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<p><b>Salary Range:&nbsp;</b>&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p><br>The Care Management Specialist II utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines.</p><p>Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases, which are those with the severest acuities or care needs and requiring the highest clinical skills and judgement. &nbsp;Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner.&nbsp;</p><p>Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit: Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team. Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines. Uses claims processing and care management software to look up member information, document contacts, and track member progress.&nbsp;</p><h4>Duties</h4><p>Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs.</p><p>Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives; reviewing member claims histories and identifies intervention opportunities through the professional standards of practice; contacting and interviewing members to conduct a baseline assessment, assess self-care ability, assess knowledge and adherence deficits; conducting comprehensive clinical assessments as indicated; developing a member centric plan of care. Maintains assigned care management caseload for with a focus on the most complex, highest-risk members particularly those with advanced chronic conditions, co-occurring mental and/or substance abuse and complex social issues (e.g. homelessness, domestic violence).&nbsp; </p><p>Collaborates with primary care physician and other treating professionals as appropriate. Authorizes initiation of care management services and specialized program services for members and specific populations, and develops interventions designed to meet member or population desired outcomes. Provides comprehensive education and resources to members about accessing services, in-network use, national guidelines for care, community resources, and self-management skills and strategies.</p><p>Employs engagement techniques to build relationships with members and their authorized representatives. Encourages participants to participate in their health care decisions and assists member with researching treatment options in order to communicate effectively with providers and to make informed decisions.</p><h4>Notifies Care Coordinators and CHWs of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines.</h4><h4>Performs field assessment and care coordination functions in community settings with members, such as at the L.A. Care Community Resource Centers, medical clinics, and member homes.</h4><h4>Duties Continued</h4><h4>Meets and assesses members at L.A. Care Community Resource Centers, as needed.</h4><h4>Provides effective care management for Individualized Care Plan summary and interventions during the Interdisciplinary Care Team meetings based on department guidelines.</h4><h4>Facilitates appropriate use of resources and coordinates necessary services to improve health status and impact the cost of care. Identifies member needs for and refers to appropriate internal and external programs, as appropriate.</h4><h4>Encourages member and family empowerment through education and use of reliable resources.</h4><h4>Monitors and evaluates member progress: evaluates member response to interventions and refines action plan to produce desired outcomes. Identifies complex care management issues and discusses possible solutions with management. Assesses effectiveness of care plan’s goals and interventions on a regular basis.</h4><h4>Uses claims and care management software to document interactions and interventions with members, vendors, and providers. Maintains case information in the member's clinical records to promote care coordination. </h4><h4>Provides ongoing direction and support to internal customers regarding Care Management programs, processes, and benefit coverage.</h4><h4>Responsible for staying current with best practices, identifying areas for personal growth opportunities and works with management to develop a plan for obtaining the necessary training.</h4><h4>Performs other duties as assigned.</h4><h4>Education Required</h4>Associate's Degree in Nursing for Registered NursesMaster's Degree in Social Work for Licensed Clinical Social Workers<h4>Education Preferred</h4>Bachelor's Degree in Nursing for Registered Nurses<h4>Experience</h4><p><br><strong>Required:</strong><br>Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments. &nbsp;</p><p>Experience providing care management with complex/catastrophic conditions.</p><h4>Skills</h4><p><br><b>Required:</b><br>Current knowledge of clinical standards of care and disease processes.</p><p>Critical thinking skill.&nbsp;</p><p>Excellent customer service skills.</p><p>Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions.</p><p>Ability to triage immediate member health and safety risks.</p><p>Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping.</p><p>Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders. &nbsp;</p><p>Ability to use a personal computer, and knowledge of medical information systems.</p><p>Knowledge of and ability to comply with HIPAA compliance.</p><p>Ability to interview, assess and coordinate care. Ability to prioritize caseload.</p><p>Knowledge of community resources.</p><p>Knowledge of Medi-Cal and Medicare regulations.</p><p>Ability to work as a part of a diverse team and gain consensus and resolution of problems.</p><p><b>Preferred:</b><br>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>Registered Nurse (RN);current and unrestricted California License OR Licensed Clinical Social Worker; current and unrestricted California License.<h4>Licenses/Certifications Preferred</h4>Certified Case Manager (CCM)Accredited Case Manager (ACM) CertificationCase Management Nurse – Board Certified (CMGT-BC)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<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>                    Social Worker, Travel Nurse, Nursing, Registered Nurse, Claims, Service, Healthcare, Insurance                                                    </p>

