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<p><b>Salary Range:&nbsp;</b>&nbsp;$171,925.00&nbsp;(Min.) -&nbsp;$232,100.00&nbsp;(Mid.) -&nbsp;$292,274.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Senior Director of the Enterprise Portfolio Management Office (EPMO) provides strategic leadership and enterprise-wide oversight for organizational project management, process improvement, planning management, including Business Solutions, IT solutions and enterprise project and program execution in alignment with L.A. Care’s strategy, goals, and regulatory obligations. This role ensures that the PMO functions as a strategic driver of organizational success, leading execution of initiatives, aligning projects and technology solutions with business objectives and long-term strategy. The Senior Director establishes EPMO governance, prioritizes initiatives across the portfolio, and fosters a culture of accountability, efficiency, and innovation.</p><p>This role is responsible for executing comprehensive program plans, outlining program objectives, scope, timelines, budgets, and resource allocation for large, multi-workstream enterprise and IT efforts. The Senior Director will coordinate with cross-functional teams and stakeholders to ensure seamless execution of complex program activities, while identifying and mitigating potential risks and issues throughout the program lifecycle.</p><p>For this role, the difference lies not just in managing projects, but in leading them through to execution, breaking organizational siloes, making smart resource allocations, and providing insight-rich reporting to leadership. This role is focused on adaptable execution in a fast-paced and changing health care environment. The role will be responsible for executing in alignment with L.A. Care’s strategic plan, and coordinating IT Development and Business Solutions required to meet strategic, compliance, and regulatory requirements. The Senior Director is adept at translating big-picture vision into action and communicating across strategic, operational, clinical, and IT teams. The role will need to communicate complex project goals, challenges, and successes to a wide variety of audiences. </p><h4>Duties</h4><p><b>Enterprise EPMO Leadership</b></p><ul><li>Lead the development and execution of an enterprise-wide PMO strategy with action-oriented project leadership and alignment with organizational strategic plan.</li><li>Establish and oversee governance frameworks, processes, and reporting standards for consistent project and portfolio execution.</li><li>Monitor progress with regular reviews and clear escalation paths to remove bottlenecks and accelerate timelines.</li><li>Drive enterprise portfolio management, prioritizing projects and resources to maximize business value.</li><li>Provide transparency to the Senior Leadership Team through KPIs, dashboards, project heatmaps, and progress reporting on enterprise initiatives.</li><li>Lead cross-silo collaboration: proactively engage and partner with business and functional leaders (e.g. medical management, member services, IT, finance) and external partners to ensure initiatives support organizational transformation, change management, and excellence.</li><li>Build business case summaries for initiatives, showing projected returns, community impact, and needed investments. </li><li>Optimize workflow management and data integration of all core functions (delegated and non-delegated) ·</li><li>&nbsp;Coordinate development and implementation of agile improvements in a logical, sustainable and measurable manner</li></ul><p><b>Department Oversight (IT Development, Business Solutions, Project Management)</b></p><ul><li>Direct IT Development to ensure delivery of reliable, scalable, and secure technology solutions.</li><li>Direct Business Solutions in evaluating needs, developing tools, and enabling process improvements across departments.</li><li>Oversee the Project Management team in applying best practices and methodologies (Agile, Waterfall, Hybrid) to ensure projects are delivered on time, within scope, and within budget.</li><li>Overall, regularly reassess assignments to ensure the most skilled and relevant teams are supporting the highest value projects, adjusting for changing needs, allocate departmental resources based on strategic priorities, not just availability, and clearly define responsibilities, ensuring teams know what is expected and how their contributions fit into project delivery.</li></ul><h4>Duties Continued</h4><p><b>Strategic &amp; Operational Responsibilities</b></p><ul><li>Deliver actionable insights to leadership for decision making, ensuring line-of-sight on risks and trade-offs to allocate resources as necessary.</li><li>Ensure business continuity, risk management, and change management practices are integrated into project execution.</li><li>Champion a culture of innovation, continuous improvement, and cross-departmental collaboration.</li><li>Develop talent and succession planning strategies within PMO, IT Development, and Business Solutions functions to ensure strong leadership pipelines and staff development.</li><li>Use formal evaluation processes to rank initiatives by impact and value to members and the business.</li></ul><p>Performs other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Business Administration or Public Administration or related field<h4>Education Preferred</h4>Master's Degree in Business Administration or Organizational Leadership or related field<h4>Experience</h4><p><b>Required:</b></p><p>At least 9 years of progressively responsible experience in project or program management roles.</p><p>At least 8 years of leading, supervising or managing staff.</p><p>At least 5 years minimum working directly within a health plan or managed care organization; experience in Medicaid or government-sponsored health insurance programs is essential.</p><p>At least 5 years of direct PMO leadership or senior project/program management experience—demonstrated track record of managing complex portfolios, leading cross-functional teams, and driving results at scale.</p><p>Successful experience in engagement with value-based care, population health initiatives, regulatory compliance, or member engagement programs.</p><p>Proven experience in portfolio prioritization, governance, and executive-level stakeholder engagement with positive outcomes.</p><p>Experience in both technology-driven and organizational change initiatives, with a strong focus on IT Development and Business Solutions.</p><p>Budget, vendor, and resource management experience at enterprise scale.</p><p><b>Preferred:</b></p><p>Experience in California Medicaid (Medi-Cal) or L.A.-based plans.</p><p>Familiarity with regulatory agencies (CMS, DHCS, DMHC), L.A. Care, and regional health/public health partnerships.</p><h4>Skills</h4><p><b>Required:</b></p><p>Ability to strategically align enterprise initiatives with organizational mission and vision.</p><p>Advanced knowledge of project, program, and portfolio management methodologies.</p><p>Highly advanced organization and project management skills.</p><p>Strong conceptual and planning skills to analyze projects of broad and diverse scope.</p><p>Strong understanding of IT systems development, business process optimization, and enterprise change enablement.</p><p>Skilled in executive communication, presentation, and relationship management.</p><p>Strong skills in using influence and persuasion to communicate with diverse stakeholders.</p><p>Ability to adapt to changing priorities, needs, and industry contexts. </p><p>Capacity to anticipate obstacles and plan for contingencies. Understands the cost impact of projects, project tracking tools and metrics.</p><p>Strong leadership, mentoring, and talent development capabilities. Strong team development skills and mentorship to develop project leaders within the department.</p><p>Strong analytical, business and financial acumen to measure ROI and optimize resources.</p><p>Advanced problem-solving skills: ability to uncover root of difficult problems and scope solutions based on knowledge of available resources and timelines as well as awareness of vision and strategy.</p><p>Expertise in risk management, organizational change, and cross-functional collaboration.</p><p>Able to establish and advance positive working relationships and a strong rapport with a diverse community of colleagues including team members, stakeholders, and community partners.</p><p><b>Preferred:</b></p><p>Demonstrated knowledge of Medicaid and the safety-net workforce.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Project Management Professional (PMP)Portfolio Management Professional (PfMP)Lean Six SigmaInformation Technology Infrastructure Library (ITIL) Certificationand/orOrganizational Change Management (OCM) 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>                    Medicaid, Public Health, Risk Management, Relationship Manager, Office Manager, Healthcare, Finance, Customer Service, Administrative                                                    </p>

