and technologies.</p><p>Knowledge of Microsoft Office applications such as Word, PowerPoint, Excel and Visio.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified ScrumMaster (CSM)<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>                    Relationship Manager, Customer Service                                                    </p>

Technical 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 Utilization Management (UM) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission requests and higher level of care (HLOC) transfer requests from inpatient facilities within regular timelines. Reviews clinical data in real-time and post admission to issue a determination based on clinical criteria for medical necessity. Assures timely, accurate determination and notification of admission and inter-facility transfer requests. Generates approval, modification, and denial communications for inpatient admission requests. Actively monitors for appropriate level of care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires extended review. Collaborates with the inpatient care team for facilitation/coordination of patient transfers between acute care facilities. Acts as a department resource for medical service requests/referral management and processes. Actively participates in the discharge planning process, including providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to the inpatient review team as necessary to ensure timely processing of concurrent reviews.</p><h4>Duties</h4><p><br>Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/post-stabilization admission requests, Higher level of care transfers and other emergent transfers or needs. Ensures appropriate determination for admission requests/HLOC transfers based on clinical data presented and established criteria/guidelines, escalating to the medical director if needed. &nbsp;Triages and assesses members for admission needs, including, but not limited to, bed and accepting physician availability. (40%)</p><p>Establishes and maintains ongoing communication with internal stakeholders and external customers while securing the L.A. Care member's admission or inter-facility transfer. &nbsp;Interfaces with physicians, house supervisors, and other hospital delegates to ensure that telephone triage results in appropriate patient placement. (10%)</p><p>Applies clinical expertise and the nursing process to triage and prioritize admission acuity, servicing as an expert clinical resource for patient placement while utilizing medical knowledge and experience to facilitate consensus-building and development of satisfactory outcomes (10%)</p><p>Continually seeks new ways to improve processes and increase efficiencies. Takes the initiative to communicate recommendations to UM Leadership. (5%)</p><p>Completes all inpatient and discharge planning requests appropriately and timely including, but not limited to: &nbsp;Skilled nursing facility, outpatient needs (home health, physical therapy, infusion), and case management referrals (5%)</p><p><br>Performs prospective, concurrent, post-service, and retrospective claim medical review processes. Utilizes clinical judgement, independent analysis, critical-thinking skills, detailed knowledge of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. Identifies requests needing medical director review or input and presents for second level review (20%)</p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p><b>Required:</b><br>Minimum of 7 years of clinical experience in an acute hospital setting.&nbsp;</p><p>Previous experience to have a strong understanding of Utilization Management/Case Management practices including, but not limited to, placement (with level of care) criteria (MCG, InterQual), concurrent review, and discharge planning.</p><p><b>Preferred:</b><br>Consistent Critical Care experience (Emergency Department, Intensive Care, Labor &amp; Delivery) background highly desirable.</p><p>Experience in bed placement decision-making highly desirable.</p><h4>Skills</h4><p><b>Required:</b><br>Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint. &nbsp;</p><p>Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team &nbsp;</p><p>Knowledge of personal computer, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Prepare clear, comprehensive written and oral reports and materials.&nbsp;</p><p>Excellent time management and priority-setting skills.</p><p>Maintains strict member confidentiality and complies with all HIPAA requirements.</p><p>Strong verbal and written communication skills. &nbsp; &nbsp;</p><p><b>Preferred:</b><br>Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM.&nbsp;</p><p>Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Certified Case Manager (CCM)American Case Management Association (ACM)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Required:</b><br>Attend mandatory department trainings as scheduled</p><p>Financial Impact: Management of all medical services has a tremendous potential impact on the cost of health care and budget. This position manages determinations to ensure services requested are medically appropriate and provided in the most cost effective manner without compromising quality healthcare delivery.</p><p>Types of Shift: &nbsp;Day (7:00am - 3:30pm), Evening (3:00pm -11:30 pm), Night (11:00pm -7:30am).&nbsp;<br>Float (Varies)*<br>*All possible shifts.</p><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nursing, Registered Nurse, ICU, Emergency Medicine, Physical Therapy, Healthcare                                                    </p>

