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<p><b>Salary Range:&nbsp;</b>&nbsp;$91,536.00&nbsp;(Min.) -&nbsp;$121,286.00&nbsp;(Mid.) -&nbsp;$151,034.00&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 Network Administrator III is responsible for providing network support for the mission critical network systems for L.A. Care. This involves troubleshooting IP equipment/LAN/WAN problems, routine administration tasks, and performance tuning. This position acts as an escalation point for the junior network staffs regarding network related problems.</p><p>Performs troubleshooting of LAN/WAN equipment i.e. CISCO, etc. Conduct daily routine administration and maintenance of all network devices. Monitors network to ensure constant uptime. Supports and maintains firewall and network security policies and IDS. Implements new technologies platforms for the network environment. Must be able to troubleshoot issues quickly to resolve the problem. Participate in Disaster&nbsp;Recovery Exercises to demonstrate the capability of establishing network connectivity in the event of an outage. Provide support in a 7x24 operation. Prioritization, Multitasking, Training, I.T. projects, and writing SOPs. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Work closely with other technical teams to determine future network needs and plan for network changes.</p><p>Develop methods and tools to be used to test to implement new LAN/WAN equipment.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Configure routing protocols such as EIGRP, OSFP, and BGP.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Engage in regular network troubleshooting and resolve network connectivity issues.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Analyze the current network structure and submit comprehensive reports to manager on how to make the network more efficient.&nbsp;&nbsp;&nbsp; </p><p>Create projects that are designed to either add functionality required by the company or to address ongoing network failure issues.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Maintain network performance by performing network monitoring and analysis, and performance tuning, troubleshooting network problems and escalating problems to vendor or lead network administrator.&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Secure network by developing network access, monitoring, control, and evaluation, maintaining documentation. </p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><b>Required:</b></p><p>Minimum of 5 years of experience as a network administrator.</p><h4>Skills</h4><p><b>Required:</b></p><p>Must have critical thinking skills and a team player. </p><p>Must have strong written and verbal communication, project management, and organization skills.</p><p>Demonstrate the ability to lead the network team on technical issues and act as a backup to the manager.</p><p>Demonstrate working knowledge of network equipment and software (Cisco Routers, Switches, firewalls, F5 Bigip, IPS/IDS, LAN/WAN).</p><p>Demonstrate working knowledge in routing protocols such as BGP, EIGRP and OSFP.</p><p>Demonstrate working knowledge in Layer 2 network switching such as VLAN, Trunking, VTP and others.</p><p>Demonstrate working knowledge in advance network troubleshooting and work with other teams or departments to resolve complex issues.</p><h4>Licenses/Certifications Required</h4>Cisco Certified Network Professional (CCNP)<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>

L.A. Care Health Plan

Network Administrator III

<p><b>Salary Range:&nbsp;</b>&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Credentialing Specialist II is responsible for managing their workload, addressing all functions for initial and re-credentialing of Health Delivery Organizations (HDOs) and initial and re-credentialing of applicants in accordance with departmental policies and procedures, National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services(CMS), California Department of Health Care Services (DHCS) requirements. This incumbent ensures data accuracy of incoming applications and re-credentialing review forms, monitoring data into Visual Cactus. Committee preparation which includes reporting, analysis, and meeting monthly deadlines. All expiries must be maintained and current. Any providers or practitioners identified as having any expired documents must be recommended for removal from the network per policies and procedures. Provider and practitioner data must be accurate and current in our Cactus database.&nbsp; </p><h4>Duties</h4><p>Ensures all applications are complete and conducts primary source verifications, identifies potential adverse events, requesting additional supporting documentation, data entry into CACTUS, prepares files for auditors QA before presenting to Credentialing Committee for decision, generating 60 day letter, scanning into Dynafile and notification to PNO. </p><p>Conducts Quality review of profiles, contract, W9 received from delegates through the PCDW application to ensure practitioner meets all regulatory requirements before being added into the network. </p><p>Monitors expiring monthly primary source verifications, scans updates into Dynafile and updates data in CACTUS, works with Auditors when potential adverse events, and/or expiring are not renewed, to review and initiate next steps. </p><p>Educates and disseminates credentialing information &amp; regulations to delegated entities. </p><p>Performs other duties as assigned.</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 1 year of credentialing or credentialing related experience.</p><p>At least 1 year of experience in a healthcare/ managed care environment. </p><h4>Skills</h4><p><strong>Required:</strong><br>Ability to audit data and make changes as appropriate with proper documentation.</p><p>Ability to audit, retrieve files/documents from our IPA and medical groups at any given time. &nbsp;</p><p>Strong knowledge of the oversight process and ability to apply requirements as per policies and procedures and instruct delegates which includes the Adds, Change, Delete (ACD) process and primary source verifications of all required elements i.e. Board Certification, License, DEA, CHDP, M/M Sanctions. &nbsp;</p><p>Confidentiality is crucial.&nbsp;</p><p>Professional computer skills.&nbsp;</p><p>Excellent communication skills (both verbal and written), high aptitude, and a facility for working on a variety of projects which require the ability to prioritize and re-prioritize, quality assurance review of credentialing files, or have a strong ability to learn. &nbsp;</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Medical Staff Coordinator (CMSC)Certified Provider Credentialing Specialist (CPCS)<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>                    Healthcare Administration, Medicaid, Medicare, Data Entry, Healthcare, Administrative                                                    </p>