L.A. Care Health Plan

Senior Director, Enterprise Portfolio Management Office

<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;$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 Specialty Health Plans Auditor III, Finance, is offering a $5,000 Sign-On.&nbsp; This role is responsible for all aspects of planning, execution, reporting, and corrective action plans, monitoring of financial solvency for specialty health plans and vendors. This includes medical, vision, dental, behavioral health, transportation, and telehealth services providers. &nbsp;These audits are intended to ensure that L.A. Care delegates comply with applicable regulatory requirements and L.A. Care contractual agreements across all lines of business.</p><p>Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Performs financial audits and/or financial analyses for Specialty Health Plans on a quarterly and annual basis.</p><p>Performs financial analyses for L.A. Care vendors on a quarterly and annual basis.</p><p>Provides timely and accurate deliverables to ensure financial solvency and claims processing compliance with regulatory and contractual requirements for plan partners, participating provider groups, capitated hospitals, specialty health plans, and vendors.</p><p>Collaborates in the creation and implementation of standardized audit workpaper and reporting templates.</p><p>Is cross-trained on financial solvency reviews for Participating Physician Group (PPGs), PPs, and capitated hospitals.</p><p>Reviews and updates annually the department’s Policies and Procedures (P&amp;Ps). &nbsp;Ensures that any new or updated Policy and Procedure is reviewed and approved by management before submission.&nbsp;</p><p>Supports the formalization of key internal processes and monitoring tools.</p><p>Accountable for the completion of requests from the Legal Department, Delegation Oversight’s monitoring oversight and reporting.</p><p>Responsible for the overall communication and collaboration with interdepartmental personnel, leadership, specialty health plans, and vendors.</p><p>Collaborates on the design, implementation, and reporting of special projects.</p><p>Collaborates on the design and implementation of reports and tools for corrective action plan issuance and non-compliance notifications.</p><p>Collaborates on the assessment, communication, and implementation of regulatory requirements that may impact internal processes.</p><h4>Duties Continued</h4><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>Performs other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Finance or Accounting 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>Required:<br>At least 4 years of experience in conducting financial audits. &nbsp;</p><p>At least 5 years of related experience in the managed health care industry. &nbsp;</p><p>Preferred:<br>Health Care experience.</p><h4>Skills</h4><p><b>Required:</b></p><p>Excellent analytical and critical thinking skills.</p><p>Action-oriented, self-starter, and excellent motivator.</p><p>Excellent verbal and written communication skills.</p><p>Able to prioritize assignments, and able to independently with minimum supervision. </p><p>Ability to interface professionally with both internal and external customers at all levels of the organization.</p><p>Proficiency in Microsoft Office (Excel, PowerPoint, and SharePoint).</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>Physical Requirements</h4>Light<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>                    Audit, Medical, Internal Audit, Behavioral Health, Accounting, Finance, Healthcare                                                    </p>