L.A. Care Health Plan

Care Management Specialist 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 Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals that meet established criteria. Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status. Generates approval, modification and denial communications, to include member and provider notification of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/family interaction to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers. Acts as a department resource for medical service requests /referral management and processes. Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner.</p><h4>Duties</h4><p>Promote and support team engagements, programs and activities to create and ensure a positive and productive workplace environment.</p><p>Perform telephonic and/or onsite admission and concurrent review, and collaborates with onsite staff, physicians, providers, the member and significant others to develop and implement a successful discharge plan. Process, finalize and facilitate inbound requests that are received from providers. </p><p>Generate appropriate member and provider communication for all determinations within the required timelines as defined by the most current department policy.</p><p>Facilitate/review requests for Higher level of care or skilled nursing/discharge planning needs. Research for appropriate facilities, specialty providers and ancillary providers to utilize for all lines of business. Identification of potential areas of improvement within the provider network.</p><p>Identify and initiate referrals for appropriate members to the various L.A. Care programs/processes and external community based programs or Linked and Carve Out Services (e.g. DDS/CCS/MH). Potential quality of care/potential fraud issues are identified and documented per L.A. Care policy. High risk/high cost cases and reports are maintained and referred to the Physician Advisor/UM Director. Document in platform/system of record. Utilize designated software system to document reviews and/or notes. </p><p>Receive incoming calls from providers, professionally handle complex calls, research to identify timely and accurate resolution steps. Follow up with caller to provide response or resolution steps. Answer all inquiries in a professional and courteous manner.</p><h4>Perform other duties as assigned. </h4><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>At least 5 years of varied RN clinical experience in an acute hospital setting.</p><p>At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting .&nbsp;</p><p><b>Preferred:</b><br>Managed Care experience performing UM and CM at a medical group or management services organization.</p><p>Experience with Managed Medi-Cal, Medicare, and commercial lines of business.</p><h4>Skills</h4><p><b>Required:</b><br>Must be computer literate, with expertise in Outlook, Word, Excel, PowerPoint. &nbsp;Effectively utilizes computer and appropriate software and interacts as needed with L.A. Care Information System. Knowledge of personal computer, keyboarding, and appropriate &nbsp;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>Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team &nbsp;<br><br>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 Care Management (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)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>May work on occasional weekends and some holidays depending on business needs.</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, Medicare, Medicaid, Claims, Healthcare, Insurance                                                    </p>