Utilization Management Admissions Liaison RN II

<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 Community Resource Center (CRC) Specialist II supports in building relationships with members of the community, L.A. Care departments, and Blue Shield of California Promise Health Plan staff (under a collaborative partnership agreement), community based agencies, government agencies, and CRC vendors and instructors. The role supports community and provider communication and engagement initiatives to increase member traffic at a CRC and provides information to members of the community to physical and health education programs, classes and resources. Acts as a key partner to support the CRC marketing and promotional initiatives to meet operational needs. Follows workflows to refer members to receive services across L.A. Care departments that support a member's health care journey to promote positive health care outcomes. Helps connect members and community participants in understanding health care access issues, identifies resource needs based on social drivers resulting from member inquiries and health assessments, and refers to the appropriate source for subject matter assistance. Provides ongoing member assistance and follow-up in select cases. Works in partnership with L.A. Care health plan departments to provide customer service, social services support, care management, health education resources, behavioral health, member engagement marketing and communication, relies on line of business product knowledge and business insight. The CRCs serve anyone in the community in which they are located; and therefore, this role will provide support on referral processes to connect non-member cases to the appropriate external resources and collaborate with key stakeholders across L.A. Care in support of positive outcomes for members.</p><p>Supports the planning and development, implementation, and analysis of CRC services, programming, and vendor management. This role may support special projects following directions and instructions from a work plan, technical procedures, and relationship management ensuring successful implementation of CRC initiatives. </p><h4>Duties</h4><p><b>Day-to-Day Representation: (25%)</b><br>Supports the coordination of member-centric customer service to respond and resolve inquiries and questions and bridges members to appropriate resources. &nbsp;Provides guidance and support to inform, guide, and educate members, community residents, and other stakeholders regarding health education programs, benefit information, resources and support available at L.A. Care and partner health plan benefits, CRC resources to meet the member/visitor needs. Collaborates with team members to create resource guides and reference materials. &nbsp;Implements the appropriate approach to identify member or visitor resource needs in complex situations and takes action to link the member/visitor to the appropriate services, programs, or resources. Actively identifies gaps in CRC services, resources, and programs, delivers recommendations for new programs and proposes solutions for the implementation of new services. &nbsp;Participates in day-to-day work operations including opening and closing of the CRC, ordering and maintaining of office supplies, and inventory. Supports CRC vendors which deliver facility maintenance. Coordinates, maintains, and schedules CRC calendar and conference rooms, including management of appointments. Prepares conference/training rooms and assists with support services, as needed. Answers incoming calls in a timely and professional manner. &nbsp;</p><p><b>High-Touch Customer Focus: (25%)&nbsp;</b><br>Performs high quality in-person service and contributes to the extended-hour schedule of the CRC to support members and visitors that may need services outside of regular operating hours and days based on business needs. Implements child development activities and programs to support children development while parents and guardians attend a class or service appointment at the CRC. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p><p><b>Cross-Collaboration: (20%)</b><br>Supports community initiatives maintaining good relationships within L.A. Care and Blue Shield Promise Health Plan, and with community stakeholders to promote access to health care programs, classes, and preventative services offered at the CRC. &nbsp;Provides information to other L.A. Care departments on services and activities that resonate with and engage members of the CRC community based on hands-on experience at the Center.</p><p><b>Outreach and Engagement: (15%)</b></p><p>Supports and nurtures relationships with key internal and external stakeholders; and, is an ambassador to promote CRC partnership brand recognition. &nbsp;Establishes relationships with key community stakeholders, informs management on community needs, and enters data to inform an integrated approach to outreach activities and targeted member engagement. &nbsp;Supports planning, development, implementation, and analysis, of member and community engagement activities to increase member traffic at the supports outreach and engagement activities to attract new L.A. Care and partner health plan members into the CRC to participate in services and programs. Provides feedback to bridge members of the community to physical and health education programs and classes which will enhance health outcomes and member experience. &nbsp;Supports communications and marketing efforts through multiple platforms to increase member traffic at assigned CRC.</p><h4>Duties Continued</h4><p><b>Implementing Strategic Initiatives: (15%)</b><br>Supports the implementation of special projects which include identifying the scope of work responsibilities, accountabilities, deliverables, key milestones, timelines, and specific tasks that &nbsp;must be completed in order to ensure project, initiatives, and events are successfully implemented within the required timeframe.<br>Supports in monitoring risks and provides recommendations for management to implement mitigation plans to keep initiatives on-track. &nbsp;Collaborates in the maintenance of consistent documentation of project deliverables, tracks and reports project status. &nbsp;&nbsp;</p><p>Performs other duties as assigned. (10%)</p><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p><b>Required:</b><br>At least 6 months of community work focused on health care, public health, or health education, OR at least 6 months of operations work experience, community events, leading projects, and supporting relationships with multiple stakeholders.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<br>Experience with data entry and reporting processes.&nbsp;</p><p><b>Preferred:</b><br>Previous experience in child development activities. &nbsp;</p><h4>Skills</h4><p><b>Required:</b><br>Ability to communicate verbally and in writing.</p><p>Organizational skills.</p><p>Detail-oriented, collaborative and enthusiastic team player.&nbsp;</p><p>Ability to assist with inquiries and identify creative solutions to assist members and community stakeholders.</p><p>Ability to troubleshoot problem areas and support effective alternative solutions and provide optimal customer service for internal and external customers.</p><p>Action oriented attitude to take on new opportunities and rewarding challenges with a sense of urgency, high energy, and enthusiasm.</p><p>Ability to multi-task and meet competing deadlines while maintaining attention to detail and accuracy.</p><p>Ability to work independently or as part of a diverse team while applying business-insight as well as empathy towards members.</p><p>Initiative to act on anticipated business needs in the operational and customer service areas.<br><br>Ability to adapt quickly to a fast-changing environment.</p><p>Knowledge of MS Office including Outlook, Word, Excel, and PowerPoint</p><p>Excellent customer service skills.</p><p>Interpersonal skills, ability to read non-verbal cues and apply situational adaptability skills.</p><p>Ability to make sound decisions with incomplete information.</p><p><b>Preferred:</b><br>Experience with the Salesforce Customer Relationship Management (CRM) platform</p><p>Knowledge and understanding of the unique needs of the Medi-Cal beneficiary populations within a social service, healthcare, not-for-profit, or government setting.&nbsp;</p><p>Knowledge of public agencies, organizations, and other resources that support Community Resource Center visitors.</p><p>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.</p><h4>Licenses/Certifications Required</h4>Cardiopulmonary Resuscitation (CPR) Certified within 120 days of hire.<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p>Within 120 days of hire: Cardiopulmonary resuscitation (CPR) and California Mandated Reporter. </p><p>Management of Aggressive Behavior (MOAB), de-escalation techniques training, safe lifting practices training. Emergency Action Plan (EAP).</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Required:</b></p><p>Travel to offsite locations for work.</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>                    Behavioral Health, Data Entry, Relationship Manager, Public Health, Social Services, Healthcare, Administrative, Customer Service, Service                                                    </p>