Specialty Health Plans Auditor III Finance **$5,000 Sign On

<p><b>Salary Range:&nbsp;</b>&nbsp;$121,056.00&nbsp;(Min.) -&nbsp;$160,400.00&nbsp;(Mid.) -&nbsp;$199,742.00&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 Application Architect III (AA) collaborates and supports a team of developers and architects to design and build L.A. Care's QNXT Solutions. Working closely with the business, application and Information Technology (I.T.) infrastructure teams, the AA assists in developing and formulating solutions that integrate with a new Service Oriented Architecture (SOA) bus framework to incorporate into QNXT event driven and batch processing entities. Supports the development of the QNXT integration architecture solutions roadmaps. Connects systems architecture to the business needs of the company by working closely with key stakeholders and partners.&nbsp; Plans and schedules all phases of system integration testing. Collaborates and supports the vendors and in-house development/configuration teams to implement roadmaps and QNXT solutions. Provides technical guidance to all departments and works closely with development teams to ensure compliance. Assists in creating roadmap documents, integration documents, process documents, standards documents and governance documents. Collaborates with program-level architects across the organization on the details of the systems architecture for their particular domain. Assists with the overall system design and architecture.&nbsp; Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.&nbsp;&nbsp; </p><h4>Duties</h4><p>Function as the QNXT Subject Matter Expert for IT, with full knowledge of all QNXT environment(s); User Interface; and backend functionality and processes.</p><p>Provide QNXT Enterprise Architecture support to IT Solution Delivery development departments, Data Architecture, and the Enterprise Architecture team. </p><p>Work with other architects with regards to QNXT business processes, data and databases, systems, and security needs, and understand how QNXT best integrates into the overall enterprise architecture solution.</p><p>Ability to integrate QNXT into a common SOA bus framework.&nbsp; </p><p>Establish standards around systems technology stacks and mechanisms for governing cloud-based infrastructure.</p><h4>Work closely with I.T. functional areas to identify and resolve QNXT integration considerations and issues. </h4><h4>Apply 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.</h4><h4>Perform other duties as assigned.</h4><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><br><b>Required:</b></p><p>A minimum of 6 years of experience working in&nbsp; IT.</p><p>Experience in Designing/Developing/Implementing Interfaces, custom Services and solutions for QNXT suite of products, Trizetto UNITS and BizTalk processing models, Trizetto Hosting Topology, Trizetto QXI and QNXT event modeling framework.</p><p>Experience in data modeling PLANDATA, CUSTOM &amp; PLANINTEGRATION databases to define the relational tables, primary and foreign keys and stored procedures in order to meet the technical requirements of QNXT Custom solutions.</p><p>Experience in collaborating in cross-functional organization teams as well as Business SMEs to ensure that Architectural principles are successfully implemented into new QNXT Business Solutions.</p><p>Experience Healthcare business domain</p><h4>Skills</h4><p><br><b>Required:</b></p><p>Excellent communication skills with business teams/operational managers – listening and providing answers.</p><p>Strong problem solving skills.</p><p>Ability to form good relationships with clients/operational managers and colleagues.</p><p>Ability to keep up-to-date knowledge of technical applications.</p><p>Extensive knowledge of quality standards, legislation and best practices.</p><p>Ability to work under pressure and meet deadlines.</p><p>Ability to think ahead and anticipate problems, issues and solutions.</p><p>Excellent verbal and written communication skills.</p><p>Ability to quickly learn new tools and technologies.</p><p>Strong and advanced knowledge of Microsoft Office applications such as Word, Power Point, Excel, and Visio.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>The Open Group Architecture Frame Work (TOGAF)<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>