Credentialing Specialist II

<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>As a key creative member of a cross-functional Communications team, the Community Relations Specialist II provides a wide range of essential project support, including co-facilitation of stakeholder meetings and trainings, as assigned, coordinating the delivery of services and goods required for meetings, verification of stakeholder eligibility for committee participation, stipend disbursement, and logistics and data management for stakeholder meetings and activities as assigned.</p><p>With guidance from management, the Community Relations Specialist II may contribute to ensuring the organization's sponsorships program aligns with strategic priorities. This involves collaboration with multiple departments; establishing and maintaining relationships internally and externally; and, evaluating and routing a high volume of sponsorship requests in accordance with sponsorships policies and procedures. Key responsibilities include writing, creative development, cultivating relationships with community-based organizations, and event planning and support.</p><p>In collaboration with key internal stakeholders, this position represents the organization in interactions with a wide variety of stakeholders, including employees, consumer council members, consumer advocates, sponsorship recipients, community partners, and online audiences, through meetings, presentations, and written, video, verbal, telephonic, and digital messaging, in alignment with organizational priorities, brand guidelines, and regulatory requirements.</p><p>With guidance from project leads, this position will create and coordinate internal and external communications strategies and campaigns and identify communications opportunities for dissemination of approved messaging. This includes but is not limited to writing and updating messaging and supporting intradepartmental communications campaigns through a variety of channels, including social media and monitoring and responding to stakeholder inquiries, tracking data, and regularly reporting on internal and external stakeholder engagement metrics.</p><h4>Duties</h4><h4>In collaboration with key internal stakeholders, represent the organization in interactions with a wide variety of stakeholders, including employees, consumer council members, consumer advocates, sponsorship recipients, community partners, and online audiences, through meetings, presentations, and written, video, verbal, telephonic, and digital messaging, in alignment with organizational priorities, brand guidelines, and regulatory requirements.</h4><p>Support the creation of multi-media messaging strategies, social media content and deliverables for multiple stakeholders, including employees, community partners, members, and other key audiences. Identify communications opportunities for dissemination of approved messaging through multiple mediums, this includes collaboration with the key stakeholders support the Enrollee Advisory Committee through co-development of presentations; creating and maintaining stakeholder engagement data; generating reports as needed; responding to stakeholder inquiries; and conducting research as needed.</p><h4>Duties Continued</h4><h4>Responsibilities associated with the planning, preparation, execution, delivery and follow-up of assigned stakeholder meetings and activities. Including but not limited to all administrative work required for successful execution of activities, and for monitoring and documenting compliance with applicable regulations, policies, and procedures, and co-facilitation of meeting topics and trainings.</h4><p>In collaboration with internal stakeholders, support annual sponsorship priorities. Identify strategic sponsorship opportunities that support organizational goals. Build and maintain positive relationships with stakeholders. Regularly evaluate sponsorship review and approval processes to identify opportunities for increased efficiency and operationalize improvements. Interface with Marketing to develop layout/design of ads for sponsorships.</p><h4>Perform other duties as assigned.</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 in Communications or Related Field<h4>Experience</h4><p><strong>Required:</strong></p><p>At least 4 years of experience developing and maintaining relationships with key stakeholders.</p><p>Experience planning and leading meetings, including developing agendas and minutes, following up on action items, such as writing reports and managing interpersonal dynamics.</p><p>Experience collaborating with multiple stakeholders to provide education to consumers, providers, and advocates.</p><p>At least 2 years of developing content for social media audiences.</p><h4>Skills</h4><p><strong>Required:</strong></p><p>Knowledge and understanding of the unique needs of special populations; experience working with culturally-diverse stakeholders; knowledge of public agencies, organizations, and other resources that support traditionally-underserved communities.</p><p>Able to clearly and appropriately communicate with diverse stakeholders in a professional manner.</p><p>Excellent oral and written communication skills, as well as the ability to represent L.A. Care and its positions to key stakeholders.</p><p>Ability to exercise good judgment in responding to situations by utilizing strong problem solving skills.</p><p>Ability to multi-task and meet competing deadlines while maintaining attention to detail and accuracy.&nbsp;</p><p>Must be able to work independently or as part of a team; be business-minded as well as empathetic towards stakeholders.</p><p>Demonstrated ability to handle a high-volume workload and to adapt quickly to a fast-changing environment.</p><p>Skilled at creating social media content like reels, stories and static posts.</p><p>Proficiency in MS Office including Outlook, Word, Excel, PowerPoint, Canva, CapCut and Chat GPT.</p><p>Must be able to persuade and influence the behavior of vendors to provide service and support continuity at stakeholder meetings. This position will also need the skills to persuade internal and external stakeholders of new and innovative partnership opportunities that will support organizational goals</p><p><strong>Preferred:</strong></p><p>Proficiency in Adobe Photoshop and InDesign, MS Visio, Project, SharePoint, and Access.</p><p>Strong knowledge and understanding of Medi-Cal, Medicare and related public health programs.</p><p>Strong interpersonal skills, ability to read non-verbal cues, high level of situational adaptability.</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>Required:</b><br>Travel to offsite locations for work.</p><p>Must be available on weekends and evenings.</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>                    Public Health, Medicare, Healthcare                                                    </p>