Community Resource Center Specialist II

<p><b>Salary Range:&nbsp;</b>&nbsp;$105,267.00&nbsp;(Min.) -&nbsp;$139,478.00&nbsp;(Mid.) -&nbsp;$173,689.00&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 .Net Developer III is responsible for the design and development of .NET applications, must maintain effective security aligned with Health Insurance Portability and Accountability Act, state and federal requirements; Develop and maintain databases in support of our developed .NET applications.&nbsp; Perform daily administration of .NET Servers and organizational Intranet system.&nbsp; Ensure all database projects and processes are fully documented.&nbsp; Complete technical documentation for all database projects and processes.&nbsp; Apply learned knowledge in software application development and database administration while utilizing: Microsoft .NET, ASP.NET and other applications and tools to work in multi-computing environments including UNIX, Linux, and AIX. Apply learned knowledge in software applications development and database administration. </p><p>The .Net Developer III must also ensure that documentation is created for system designs and modifications, and assist collaboratively in following the established software development life cycle procedures to develop, test and modify system software, utilities; support integrations with other applications by coding, reviewing, preparing test data, testing and debugging, in order to ensure that the developed software is robust and meets user functional and performance requirements. Must develop, foster and maintain an open, professional relationship with other team members within IT and also with other departments to enhance team effectiveness and efficiency and customer satisfaction. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Lead and evaluate seeking solutions to production issues as well as new projects. Lead and work closely with applications developers in solving production issues. Successful resolution of production issues. Successful relationship with application developers.</p><p>Prepare short and long term plans to address infrastructure projects as well as support and provide technical leadership for internally/externally sponsored company projects. Successful leadership for the resolution of production issues. Successful relationship with application developers.</p><p>Recommend schedules for database upgrades; assist in the planning and implementation of major software upgrades; adhere to change management procedures and methodologies.</p><p>Ensure all database projects and processes are fully documented, and that complete technical documentation exists for all database projects and processes.</p><p>Develop and maintain databases in support of our developed .NET applications.&nbsp; Perform daily administration of .NET Servers and organizational Intranet system.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Information Technology or Computer ScienceIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Information Technology or Computer Science<h4>Experience</h4><p><b>Required:</b></p><p>At least 5 years of experience in a technical function creating and maintaining .Net databases and software applications. </p><p><b>Preferred:</b></p><p>Experience on Managed Health-care Information systems, subsystems and applications.</p><h4>Skills</h4><p><b>Required:</b></p><p>Excellent and extensive knowledge of .Net systems.</p><p>Must have the ability to code complex .Net packages, functions, and procedures.</p><p>Solid communication skills (oral, written, and presentation) and strong interpersonal skills required.</p><p>Must have a very high ability to learn new things, especially about new technology developments. </p><p>Ability to accurately set and adhere to deadlines.</p><p>Ability to prioritize projects and workload. </p><p>High level of independent judgment.</p><p>Must be flexible, organized, and able to handle multiple tasks simultaneously. </p><p>Strong project management skills.</p><p>Must understand Managed Health Care Information systems, subsystems and applications. </p><p>Must develop, foster and maintain an open, professional relationship with other team members within IT and also with other departments to enhance customer satisfaction.</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                                                </p>