Application Architect III

<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>Additional Information</h4><p><b>Department Specifics:</b></p><p><b><em>IT Enterprise Architecture:</em></b></p><p><b>Additional Duties and Responsibilities:</b></p><p>Develop Data Integration, API Integration and Application Integration architecture to meet the business needs of the company by working closely with key stakeholders and partners.</p><p>Integrate I.T. Solutions into the Enterprise Data Management Cloud framework.</p><p><b><em>IT Solutions Delivery:</em></b></p><p><b>Additional Duties and Responsibilities:</b></p><p>Develop SOA integration and Business Workflow architecture to meet the business needs of the company by working closely with key stakeholders and partners.</p><p>Integrate common SOA, BPEL, BAM, OSB, B2B, SQL, Core JAVA and Service Gateway Standards.</p><h4>Job Summary</h4><p>The Enterprise Architect Integration Engineer II is responsible for developing standards, tools and governance for capturing, storing and delivering enterprise data. This position is responsible to design and build L.A. Care's Data API work and/or SOA architecture. Working closely with the business, application and Information Technology (I.T.) infrastructure teams, the Enterprise Architect Integration Engineer II will analyze business and technical problems and develop the appropriate the framework to incorporate Master Data, event driven and batch processing entities to the Enterprise Data Management Cloud (EDMC) and/or master service bus.</p><h4>Duties</h4><p>Develop integration and architecture to meet the business needs of the company by working closely with key stakeholders and partners.</p><p>Integrate I.T. Solutions into a common framework. Enforce standards around systems technology stacks and mechanisms for governing cloud-based infrastructure.</p><p>Support in-house development teams to implement solutions. Responsible for providing technical and management guidance to all departments and works closely with development teams to ensure compliance. Supports the creation of roadmap documents, architectural documents, process documents, standards documents and governance documents. Collaborates with program-level architects across the organization on the details of the systems architecture for their particular domain.</p><p>Work closely with I.T. functional areas to identify and resolve integration and workflow considerations and issues. Responsible for assisting with the overall system design and architecture. Responsible for providing EA support to the Development department and Enterprise Architecture team. Work with other architects around business, data, systems, and security needs and how applications best participate in the overall enterprise architecture.</p><p>Performs 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></p><p>At least 5 years of experience in design and implementation of data applications and integrations, using modern development tools, i.e. Java JSP applications or ORACLE/PL/SQL, or SQL Server Batch processes or similar technologies. </p><p>At least 5 years of experience designing and building solutions with SOAP, Rest API, Micro service development suites, i.e.&nbsp; Informatica IDMC/IICS, Mulesoft, or ORACLE SOA suite (ESB/BPEL/SOA/BAM).</p><p>Strong experience of managing advanced technical resources.</p><p>Demonstrated experience designing and building enterprise level canonical models.</p><p>Experience in multiple database platforms, including NoSQL, SQL Server and/or Oracle, Snowflake, Red Shift, Data Bricks, etc.</p><p>Experience working with end users to gather requirements and build technical solutions from concept to implementation.</p><p><b>Preferred:</b></p><p>Previous healthcare experience.</p><h4>Skills</h4><p><b>Required:</b></p><p>Strong understanding of process and queueing design patterns.</p><p>Strong problem-solving and analytical skills.</p><p>Excellent verbal and written communication skills with the ability to discuss and understand HealthCare business partners across all operations.&nbsp; </p><p>Must be well organized, flexible, motivated and enjoy the challenges of supporting a complex, changing environment, with attention to detail, at times under pressure, remaining flexible, proactive, resourceful and efficient. </p><p>Ability to build relationships throughout business units, our customers, and their teams to ensure that the services provided are of exceptional quality.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<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>

SOA Integration Engineer II