Utilization Management Nurse Specialist RN II

<p><b>Salary Range:&nbsp;&nbsp;<b><b><b><b>$47,840.00</b></b></b></b>&nbsp;(Min.) -&nbsp;<b><b><b><b>$57,062.00</b></b></b></b>&nbsp;(Mid.) -&nbsp;<b><b><b><b>$68,474.00</b></b></b></b>&nbsp;(Max.)</b></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 Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.</p><p>The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports.</p><p>In addition, the position performs data entry and processing of referrals/authorizations in the system, &nbsp;authorizes request consistent with auto authorization criteria, maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers, with other duties as assigned.</p><h4>Duties</h4><h4>Functional Elements: Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely processing referrals/authorizations and distribute a complete file to UM Specialist within 2 hours of receipt; identify duplicate requests using the claims and verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system; appropriately documenting what information was used in making this determination within 4 hours of receipt. Appropriate identification and timely notification of time sensitive requests; appropriately identifying for the staff which you support, request that are priority based on date of receipt and established Turnaround Time criteria for compliance. Accurate filing/maintenance of confidential member information. Creating secure, complete, files. Interface with members, medical personnel and other internal and external agencies; ensure&nbsp; all comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: ICD 10 codes, CPT, HCPC codes. (35%)</h4><h4>Assist in the preparation of communication for authorization determinations, including, but not limited to preparing template letters for members and providers (authorization approval, denial, deferral, modification and pay/education). (30%)</h4><h4>Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing: Set up GNA files for review, log and keep track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to Grievances Specialist on daily basis. (20%)</h4><h4>Support UM Committee and Audit activity via Department performance reporting. Assure the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames. (5%)</h4><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><h4>Experience</h4><p><b>Required:</b></p><p>At least 6 months of health care experience.</p><p>Experience working in a cross functional work environment.</p><p><b>Preferred:</b></p><p>Experience in Medi-Cal managed care.</p><p>1 year of experience in UM/Prior Authorization.</p><h4>Skills</h4><p><b>Required:</b></p><p>Demonstrated proficiency in Medical Terminology required.</p><p>Strong verbal and written office communication skills.</p><p>Proficient with Microsoft Office Suite and Adobe PDF. and </p><p>Excellent organizational, interpersonal and time management skills. </p><p>Must be detail-oriented and an enthusiastic team player.</p><p><b>Preferred:</b></p><p>Knowledge of QNXT computer systems a plus.</p><p>Knowledge of the UM patient referral process.</p><p>Knowledge of member’s health plan eligibility.</p><p>Knowledge of member’s benefits coverage. </p><p>Knowledge of Health Plan regulations.</p><p>Knowledge of HMO/UM functions.</p><p>Knowledge of ICD-10/CPT coding. </p><p>Proficient utilizing electronic medical records and documentation programs.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Medical Coding Certification<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Required:</b></p><p>Weekends and holidays hours may be required, as well as OT based on a business need.</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>This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.</p><p><br><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>                    Data Entry, Claims, Medical Coding, EMR, Administrative, Insurance, Healthcare                                                    </p>

Authorization Technician II (ALD)

<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, Relationship Manager, Data Entry, Social Services, Public Health, Healthcare, Customer Service, Administrative, Service                                                    </p>