Community Relations Specialist II (Temporary- 3 months)

<p><b>Salary Range:&nbsp;</b>&nbsp;$105,267.00&nbsp;(Min.) -&nbsp;$139,478.00&nbsp;(Mid.) -&nbsp;$173,689.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The .Net Developer III is responsible for the design and development of .NET applications, must maintain effective security aligned with Health Insurance Portability and Accountability Act, state and federal requirements; Develop and maintain databases in support of our developed .NET applications.&nbsp; Perform daily administration of .NET Servers and organizational Intranet system.&nbsp; Ensure all database projects and processes are fully documented.&nbsp; Complete technical documentation for all database projects and processes.&nbsp; Apply learned knowledge in software application development and database administration while utilizing: Microsoft .NET, ASP.NET and other applications and tools to work in multi-computing environments including UNIX, Linux, and AIX. Apply learned knowledge in software applications development and database administration. </p><p>The .Net Developer III must also ensure that documentation is created for system designs and modifications, and assist collaboratively in following the established software development life cycle procedures to develop, test and modify system software, utilities; support integrations with other applications by coding, reviewing, preparing test data, testing and debugging, in order to ensure that the developed software is robust and meets user functional and performance requirements. Must develop, foster and maintain an open, professional relationship with other team members within IT and also with other departments to enhance team effectiveness and efficiency and customer satisfaction. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Lead and evaluate seeking solutions to production issues as well as new projects. Lead and work closely with applications developers in solving production issues. Successful resolution of production issues. Successful relationship with application developers.</p><p>Prepare short and long term plans to address infrastructure projects as well as support and provide technical leadership for internally/externally sponsored company projects. Successful leadership for the resolution of production issues. Successful relationship with application developers.</p><p>Recommend schedules for database upgrades; assist in the planning and implementation of major software upgrades; adhere to change management procedures and methodologies.</p><p>Ensure all database projects and processes are fully documented, and that complete technical documentation exists for all database projects and processes.</p><p>Develop and maintain databases in support of our developed .NET applications.&nbsp; Perform daily administration of .NET Servers and organizational Intranet system.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Information Technology or Computer ScienceIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Information Technology or Computer Science<h4>Experience</h4><p><b>Required:</b></p><p>At least 5 years of experience in a technical function creating and maintaining .Net databases and software applications. </p><p><b>Preferred:</b></p><p>Experience on Managed Health-care Information systems, subsystems and applications.</p><h4>Skills</h4><p><b>Required:</b></p><p>Excellent and extensive knowledge of .Net systems.</p><p>Must have the ability to code complex .Net packages, functions, and procedures.</p><p>Solid communication skills (oral, written, and presentation) and strong interpersonal skills required.</p><p>Must have a very high ability to learn new things, especially about new technology developments. </p><p>Ability to accurately set and adhere to deadlines.</p><p>Ability to prioritize projects and workload. </p><p>High level of independent judgment.</p><p>Must be flexible, organized, and able to handle multiple tasks simultaneously. </p><p>Strong project management skills.</p><p>Must understand Managed Health Care Information systems, subsystems and applications. </p><p>Must develop, foster and maintain an open, professional relationship with other team members within IT and also with other departments to enhance customer satisfaction.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p><b>L.A. Care offers&nbsp;a wide range of benefits including</b></p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