<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 Manager, Information Technology Enterprise Architecture leads a team of enterprise architects and solution architects to define, evolve, and enforce the enterprise technology strategy and architectural standards across the organization. This position ensures alignment of business objectives with technology strategy, drives modernization, integration, and scalability of Information Technology (I.T.) solutions, and governs the lifecycle of enterprise systems to ensure efficiency, agility, and security. The ideal candidate will provide visionary leadership and operational oversight to ensure architecture disciplines are embedded into solution delivery practices across the enterprise. This position is responsible for managing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.</p><h4>Duties</h4><p>Manage staff, including, but not limited to monitoring of day-to-day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.</p><p>Define and maintain enterprise architecture frameworks, roadmaps, and reference models aligned to business strategy.&nbsp; Guide architecture governance processes, including review boards, architectural standards, and solution design reviews.</p><p>Oversee architecture alignment across data, application, integration, security, and infrastructure domains.</p><p>Evaluate emerging technologies, platforms, and industry trends; assess applicability and value for enterprise adoption.</p><p>Collaborate with business and I.T. leadership to develop strategic technology direction and target state architectures.</p><p>Collaborate with cybersecurity and data governance teams to embed compliance, privacy, and resiliency in technology design.</p><p>Partner with solution delivery teams to ensure architectural best practices are applied to new development and system integration efforts.&nbsp; Support I.T.&nbsp; portfolio planning and participate in annual and multi-year technology investment planning.</p><p>Develop and maintain current state, transition state, and future state architecture documentation.&nbsp; Ensure architecture artifacts and decision logs are current and accessible in enterprise tools (e.g., modeling repositories).</p><p>Lead vendor evaluations from an architecture and integration perspective; participate in software procurement decision-making.</p><h4>Duties Continued</h4><p>Establish metrics to measure the effectiveness and impact of architecture practices.</p><p>Manage complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</p><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.&nbsp; </p><h4>Performs other duties as assigned.</h4><h4>Education Required</h4>Bachelor's Degree in Computer Science or Information TechnologyIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Computer Science<h4>Experience</h4><p><b>Required:</b></p><p>At least 7 years of progressive experience in I.T., that includes at least 5 years of experience in enterprise or solution architecture roles.</p><p>At least 4 years of experience inleading, supervising and/ or managing staff. leading</p><p>Demonstrated experience developing technology strategies and architecture roadmaps.</p><p>Experience in cloud transformation (AWS, Azure, or GCP), application modernization, and enterprise integration.</p><p>Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><p><b>Preferred:</b></p><p>Experience in regulated industries such as healthcare, finance, or insurance.</p><h4>Skills</h4><p><b>Required:</b></p><p>Strong knowledge of enterprise architecture frameworks (TOGAF, Zachman, etc.).</p><p>Strong leadership and team-building skills with experience managing cross-functional architecture resources.</p><p>Ability to align I.T. &nbsp;strategy with business objectives and ensure I.T. &nbsp;support business goals.&nbsp;</p><p>Excellent verbal and written communication skills, including the ability to present complex technical topics to non-technical audiences.</p><p>Deep understanding of enterprise IT ecosystems, including cloud platforms, APIs, data architecture, DevOps, and cybersecurity.</p><p>Proven ability to influence and collaborate across multiple business units and technology teams.</p><p>Analytical mindset with strong problem-solving capabilities.</p><p>Organizational agility and adaptability to manage competing priorities in a dynamic environment.</p><p>Strong strategic thinking and planning skills with an enterprise mindset.</p><p>Demonstrated understanding and implementing architectural governance to ensure consistency and compliance.&nbsp;</p><p>Exceptional ability to monitor system performance and ensure it meets business needs.</p><p><b>Preferred:</b></p><p>Familiarity with architecture frameworks such as TOGAF, Zachman, or FEAF.</p><p>Knowledge of enterprise architecture tools (e.g., LeanIX, Bizzdesign, Sparx EA).</p><p>Familiar with I.T.&nbsp; governance, risk, management and regulatory requirements.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>The Open Group Architecture Frame Work (TOGAF)<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>