Community Resource Center Specialist II

<p><b>Salary Range:&nbsp;</b>&nbsp;$60,778.00&nbsp;(Min.) -&nbsp;$75,950.00&nbsp;(Mid.) -&nbsp;$91,166.00&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 Help Desk Technician III plays a critical role within the Information Technology (IT) team at L.A. CareHealthPlan, providing advanced technical support for complex incidents and serving as a mentor for Level 2 technicians. The Technician serves as a key liaison between the I.T. Service Desk, business units, and other I.T. teams, collaborating to resolve technical problems efficiently and maintain a high level of user satisfaction.&nbsp; This position also contributes to the completion of I.T. projects. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. This position also ensures established monthly performance baselines are completed.</p><h4>Duties</h4><p>Manages complex issues escalated from Level 2 Service Desk Technicians, serving as a key liaison between the I.T. Service Desk and internal business units. Collaborates with other I.T. teams to resolve critical incidents, ensuring high-level customer service and quick resolution. (50%)</p><p>Takes the lead and/or assists I.T. Management with the completion of department related projects. 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. (5%)</p><p>Conducts audits by analyzing results and recommending and implementing process improvements. Assists with regulatory audits and HIPPA compliance. Accurately audits department-specific processes, analyzes and reports audit findings based on established guidelines (GAP analysis), and makes recommendations to I.T. Management as needed. Conducts entitlement reviews, monitors compliance activities, and provides recommendations for improvements. (5%)</p><p>Provides training to new and existing Level 2 technicians, sharing valuable I.T. knowledge and ensuring the team is up to date with the latest tools, technologies, and best practices. (5%)</p><p>Collaborates and completes all reporting functions for the I.T. Service Desk, including inventory management of software, hardware, laptops, desktops, monitors, and user data. Develops and maintains an inventory control system and implements strategies to identify and mitigate discrepancies. Collaborates effectively with cross-functional teams and communicate complex technical concepts to non-technical stakeholders. (5%)</p><p>Logs into the phone queue to assist with incoming calls in the morning or as needed, ensuring timely support for end users. Assists in responding to user inquiries and technical issues via phone, email, or chat, ensuring professional and timely resolution. (5%)</p><p>Writes, reviews, and updates Standard Operating Procedures (SOPs) based on ongoing business changes and evolving processes, ensuring documentation is accurate and aligned with organizational needs and policies<b>. </b>Manages and ensures the successful execution of the On/Offboarding process in alignment with established Standard Operating Procedures (SOPs). (5%)</p><h4>Duties Continued</h4><p>Ensures adherence to all I.T. policies, with a particular focus on those related to security, risk management, and data protection, to maintain a secure and compliant environment across the organization. (5%)</p><h4>Participates in the after-hours on-call rotation, assisting Level 2 technicians with escalated issues and offering guidance as needed to ensure effective resolution. (5%)</h4><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 in Information Technology or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 2 years of experience in Call Center Help desk, configuring &amp; administering networked computer systems in a Windows environment.</p><p>Extensive experience with MS Office 365 Suite, Entra ID, Active Directory, Intune, and laptop/desktop configurations.</p><p>Experience with diagnosing and resolving advanced issues related to Active Directory, VPN, and remote desktop functionality.</p><p>Experience with ticketing systems (e.g., Jira Service Management).</p><p>Experience with on-call support and afterhours troubleshooting.</p><h4>Skills</h4><p><b>Required:</b><br>Expertise in troubleshooting Windows 10 and 11, Active Directory, Microsoft Office 365, software imaging solutions, network connectivity issues, hardware diagnostics, remote desktop support, (Information Technology Infrastructure Library (ITIL) best practices, and incident management. </p><p>Excellent knowledge of security protocols, endpoint management tools, and user access management, with the ability to resolve complex technical issues and deliver high-quality support in a fast-paced environment.</p><p>Excellent track record of delivering excellent customer service, meeting deadlines, and achieving first-time resolution of technical issues.</p><p>Excellent initiative and ownership of tasks, with the ability to work independently and effectively troubleshoot complex issues.</p><p>Excellent problem-solving skills with the ability to remain composed under pressure, ensuring timely and effective resolutions.</p><p>Knowledge in configuring and managing remote LAN access for VPN.</p><p>Proven ability to manage and prioritize multiple tasks and incidents in a fast-paced environment.</p><p>Ability to log all calls and incidents into Jira Service Management, ensuring accurate tracking and resolution.</p><p>Ability to resolve escalated Incidents and Service Requests within the agreed Service Level Agreements (SLAs).</p><p>Ability to collaborate effectively with team members, demonstrating strong teamwork and a proactive work ethic.</p><p>Excellent customer service skills, ensuring user satisfaction and prompt issue resolution.</p><p>Excellent written and verbal communication skills.</p><p>Proven ability to work within defined SLAs for incident and service request resolution.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Computing Technology Industry Association (CompTIA) A+ CertificationComputing Technology Industry Association (CompTIA) Network+ CertificationComputing Technology Industry Association (CompTIA) Security+ CertificationMicrosoft Certified: Azure Fundamentals<h4>Required Training</h4><h4>Physical Requirements</h4>Moderate<h4>Additional Information</h4><p>In addition to the main corporate office, L.A. Care supports 14 Community Resource Centers across L.A County. </p><p>L.A. Care Health Plan is available 24 hours a day, &amp; 7 days a week, including holidays. Help Desk Shifts are assigned based on business need and may include but not limited to evenings, weekends, and holidays.</p><p>Travel to offsite locations for work required.</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>                    Service Desk, Call Center, Risk Management, Customer Service, Finance                                                    </p>

Help Desk Technician III (Hybrid)