.Net Developer III

<p><b>Salary Range:&nbsp;</b>&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&amp;G) clinical unit.</p><p>This position is responsible for the quality review of complex and/or escalated clinical A&amp;G cases for all line of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved Customer Service to L.A. Care’s (LAC) membership. This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines. </p><p>Leads and works closely with assigned team daily. This position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and project completion.</p><h4>Duties</h4><p>Review and process complex and/or escalated clinical A&amp;G cases. Analyze the patient medical records, clinical documentation, and insurance policies to determine medical necessity. Prepares and reviews A&amp;G files for submission to providers and internal departments.</p><p>Work with other departments to ensure all aspects of a case are appropriately managed.</p><p>Conduct targeted and random clinical case audits to ensure that all regulatory and departmental guidelines, policies, procedures, and standards are met. Work closely with the leadership team to create and/or modify Desk Level Procedures and recommends enhancements to process and procedures. </p><p>Assist the Clinical Supervisors in identifying deviations in performance and process changes are implemented to redirect performance to acceptable levels. Recommend and implement resolutions, new processes, and/or process improvement. </p><p>Provides accurate and timely written statistical reports that includes historical and/or current data to aid in projecting or evaluating compliance status. Identify and analyze trends in appeals and grievances to find the root cause of denials.</p><h4>Duties Continued</h4><p>Check, verifies and ensure that all clinical A&amp;G cases are processed accurately and within established timelines to meet or exceed member satisfaction goals and regulatory (CMS, DMHC, DHCS, NCQA), Health and Safety Code and company compliance.</p><p>Maintains documentation of all communications in the A&amp;G system to ensure thorough tracking of case status.</p><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. Work closely with management to review performance and quality standards on an ongoing basis. As well as motivational programs needed to achieve regulatory standards.</p><p>Acts as a back-up to the Supervisor in leading meetings and handling escalations as required.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Associate's Degree in Nursing for Registered Nurses<h4>Education Preferred</h4>Bachelor's Degree in Nursing for Registered Nurses<h4>Experience</h4><p><b>Required:</b></p><p>At least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting,</p><p>At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment.</p><p>At least 1 year of leading a process, program, or staff experience.</p><p><b>Preferred:</b></p><p>Clinical acute experience.</p><h4>Skills</h4><p><b>Required:</b></p><p>Extensive knowledge of healthcare regulations and managed care guidelines</p><p>Demonstrated ability to provide recommendations towards resolution.</p><p>Strong critical thinking and problem-solving abilities to assess complex clinical cases and evaluate medical necessity.</p><p>Ability to communication, conflict resolution, and motivational skills. </p><p>Ability to work independently and closely with a team in a collaborative and interactive environment.</p><p>Ability to adjust to changing circumstances within the team. </p><p>Good verbal and written communication skills.</p><p><b>Preferred:</b></p><p>Strong project management skills with the ability to manage multiple training initiatives simultaneously.</p><h4>Licenses/Certifications Required</h4>Licensed Registered Nurse (RN) - Active, current and unrestricted California License and/or Physician Assistant (PA) - California License Required<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, and 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>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, Medical, Registered Nurse, Medicare, Medicaid, Healthcare                                                    </p>