Manager, Information Technology Enterprise Architecture

<p><b>Salary Range:&nbsp;</b>&nbsp;$121,056.00&nbsp;(Min.) -&nbsp;$160,400.00&nbsp;(Mid.) -&nbsp;$199,742.00&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 Application Manager II reports to the Senior Manager Information Technology I.T. Solutions Delivery. This role acts as the Technical Leader enterprise-wide for the assigned Domain, overseeing design, delivery, integration and support. This person should have a strong understanding of related Business Processes, corresponding I.T. Systems, Data Interfaces and Regulatory Requirements.&nbsp;</p><p>This person needs to quickly gain working knowledge of L.A. Care Domain Business Practices and Information Technology Solutions, including the identification of gaps between current business need and system functions. Additionally, this person needs to develop a Solutions Delivery plan for meeting current and anticipated Domain needs; this plan includes Application Roadmaps, Staffing Model (FTE and Consultant), SOA Service Definition, Data Management/Interfaces. This position works closely with the Business Domain leads, Business Relationship Managers, Security, Infrastructure, Quality Assurance, Production Support, Business and Technical Architecture teams.</p><p>The candidate should be well-organized, flexible and capable of driving accountability within the Solution Delivery Domain for all system functionality and performance. This person needs to manage ambiguity, negotiates optimal approaches, prioritizes and remediates in a complex and dynamic environment. This person needs to demonstrate an ability to manage Commercial Software Vendor relationships and Consulting teams in support of Domain Solution needs. This person also oversees any escalated Production Support issues for Domain Solutions.</p><p><br>The ideal candidate has demonstrable experience in overseeing and delivering I.T. Solutions, preferably in the Provider Network Management space.</p><p>• Understand how each System (Commercial or Custom) capability meets the Processing and Information requirements to implement business functions effectively<br>• Be aware of all major Initiatives (Programs, Projects, Service Requests) that require enhancements or customizations to Domain Systems<br>• Drive all interface requirements (Service Bus, EDI, File Processing, Portal etc.) from each Domain System<br>• Provide Level 3 Production Support for each Domain System<br>• Drive all Consulting/Contractor enhancements and customizations to Domain Systems<br>• Manage System Roadmaps (Upgrades, Customizations, Configurations, Replacements, Retirements)<br>• Participate in Impact Assessments to determine Domain System impact to new Enterprise Initiatives.</p><h4>Duties</h4><p>Document current and future state Domain System Process Flow, Data Flow and Interfaces.</p><p>Provide technical direction to Business Systems Analysts, Technical Leads, Development Staff comprised of Full Time Employees and Consultants. Act as liaison between IT Solution Delivery team and Program/Project Managers for all Enterprise Initiatives.</p><p>Manage and prioritize backlog of Solutions Delivery Domain service requests and maintenance work.</p><p>Develop and manage Domain Application Roadmaps including System Configurations, Functions, Service Bus Integrations, Data/File Integrations, Monitoring and Security milestones.</p><p>Manage Solutions Delivery Domain Software and Consulting vendors.</p><p>Provide ‘escalated’ Production Support and Incident Management.</p><p>Perform Impact Assessments and Solution Reviews for Solutions Delivery Domain.</p><p>Assist in Enterprise Roadmap Planning Activities, Business and Enterprise Architecture.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Computer ScienceIn 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 6 years of I.T. Applications work experience with 4 years of progressive technical oversight.</p><p>At least 5 years developing Software Solutions leveraging a Software Development Lifecycle Methodology.</p><p>At least 4 years of specified Domain experience, see attached addendum.</p><p>At least 4 years of I.T. Vendor (Software and Consultant) Management.</p><p><b>Preferred:</b><br>At least 3 years of Production Support experience.</p><p>At least 3 years of Health Plan I.T. experience.</p><p>At least 3 years of Service Bus development experience.</p><h4>Skills</h4><p><strong>Required:</strong><br>Technical leadership, Application Roadmaps, Vendor Management (Software Product and Labor).</p><p>Well-organized, flexible and self-starter.</p><p>High level of written and verbal communication skills.</p><p>Strong decision making ability and attention to detail.</p><p>Ability to influence key internal and external business/IT partners.</p><p>Active listening skills.</p><p>Ability to understand complex technical issues.</p><p>Ability to navigate ambiguity and proactively develop effective plans.</p><p>Ability to create Application Architecture diagrams and Roadmaps.</p><p>Agile Development.</p><p><strong>Preferred:</strong><br>Program/project management skills.</p><p>Microsoft Project Server, Excel, PowerPoint, Word.</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>Department Specifics:</b></p><p><b>Finance:</b><br>Minimum of 4 years of Financial Services Domain experience required.<br>Critical Thinking Skills (Analyzing, Logical Reasoning, Predicting, Transforming Knowledge and Applying Standards) required.<br>Functional knowledge of Financial (Accounting Principles and Theory) preferred.</p><p><b>Health Services</b><br>Minimum of 4 years of Health Services Domain experience required.<br>3 years of Clinical Care and 3 years of HIE, HEDIS experience preferred.<br>Functional knowledge of HEDIS, HIE, Health Analytics required.<br>Functional knowledge of Utilization Management, Care Management, Clinical Case Management, Disease Management preferred.</p><p><b>Provider Domain TPM</b><br>Minimum of 4 years of Provider Data Management Domain experience required.<br>3 years of Provider Network experience preferred.<br>3 years of Provider Data experience preferred.<br>3 years of Service Bus development experience, Micro services (Mulesoft), NoSQL (MarkLogic), Informatica Data Quality, Informatica MDM, Tableau, Informatica (AXON), Oracle database preferred.<br>Functional knowledge of Provider Data Management, Provider Network Management preferred.</p><p><b>Customer Relationship Management/Salesforce Surround Systems:</b><br>Minimum of 4 years of CRM Domain and integration experience required.<br>3 years of Service Bus development experience preferred.<br>Functional knowledge of CRM (Salesforce) preferred.</p><p><b>Clinical Services</b><br>Minimum of 4 years of Health Services Domain experience required<br>Minimum of 4 years of Clinical System experience (e.g. Clinical Care Advance, ZeOmega, Altruista, Thrasys) required.<br>Functional knowledge of Utilization Management, Care Management, Clinical Case Management, Disease Management required.<br>Functional knowledge of HEDIS, Health Information Exchange preferred.</p><p><b>Membership</b><br>Minimum of 4 years of Health Plan Membership Domain experience required.<br>Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred.</p><p><b>EDI</b><br>5 years of EDI Domain experience required.<br>5 years of HIPAA X12 standards experience preferred<br>Functional knowledge of all aspects within the HIPAA Administration Simplification Rule, including the transaction operating rules preferred.<br>Functional&nbsp;&nbsp;knowledge of basic industry protocal mapping tools, such as Edifecs, IBM WEBSPHERE , etc. preferred.</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>                    Relationship Manager, Customer Service                                                    </p>