<p><b>Salary Range:&nbsp;</b>&nbsp;$60,778.00&nbsp;(Min.) -&nbsp;$75,950.00&nbsp;(Mid.) -&nbsp;$91,166.00&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 Customer Solution Center Member Navigator II is responsible for resolving member inquiries. Coordination of care for complex cases which may involve benefit coordination, continuity of care, access to care, quality of care issues, member eligibility, assignment, disenrollment's issues and interpreting requests for all product lines (Medi-Cal, L.A. Care Covered, Cal MediConnect (CMC)). It will be expected that the main focus is to provide member satisfaction. In addition, this position is responsible for handling disenrollment's in coordination with U.M. department and Plan Partners: Department of Health Services (DHS), Centers for Medicare and Medicaid Services (CMS) National Committee Quality Assurance (NCQA) as well as L.A. Care guidelines. The Navigator ensures the proper handling of member issues whether presented by members, the Ombudsman's, state contractors, member advocates, Executive Community Advisory Committee (ECAC), L.A. Care Board Members or providers are resolved expeditiously. The Navigator handles and coordinates the identification, documentation, investigation and resolution of complex cases, in a timely and culturally-appropriate manner. Coordinates multi-departmental (Member Services, Product Network Operations (PNO), Claims, Utilization Management (UM), Pharmacy, Medicare Enrollment/Disenrollment, Sales and Quality Management (QM)) processes to ensure identification of member's claims of gaps in coverage and resolution of cases for members' satisfaction and of referral cases to plan partners when applicable. The Navigator will be stationed and available to assist our members at any of our designated Community Resource Center/Walk-In Center. Will provide Navigator support at other Community &nbsp;Resources Center locations as needed.</p><h4>Duties</h4><p>Coordinate multi-departmental (Member Services, PNO, Claims, UM, Sales, Medicare enrollment and QM) processes to resolve members 'issues and complex cases to the members' satisfaction. This process may include referrals to plan partners to ensure compliance with regulatory and L. A. Care guidelines. Ensure to follow departmental guidelines/matrixes for all processes. Urgent Complex cases will be handled within 24hrs. All others within 48hrs. (30%)</p><p>Work as a navigator to our Medicare Line Of Business (LOB): A. Ensure to meet deadline for completion of Welcome Calls; B. Ensure to follow through on all cases forwarded to other areas for assistance; C. Document all transportation services provided to each member. Ensure to confirm appointment and authorization; D. Coordinate/assist with all other departments regarding Medicare Services; E. Thorough Reinstatement of enrollment of members whose disenrollment are questionable; F. Identify and complete Organization and Coverage Determination for timeliness and resolution; G. Ensure proper Guidelines are followed for Medicare disenrollment request; H. Ensure to complete all BAE and/or LIS request. (25%)</p><p>Identify potential quality of care issues and referral to QM Department, through calls received from our Call Center and other internal customers. (10%)</p><p>Handle disenrollment's requests from members, providers and plan partners: 1) Long Term Care (Exhaustion of Benefits); 2) Move out of County; 3) Major Organ Transfers; 4) Incarceration; 5) Foster Care. (5%)</p><h4>Work with Compliance Department regarding suspected fraudulent activities received through the L.A. Care hot line and the Call Center personnel. (5%)</h4><h4>Communicate with collection agencies, billing business offices regarding delinquent and problematic member accounts which includes claims issues from L.A Care Medi-Cal Direct Program (MCLA), Healthy Families (HF), Healthy Kids (HK), and Special Needs Populations (SNP) members. (5%)</h4><h4>Work with Cultural &amp; Linguistic (C&amp;L) to provide translations for members' correspondence into the appropriate languages. As requested review documents submitted by C&amp;L to ensure proper translation and culturally sensitive materials for distribution to our members (brochures pamphlets and educational materials). (5%)</h4><h4>Meet general L.A. Care requirements for attendance and punctuality and follow department guidelines. (5%)</h4><p>Perform other duties as assigned. (10%)</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><br><b>Required:</b></p><p>At least 2 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services and /or public services or public benefits programs with claims and Medicare experience.</p><p><b>Preferred:</b></p><p>Health Plan background a plus along with strong advocacy background.</p><h4>Skills</h4><p><br><strong>Required:</strong><br>Strong customer service skills.</p><p>Excellent oral and written communication skills.</p><p>Strong analytical and conflict resolutions skills as well as persuasion skills.&nbsp;</p><p>Proficient in MS Office applications, Word, Excel, Power Point, and Access.</p><p><strong>Preferred:&nbsp;</strong><br>Medical terminology a plus.</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><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>                    Medicare, Claims, Call Center, Medicaid, Pharmacy, Healthcare, Insurance, Customer Service                                                    </p>

Customer Solution Center Member Navigator II- Palmdale Location (Onsite)

Customer Solution Center Member Navigator II- West Los Angeles Location (Onsite)