Lead Customer Solution Center Appeals and Grievances RN

<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 Customer Solution Center Appeals and Grievances (A&amp;G) Specialist II &nbsp;will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance (NCQA) regulatory requirements. This position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations, and complex provider claim disputes. &nbsp;The position is further responsible for tracking, trending and reporting complaints and appeals, as well as participating in internal and external oversight activities.</p><p>The position is responsible for maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, adhering to company policy and procedures, including accreditation requirements, applicable federal, state and local laws and regulations.</p><h4>Duties</h4><p>Identifies, investigates, and resolves administrative complaints, complex provider appeals and State Fair Hearing adhering to CMS, DHCS, DMHC, MRMIB and NCQA standards and regulations.</p><p>Intakes, acknowledges, prepares case files and routes complaints to appropriate internal department for investigation and resolution, exercising strong independent judgment.&nbsp;</p><p>Ensures integrity of A&amp;G database by thorough, timely and accurate assignment of cases. &nbsp;Monitors closure of complaints and works with Quality Control Supervisor to resolve all database issues.&nbsp;</p><p>Prepare and analyze monthly appeal and grievance reports to meet internal and external reporting requirements.</p><p>Participates in internal and external oversight activities, inter-rater reliability reviews and focused audits. &nbsp;Recommends opportunities for improvement</p><p>Perform 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><b>Required:</b></p><p>At least 2 years of experience in Managed Care with specific experience in resolving member and provider complaint and appeals issues, including eligibility, access to care, claims, benefit, and quality of care concerns.&nbsp;</p><p><br>Experience working with firm deadlines, able to interpret and apply regulations. &nbsp;</p><p>At least 5 years of experience in Managed Care working with Medicare, Medi-Cal and other State Sponsored programs. &nbsp;</p><p>Knowledge of Medical terminology and strong advocacy experience.</p><h4>Skills</h4><p><b>Required:</b><br>Must be organized, detail oriented, able to exercise strong independent judgment; poses conflict resolution and persuasion skills. &nbsp;</p><p>A team player with excellent communication and presentation skills, able to work effectively with various internal departments/service areas, plan partners, participating provider groups and other external agencies.<br><br>Proficient in MS Office applications, Word, Excel and Power Point.&nbsp;</p><p>Requires strong knowledge of regulatory standards and claims processing; strong analytical, oral, written and presentation skills, able to monitor and be compliant with strict regulatory deadlines.&nbsp;</p><p><b>Preferred:</b><br>Proficient in MS Office applications, Access, 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>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicare, Medicaid, Healthcare, Insurance                                                    </p>

Customer Solution Center Appeals and Grievances Specialist II (Temporary)

<p><b>Salary Range:&nbsp;</b>&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty level appeals and grievances work supporting the higher level position in this class series to ensure positive outcomes for members. It will support the Appeals and Grievances team to receive, investigate and resolve member and provider complaints and appeals; escalates complex issues or questions to leadership team as appropriate.</p><p>The position is responsible for maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, adhering to company policy and procedures, including accreditation requirements, applicable federal, state and local laws and regulations.</p><h4>Duties</h4><p>Primary function of this role is to learn the specialty level appeals and grievances work by resolving less complex cases to ensure positive outcomes for members. (20%)</p><p>Supports the identification, investigation and resolve administrative complaints, simple appeals while adhering to Center for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MRMIB) and National Committee for Quality Assurance (NCQA) standards and regulations. (20%)</p><p>Intakes, acknowledges, prepares case files and routes complaints to appropriate internal departments and external business partners for investigation and resolution, exercising strong independent judgment. (20%)</p><p>Processes assigned cases accurately and in a timely manner per instructions. Escalates complex issues or questions to leadership as appropriate. (20%)</p><p>Actively participates in team meetings and provides recommendation for improvement as appropriate based on discoveries. (10%) </p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p><b>Required:</b></p><p>At least 1 year of experience in Managed Care working with Medicare, Medi-Cal and other State Sponsored programs.</p><p>Experience working with firm deadlines, able to interpret and apply regulations.&nbsp; </p><p>Strong advocacy experience.</p><h4>Skills</h4><p><b>Required:</b><br>Must be organized, detail oriented, able to exercise strong independent judgment; poses conflict resolution and persuasion skills. &nbsp;</p><p>A team player with excellent communication and presentation skills, able to work effectively with various internal departments/service areas, plan partners, participating provider groups and other external agencies.<br><br>Proficient in MS Office applications including Word, Outlook and Excel.&nbsp;</p><p>Ability to provide confidentiality and professional customer service skills.&nbsp;</p><p>Ability to work under tight deadline.</p><p>Strong analytical, verbal, written and presentation skills, able to monitor and be compliant with strict regulatory deadlines.&nbsp;</p><p>Knowledge of Medical terminology.</p><p><b>Preferred:</b><br>In depth knowledge of DHCS, NCQA, CMS, DMHC regulartories and guidelines.</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>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, Medicaid, Healthcare                                                    </p>