Technical Applications Manager II

<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 Supervisor, Customer Solution Center Appeals and Grievances is responsible for direct supervision and support of the team responsible for the intake, research, resolution, tracking, trending and reporting within the Appeals and Grievances department. This position will be accountable for leading and directing the work for the Appeals and Grievances department by monitoring the research, negotiation and resolution of all types of appeals and grievances to ensure thorough investigations are completed as outlined in the company policies and procedures. Provides support and ownership of cases identified as escalated, complex and/or multi-issue appeals and grievances on an as needed basis. Collaborates with internal departments to ensure timely resolution. This position will be responsible for analyzing and trending for all appeals and grievances. Responsible for the development and maintenance of the appeal and grievance Policies and Procedures, workflows, Member correspondence, and training as needed, or on an annual basis. The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.</p><h4>Duties</h4><p>Evaluate daily reports to ensure individual and team Key Performance Indicators (KPIs), SLAs, Performance Scorecards meet regulatory requirements.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Provide direction to staff for complex/sensitive member and provider inquiries, concerns, complaints, appeals, and grievances. Conduct weekly 1:1s with direct reports.</p><p>Build and maintain strong working relationships with internal departments involved in appeal and grievance resolution.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Development, maintenance and implementation of P&amp;Ps, workflow and training.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Audit preparation and providing recommendations for Corrective Action Plans from state regulatory agencies.</p><p>Supervise staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.</p><p>Perform 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>Master's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 3 years in a healthcare setting in Grievances and Appeals, Compliance, Claims or Call Center.</p><p>At least 2 years of leading process, program, or staff or supervisory experience.</p><p><b>Equivalency:</b>&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><p><b>Preferred:</b></p><p>Previous experience in Managed Health, preferably in Customer Service, Appeals and Grievances and/or Claims.</p><h4>Skills</h4><p><br><strong>Required:</strong><br>Ability to manage and organize large volumes of data.</p><p>Knowledge of regulatory and accreditation entities and their requirements.</p><p>Excellent verbal and written communication skills and interpersonal skills.</p><p>Good working knowledge of licensure and regulatory requirements, and accreditation standards.</p><p>Ability to work independently.</p><p>Ability to solve complex issues and identify creative solutions.</p><p>Computer ease and literacy with Microsoft Office (Word, Excel, Power Point, Access, &nbsp;and Visio).</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>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</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>Medical, Dental and Vision</li><li>Wellness Program</li><li>Paid Sick Leave</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Call Center Manager, Call Center Supervisor, Claims, Call Center, Customer Service, Insurance                                                    </p>

Supervisor, Customer Solution Center Appeals and Grievances (Temporary)

<p><b>Salary Range:&nbsp;</b>&nbsp;$67,186.00&nbsp;(Min.) -&nbsp;$87,342.00&nbsp;(Mid.) -&nbsp;$107,498.00&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 Customer Solution Center Member Advocate II serves as primary point of contact for community-based organizations, advocacy groups, public agencies, regulators, members and families with complex issues or concerns. This position manages relationships and strengthens linkages with community-based organizations and other advocacy organizations.</p><h4>Duties</h4><p><br>Ensures proper and timely handling and coordination of escalated members issues presented by community based organizations, advocacy groups, public agencies, regulators, and members.</p><p>Maintains relationship and strengthens linkages with advocacy agencies, Regional Center, community-based organizations and other external agencies.</p><p>Identifies systematic issues and works with other L.A. Care staff to develop solutions and education.</p><p>Develops and delivers educational and outreach training presentations regarding L.A. Care's services to external agencies.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><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><strong>Required:</strong><br>At least 4 years demonstrated experience working with low economic status populations or other diverse communities in settings such as community-based organizations, social service agencies, clinical settings, advocacy groups, or civic organizations.</p><p>Experience resolving individual cases with regulatory state agencies.</p><h4>Skills</h4><p><strong>Required:</strong><br>Knowledge of health care regulations, and policies and procedures.</p><p>Excellent interpersonal communication skills.</p><p>Excellent public speaking/public presentation skills.</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>