.Net Developer 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 Enterprise Risk Adjustment Analyst III provides a key leadership role in the Risk Adjustment Department by independently determining and recommending the source/type of data to be used, design/method in which to create reports or conduct analysis to address business objectives, and recommendations for course of action.&nbsp; </p><p>This position works in collaboration with the Enterprise Risk Adjustment department leadership and provides leadership/guidance in matters related to data processing, data storage, and data architecture. The position provides guidance and direction to the analyst, internal and external stakeholders with regards to reporting and analytics.</p><p>Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Serves as Subject Matter Expert (SME) for the data processing, reporting, and analytics required to support the Risk Adjustment department operations Chief Architect for reporting and analytics in support of Risk Adjustment operations for multiple lines of businesses. Serves as key contact for both internal (L.A. Care) and external (Vendors, regulatory agencies, etc.) requestors for Risk Adjustment data and reporting. Works with the risk adjustment vendors and keeps up to date on the latest risk adjustment changes that regulatory bodies pass on to health plans as it relates to reimbursement reporting requirements. Brings identified concerns to the Manager with recommendations for resolution.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Creates and produces summary reporting artifacts to give the Risk Adjustment Department the ability to monitor its performance. Provides guidance and direction to the analyst, internal and external stakeholders with regards to reporting and analytics. Conducts and provides analytical insight to gaps in performance.&nbsp; </p><p>Continuously monitors and reviews the daily operations to identify areas of improvement and for automation process. Designs and creates processes for data extraction, summaries, and higher level analytic functions to create and use on data queries and stored procedures. Creates and maintains database for the Risk Adjustment team to improve the workflow in various operational areas of risk adjustment.</p><p>Understands the end to end requirements for XML and 837 data processing channels to provide impact analyses from regulatory changes to these processes, and data reconciliation gaps.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong><br>At least 5 years of experience working in a risk adjustment role with increasing responsibilities and working with data submitted to regulatory agencies, and the return reports received from same.</p><h4>Skills</h4><p><b>Required:</b><br>Ability to consult with senior management help define business objectives and recommend analysis approach to address these objectives.</p><p>Ability to provide expertise on analytic, programmatic, and process changes that is a response to changing business needs.</p><p>Ability to query from various internal databases and external vendors systems in order to write/build/develop needed data to perform higher level of analytics to address business objectives. Provide recommendations to senior leadership based on analytics outcome.</p><p>Knowledge of risk adjustment processes for multiple lines of business.</p><p>Reporting and analytics experience of SQL Server, Visual Studio 2012, Oracle, Microsoft Access and Excel.</p><p>Knowledge of MS Word, Adobe Reader, PowerPoint programs.</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>                    Risk Management, Finance                                                    </p>

49 L.A. Care Health Plan Jobs