<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>The Lead Community Resource Center (CRC) 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; The Lead will assist the CRC Manager with developing a successful and cohesive CRC team.</p><p>The CRCs serve anyone in the community in which they are located; and therefore, this role will additionally provide expertise on developing and monitoring effective referral processes to connect non-member cases to the appropriate external resources.&nbsp; The lead will monitor and assess the planning, development, implementation, and analysis of CRC services, programming, and vendor management.</p><p>The Lead will support manager with immediate urgent decisions for center operations as applicable if manager is not available.&nbsp; 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. </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; 10%</p><p>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval. 10%</p><p>Mentors and trains staff on special projects and processes that support the overall operation of the CRC to provide an excellent customer experience, represent the CRC brand, and implement innovative programs.&nbsp;&nbsp; Proactively monitors risks and provides recommendations and implements mitigation plans to keep initiatives on-track.&nbsp;&nbsp; Implements continuous process improvements to workflows, processes, and customer-centric support and member engagement are well as propose solutions for the implementation of new services. 10%</p><p>Oversees member-centric customer service to respond to a wide range of simple to complex inquiries and bridges members to appropriate resources.&nbsp; Monitors implementation of child development activities and programs to support children development while parents and guardians attend a class or service appointment at the CRC.&nbsp;&nbsp; 10%</p><p>Leads implementation of extended-hour schedule by providing operational support and demonstrated commitment to offering high quality in-person service supporting CRC staff working extended-hour schedules to support members and visitors that may need services outside of regular operating hours and days based on business needs. Escalates complex member/visitor or staffing issues to manager as appropriate. 10%</p><p>Create desk level procedures and provides extensive consultation on health care access issues and identification of resource needs based on social drivers identified through a health assessment process.&nbsp; Leads cross-functional collaboration with multiple L.A. Care health plan departments.&nbsp; Implements the coordination of member service support across L.A. Care departments to ensure accountability and promote positive health care outcomes. 10%</p><h4>Duties Continued</h4><p>Leads work plan development to define building, maintaining, and nurturing meaningful relationships with key internal and external stakeholders; and, monitors the growth of the CRC partnership brand recognition.&nbsp; 10%</p><p>Assesses partnership opportunities and identifies key community stakeholders, assesses community needs, and gathers and analyzes data to inform an integrated approach to outreach activities and targeted member engagement.&nbsp; Makes recommendations for bridging members of the community to physical and health education programs and classes that will enhance health outcomes and member experience.&nbsp;&nbsp; 5%</p><p>Provides support to the CRC management in developing strategies and tactics to implement community and provider outreach and engagement initiatives to increase member traffic at a CRC and bridge members of the community to classes and resources.&nbsp;&nbsp; Oversees the&nbsp; member engagement platforms by developing and implementing&nbsp; a strategy for CRC staff to act as a liaison to the L.A. Care departments that play a role on CRC-specific marketing, communications, and promotional initiatives to promote member and community engagement.&nbsp; 10%</p><p>Creates and leads community initiatives leveraging 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. 5%</p><p>Provides training and education to 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. 5%</p><p>Performs other duties as assigned.&nbsp; 5%</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>Required:</p><p>A minimum of 4 years of experience in community events and leading projects focused on health care, public health, or health education.</p><p>At least 6 months of experience leading projects and/or staff, managing relationships with multiple stakeholders and have worked as a senior CRC Specialist.</p><p>Health care product experience including one of the following health care programs: Medicaid/Medi-Cal, Covered California, or Medicare Special Needs Plan.</p><p>Experience working cross-functionally with Care Management, Social Services, Health Education, and other social service or clinical teams.&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;&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; </p><p>Preferred: </p><p>Experience with Salesforce Customer Relationship Management (CRM) platform.</p><h4>Skills</h4><p><b>Required:</b></p><p>Strong verbal and written communication and presentation skills</p><p>Excellent organizational skills.</p><p>Must be a detail-oriented, collaborative and enthusiastic team player. </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. </p><p>Demonstrated ability to solve complex issues and identify creative solutions to assist members and community stakeholders.</p><p>Demonstrated ability to troubleshoot problem areas, recommend effective alternative solutions, and provide optimal customer service for internal and external customers.</p><p>Demonstrates action oriented leadership ability to take on new opportunities and rewarding challenges with a sense of urgency, high energy, and enthusiasm.</p><p>Strong ability to multi-task and meet competing deadlines while maintaining attention to detail and accuracy.</p><p>Strong ability to build effective teams with persuasive skills and ability to motivate others.</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>Ability to take initiative and act on anticipated business needs without prompting from management.</p><p>Exceptional customer service skills.</p><p>Strong 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></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. </p><p>Knowledge of public agencies, organizations, and other resources that support Community Resource Center visitors.</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>Light<h4>Additional Information</h4><p><b>Required:</b><br>Requires walking, standing to a significant degree, dexterity of hands and fingers to operate a variety of standard office equipment. Requires sitting most of the time, but entails bending/ lifting, pushing and/or pulling of arm or leg controls. The job may require working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible.)</p><p>Travel to offsite locations for work</p><p>Ability to work some evenings and weekends.</p><p><b>Preferred:</b></p><p>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&nbsp;&nbsp; </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>Job Segment: </strong>                    Behavioral Health, Social Services, Medicaid, Medicare, Relationship Manager, Healthcare, Service, Customer Service                                                    </p>