Customer Solution Center Member Advocate 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 Community Resource Center (CRC) Specialist III builds and maintains meaningful relationships with members of the community, L.A. Care departments, partner health plans, community based agencies, government agencies, and CRC vendors and instructors. The role leads community and provider outreach and engagement initiatives to increase member traffic at a CRC and bridges members of the community to physical and health education programs, classes and resources. Acts as a liaison to the L.A. Care on CRC marketing and promotional initiatives to meet operational needs. Implements processes including coordination of member service support across L.A. Care departments and promote positive health care outcomes. Provides extensive consultation on health care access issues, and identification of resource needs based on social drivers identified through a health assessment process. This position also conducts ongoing member assistance and follow-up in select cases. Collaborates with cross-functional L.A. Care health plan departments The CRCs serve anyone in the community in which they are located; and therefore, this role will provide expertise on referral processes to connect non-member cases to the appropriate external resources.</p><p>Participates in the planning, and development, implementation, and analysis of CRC services, programming, and vendor management. This role may serve as a lead on special projects through the development and implementation of a work plan, technical procedures, and relationship management ensuring successful implementation of CRC initiatives. &nbsp;Acts as a &nbsp;Subject Matter Expert, serves as a resource and mentor for other staff. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p><h4>Duties</h4><p><b>Outreach and Engagement:</b> (25%) &nbsp;<br>Builds, maintains, and nurtures meaningful relationships with key internal and external stakeholders; and, is an ambassador to grow CRC partnership brand recognition. &nbsp;Identifies key community stakeholders, assesses community needs, and gathers and analyzes data to inform management with an integrated approach to outreach activities and targeted member engagement. &nbsp;Plan, develop, analyze and implement member and community engagement activities to increase member traffic at the CRCs. Makes recommendations for bridging members of the community to physical and health education programs and classes which will enhance health outcomes and member experience. &nbsp;Responsible for communications and marketing efforts through multiple platforms to increase member traffic at assigned CRC; and, engages and educates members of the community on L.A. Care and CRC programs. Responsible for CRC outreach and engagement opportunities relevant to the mission of L.A. Care and the CRCs; recommends to senior management in the development and implementation of &nbsp;work plans. &nbsp;Identifies and recommends what outreach activities to prioritize &nbsp;and implement tactics to attract new L.A. Care and partner health plan members to participate into the CRC services and programs. Responsible for collecting, transporting, and distributing CRC promotional items to community partners with the goal of generating brand awareness across various L.A. Care membership communities and geographical areas in Los Angeles County.</p><p><b>Cross-Collaboration: </b>&nbsp;(25%)<br>Oversees the community initiatives leveraging relationships within L.A. Care, partner health plans, and with community stakeholders to promote access to health care programs, classes, and preventative services offered at the CRC. &nbsp;Educates other L.A. Care departments on the necessary steps to implement relevant services and activities that will resonate with and engage members of the CRC community. &nbsp; &nbsp;</p><p><b>Implementing Strategic Initiatives: </b>&nbsp;(20%) &nbsp;<br>Leads &nbsp;the implementation of special projects and specific tasks that &nbsp;must be &nbsp;completed in order to ensure project, initiatives, and events are successfully implemented within the required timeframe. Proactively monitors risks and provides recommendations and implements mitigation plans to keep initiatives on-track. &nbsp;Maintains consistent documentation of project deliverables, tracks and reports project status. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</p><h4>Duties Continued</h4><p><b>High-Touch Customer Focus</b>: (15%)&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 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. &nbsp;Provides support in the creating of child creating of activities and programs to support children development while parents and guardians attend a class or service appointment at the CRC.</p><p><b>Day-to-Day Representation: </b>(15%)&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; Guides the coordination of member-centric customer service to respond and resolve simple inquiries and complex questions and bridges members to appropriate resources. &nbsp;Creates resource guides and reference materials to identify available CRC, L.A. Care and Plan Partner benefits, resources, and programs to meet the member/visitor needs. &nbsp;Provides guidance and support staff to identify, understand, and master meaningful program and benefit information and resources to inform and educate members, community residents, and other stakeholders. Implements the appropriate approach to identify member or visitor resource needs in complex situations and takes action to link the member/visitor to those services, programs, or resources. &nbsp;Informs L.A. Care and Plan Partner members of health care tailored services including Care Management, Social Services, Health Education, and others. Actively identifies gaps in CRC services, resources, and programs, delivers recommendations for new programs and proposes solutions for the implementation of new services.</p><p>Performs other duties as assigned.&nbsp; (10%)&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</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 1 year of community work focused on health care, public health, or health education or</p><p>At least 1 year of operations work experience with community events, leading complex projects, and managing relationships with multiple stakeholders or experience related to health plan member services, health plan member benefits and knowledge of any of the following services: Care Management, Social Services, Health Education, or other social service or clinical teams.</p><p>Product experience including knowledge of at least one of the following health care programs: Medicaid/Medi-Cal, Covered California, Medicare, or Medicare Dual Special Needs Plan.&nbsp;</p><p>Minimum of 1 year experience related to marketing, brand awareness tactics, or social media&nbsp;</p><p>Experience with database software, data entry, and reporting process.&nbsp;</p><p><b>Preferred:</b><br>Minimum of 3 years experience with database software, data entry, and reporting processes. Salesforce knowledge.</p><h4>Skills</h4><p><b>Required:</b><br>Strong verbal and written communication skills</p><p>Excellent organizational skills.</p><p>Must be a detail-oriented, collaborative and enthusiastic team player.&nbsp;</p><p>Strong ability to garner consensus on and support for new partnerships and initiatives, particularly when projects rely on participation by multiple internal or external stakeholders.&nbsp;</p><p>Ability to solve complex issues and identify creative solutions to assist members and community stakeholders.</p><p>Must have the ability to troubleshoot problem areas and recommend effective alternative solutions and provide optimal customer service for internal and external customers.</p><p>Demonstrates action oriented leadership 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>Must be able to work independently or as part of a diverse team while being business-minded as well as empathetic towards members.</p><p>Must show initiative and act on anticipated business needs without prompting from management.<br><br>Ability to adapt quickly to a fast-changing environment.</p><p>Advanced proficiency in MS Office including Outlook, Word, Excel, and PowerPoint</p><p>Strong interpersonal skills and ability to read non-verbal cues with a high level of situational adaptability.</p><p>Ability to make sound decisions with incomplete information.</p><p><b>Preferred:</b><br>Experience with the Salesforce 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.<br></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><b>Required:</b></p><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>Moderate<h4>Additional Information</h4><p><b>Required:&nbsp;</b><br>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>                    Medicare, Social Services, Data Entry, Relationship Manager, Medicaid, Healthcare, Service, Administrative, Customer Service                                                    </p>

26 L.A. Care Health Plan Jobs