Lead Community Resource Center

<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 Salesforce Business and Technical Design Analyst II focuses in satisfying business requirements &amp; business process flows while participating in the development and software delivery of Salesforce Customer Relationship Management (CRM) solutions for L.A. Care. This position participates in full software development life cycle from UI/ UX and technical design to development, testing and deployment of the client solution on Salesforce platform leveraging, fully Salesforce out-of-the-box capabilities. This position may use APEX and Visualforce to create unique customer-based solutions, and participate in the estimation and timeline processes. </p><h4>Duties</h4><p>Understand and translate business requirements, business process flows etc. to software oriented solutions based upon Salesforce architecture.</p><p>Analyze the business processes and data requirements to come up with mockups. Document current baselines, collect new requirements, and write user stories, storyboards and future state.</p><p>Leverage out-of-the-box Salesforce UI/UX and functions and features.</p><p>Participate in translating business requirements to solutions on the Salesforce platform. Provide thought leadership to influence business logic to improve user experience/ interfaces, navigation, and design.</p><p>Interview, investigate and probe through multiple layers to better understand business drivers and conditions. Participate in the business process redesign and documentation. Actively participate in the development of detailed design structure after understanding the design requirements.</p><p>Actively participate in the translation of engineering/ technical realities into simple terms for non-technical stakeholders. Provide such translation, adjusting the level of detail depending on the audience. Act as the interface between the team and the management. </p><p>Communicate, both written and verbally, with business end users and team members in order to deliver high quality UI/UX and capabilities in Salesforce. Act as a technical analyst to evaluate, assess, coordinate and verify development work. Provide a clear example of technical excellence and productivity.</p><p>Participate in developing APEX and Visualforce code.</p><h4>Participate in developing and delivering Web solutions using HTML, JavaScript, CSS. </h4><h4>Understand technical requirements and implement solutions leveraging Salesforce native functionality based upon in-depth understanding of Salesforce object model and architecture. Identify new opportunities for improvement, define solution capabilities. Propose best practices &amp; standards for the project and work with team members for implementation.</h4><h4>Deliver Lightning components and customizations.</h4><h4>Duties Continued</h4><h4>Configure workflows and approvals processes, create test classes and deployment sets. Work with Quality Assurance Testing team to verify test cases and assist business unit. Work with project teams to ensure</h4><h4>the testing approach is sound and appropriately executed in all SDLC phases and across all Salesforce based apps and systems interfaces. Provide inputs into roadmap planning, system investments and operations performance.</h4><h4>Participate in creating SOAP/REST web services for integration.</h4><h4>Perform data integration and/or migration.</h4><h4>Collaborate with team members to identify processes and raise concerns about dependencies or impacts. Work with SOA Bus (Oracle Bus).</h4><h4>Work with ETL (Extract, Transform Load) tools such as Informatica. </h4><h4>Perform other duties as assigned.</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 6 years of Information Technology experience with 4 years of Salesforce experience.</p><p>Experience in the concepts and methodologies of enterprise and application architecture.</p><p>Experience in back-end development of Salesforce including but not limited to design of data models, a strong knowledge of SOQL, and usage of web technologies.</p><p>Experience with configuration and customization.</p><p>Must have Apex/Visualforce Experience.</p><p>Broad understanding of technologies and experience in implementation methodologies, software development life cycle process, and project management.</p><p><b>Preferred:</b><br>Service Cloud experience.</p><h4>Skills</h4><p><br><b>Required:</b></p><p>Knowledge of Information Technologies (Databases, Business Intelligence, Infrastructure, Networks, Web and Integration software).</p><p>Excellent planning and organization, project management and time management skills.</p><p>Exceptional written, verbal and presentation skills for both business and technically oriented communications with the ability to create appropriately high quality documentations to effectively convey goals and initiatives to staff and management.</p><p>Comprehensively understand the roadmap and work with project /program management to prioritize the work.</p><p>Knowledge of the vendor market and possess existing relationships.</p><p>Must have Lightning knowledge.</p><p>Must understand the technical details of the overall project.</p><p>Familiar with enough detail to catch inconsistencies to enable sound decisions.</p><h4>Licenses/Certifications Required</h4>Salesforce Certified AdministratorSalesforce Certified Platform Developer ISalesforce Certified Platform App Builder<h4>Licenses/Certifications Preferred</h4>Salesforce Certified Community Cloud ConsultantSalesforce Certified Sales Cloud ConsultantSalesforce Certified Service Cloud ConsultantSalesforce Certified Platform Developer II<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>

Salesforce Business and Technical Design Analyst II

<p><b>Salary Range:&nbsp;&nbsp;<b><b><b><b>$46,800.00</b></b></b></b>&nbsp;(Min.) -&nbsp;<b><b><b><b>$52,597.00</b></b></b></b>&nbsp;(Mid.) -&nbsp;<b><b><b><b>$62,270.00</b></b></b></b>&nbsp;(Max.)</b></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 Quality and Population Health Coordinator I (QPHC) is responsible for outreaching to members to close care gaps. The QPHC also outreaches to providers for medical record pursuit and retrieval.&nbsp; This position supports the L.A. Care medical groups by assisting with scheduling member appointments. While this role is a combination of remote and in office work, this role is intended to support L.A. Care medical groups by being embedded in the provider offices and providing direct outreach to L.A. Care members. The QPHC is an important member of L.A. Care’s quality improvement team, helping to drive improvement in health outcomes, population health, and health equity, as well as member and provider experience.</p><h4>Duties</h4><h4>Make outbound calls to members to assist with scheduling and coordinating services (e.g. appointments, lab tests, health screenings, other diagnostic studies, transportation, etc.). (25%)</h4><h4>Educate members on missing gaps in care. Encourage them to close care gaps and pursue preventative health and health promotion activities such as health fairs. (25%) </h4><h4>Outreach to providers to request medical reports by fax, electronic medical records, or on-site visits if needed. (15%) </h4><h4>Review medical records, claims, and encounter data to identify key information to help close gaps in care. (15%)</h4><h4>Provide support as needed for care gap closure campaigns and other quality improvement programs. (10%)</h4><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>At least 3 months of experience following basic workflows, procedures, and standards related to patient or provider communication and outreach.</p><p>Previous experience working in an office setting with basic office equipment such as telephones, fax machines, computers, etc.</p><p><b>Preferred:</b></p><p>Health Plan, provider practice, or health education experience. </p><h4>Skills</h4><p><b>Required:</b></p><p>Demonstrates deep compassion and sensitivity towards patient needs and community well-being. </p><p>Driven by strong motivation to positively impact people’s lives.</p><p>Excellent verbal and written communication skills.</p><p>Excellent interpersonal skills.</p><p>Proficient with Microsoft Word, Excel, PowerPoint, and Outlook.</p><p>Skills in utilizing various online platforms and search engines to efficiently gather accurate and relevant information. </p><p>Highly organized with ability to maintain accurate notes and records.</p><p>Demonstrates high efficiency in managing tasks and consistently delivering projects to successful and reliable completion. </p><p>Ability to communicate effectively with patients and health care providers. </p><p><b>Preferred:</b></p><p>Some knowledge of HEDIS and other quality measures.</p><p>Some knowledge of quality improvement processes.</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&nbsp;&nbsp; </p><h4>Licenses/Certifications Required</h4>Active &amp; Current Driver's License, with a clean record and Auto Insurance.<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><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>This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.</p><p><br><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>                    EMR, Claims, Equity, Medical, Healthcare, Insurance, Finance                                                    </p>

37 L.A. Care Health Plan Jobs