Customer Solution Center Appeals and Grievances Specialist I (Temporary)

<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 Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan’s enterprise special investigations unit (SIU) and FWA program. The Director oversees internal and external investigations into potential misconduct, regulatory violations, and fraudulent activity while ensuring compliance with federal and state regulatory requirements. </p><p>The Director provides strategic direction, operational leadership, and subject matter expertise to safeguard L.A. Care’s integrity, protect member trust, and mitigate financial and reputational risks. This position leads investigative governance across the enterprise, coordinating with internal stakeholders and external regulators to ensure timely, thorough, and effective resolution of investigative matters. </p><p>This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.</p><h4>Duties</h4><p><b>Leadership and Program Oversight:</b></p><p>Lead L.A. Care’s Special Investigations Unit (SIU) in overseeing the internal and external investigations into fraud, waste, abuse, and compliance violations. </p><p>Drive the design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program, ensuring compliance with Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and state/federal requirements. </p><p>Ensure effective case intake, triage, investigation, tracking, and resolution processes, including referral to law enforcement, regulators, or external entities as needed. </p><p>Develop and support enterprise policies, procedures, and training programs supporting FWA prevention, detection, and response.</p><p><b>Investigations and Regulatory Engagement: </b></p><p>Direct and oversee investigations into allegations of non-compliance, ethical violations, or fraudulent behavior involving employees, delegated entities, providers, or vendors.</p><p>Partner with Legal, Compliance, and Human Resources on sensitive internal investigations to ensure confidentiality, integrity, and fairness.</p><p>Ensure timely and accurate reporting of SIU/FWA activity to external agencies to meet regulatory requirements.</p><p>Lead enterprise readiness for external audits, regulatory inquiries, and enforcement actions involving SIU and FWA matters. </p><h4>Duties Continued</h4><p><b>Risk Management and Oversight</b></p><p>Conducts strategic planning to use resources to meet current and future departmental and Enterprise-wide goals.</p><p>Monitor investigative trends, emerging risks, and regulatory developments to proactively adapt investigative strategy and resource allocation.</p><p>Develop dashboards, analytics, and reporting tools to provide executives and the Board with visibility into investigative outcomes, financial recoveries, and risk trends.</p><p>Ensure alignment of investigative and FWA activities with organizational risk appetite, compliance strategy, and enterprise risk management frameworks.</p><p><b>Collaboration and Culture:</b></p><p>Serve as a trusted advisor and subject matter expert to senior leadership, the Compliance Committee, and the Audit Committee on investigative matters.</p><p>Collaborate with cross-functional leaders to embed FWA prevention and detection mechanisms across operations.</p><p>Champion a culture of integrity, accountability, and transparency by promoting awareness of FWA risks and prevention strategies.</p><p>Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.</p><p>Manages budgets and resources effectively.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Criminal Justice or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Public Policy or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field.</p><p>At least 5years of experience in leading teams, projects, initiatives, or cross-functional groups.</p><p>Demonstrated experience managing complex investigations in a managed care or healthcare environment. </p><p>Experience in coordinating with external regulators and law enforcement agencies. </p><p><b>Preferred:</b></p><p>Prior leadership of a Special Investigations Unit (SIU) or equivalent function in a health plan, government agency, or large healthcare system.</p><p>Experience with compliance technology platforms and advanced data analytics for FWA detection.</p><h4>Skills</h4><p><b>Required:</b></p><p>Proven knowledge of CMS, DHCS, DMHC, OIG, and DOJ regulatory frameworks governing FWA programs</p><p>Strong investigative skills, including evidence gathering, interviewing, and case documentation. </p><p>Demonstrated success in leading complex, multi-party investigations with integrity and discretion.</p><p>Excellent communication skills, with the ability to present investigative findings clearly to executives, boards, and regulators. Presented at NHCAA, HCCA or other professional organizational conferences</p><p>Strong organizational and project management abilities; able to manage multiple investigations concurrently under tight deadlines.</p><p>Executive presence with ability to influence and build trust across the enterprise.</p><p>Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.</p><p><b>Preferred:</b></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><h4>Licenses/Certifications Preferred</h4>And/Or any of the following Licenses/ Certifications:Certified Fraud Examiner (CFE)Certified HealthCare Compliance (CHC)Certified Internal Auditor (CIA)Certified Coder, RN, MD,  PharmaD, or equivalent<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, Public Policy, Internal Audit, Medicaid, Medicare, Finance, Government, Healthcare                                                    </p>

Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

<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>

Senior Application Architect

<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>&nbsp;The Delphix Engineer III responsible for designing, building, and maintaining secure, compliant, and efficient non-production data environments using advanced automation, data masking, and virtualized data provisioning with Delphix Masking &amp; Virtualization Software. This also includes environment cloning and copying, workflow scheduling, data synchronization across environments, data auditing processes. This position streamlines data workflows for development, testing, and compliance, (of what) ensuring alignment with business requirements. This includes evaluating, crafting, and supporting all aspects of masking and virtualization for optimized database environments. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p><b>Delphix Integration &amp; Automation</b>: Develops custom Python/PowerShell scripts using Delphix APIs for CI/CD pipeline integration and IT system automation.</p><p><b>Data Management &amp; Security</b>: Configures and profiles application databases in Delphix to identify and mask sensitive data; collaborates with SMEs to validate accurate masking in non-production environments.</p><p><b>Virtualization &amp; Optimization</b>: Implements Delphix Virtualization to reduce disk space in non-production environments; ensures new application databases are effectively masked and virtualized.</p><p><b>Compliance &amp; Audit</b>: Generates reports on data usage, masking, and access for audit readiness; revises Profile Expressions in the Masking Engine to enhance critical data identification.</p><p><b>Process Development</b>: Creates and documents SOPs for provisioning, virtualization, and restoration; leads software upgrades and maintains Delphix architecture documentation.</p><p><b>Collaboration &amp; Security</b>: Partners with Governance and Information Security teams to address security concerns; proactively identifies and resolves potential issues in non-production environments.</p><p><b>Continuous Improvement</b>: Updates workflows to account for evolving database schemas and automates non-production restores; develops SQL pre/postscripts to ensure comprehensive data masking.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>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>Master's Degree in Computer Science or Related Field<h4>Experience</h4><p><b>Required:</b></p><p>At least 4 years of experience with Delphix and Virtualization software, including setup, configuration, optimization, and automation. </p><p>Experience in developing and enforcing data masking policies to ensure sensitive data is protected and non-production environments. </p><p>Experience working with Delphix APIs for custom automation, integration Delphix into CI/CD pipelines, and creating reusable scripts for data provisioning and refreshes. </p><p>Experience m planning and executing Delphix implementations, upgrades, and customizations; documenting and maintain Delphix architecture, workflow processes, and restoration procedures for team reference and training. monitoring Delphix configurations to ensure optimal resource usage, scalability, and performance across environments.</p><h4>Skills</h4><p><b>Required:</b></p><p>Delphix database virtualization, data de-identification knowledge or skills.</p><p>Automation using scripting languages like PowerShell, Python, or Shell scripting to streamline operations (automating data refreshes, masking workflows, and environment provisioning) Experience working with Delphix APIs for custom automation.</p><p>Mastery of database architecture (SQL Server 2016,18,19,22 and Oracle 19c and above).</p><p>Expert in SQL and PL/SQL for complex database querying, scripting, and stored procedure development.</p><p>Proficient in data modeling, database schema design, normalization, and denormalization.</p><p>Excellent communication skills for interacting with team members, stakeholders, and upper management.</p><p>Familiarity with data compliance standards (HIPPA, GDPR) and aligning data management processes with these regulations. Ability to perform audits and compliance checks using Delphix tools, ensuring continuous data security.</p><p>Strong skills in automation, using scripting languages like PowerShell, Python, or Shell scripting to streamline operations (automating data refreshes, masking workflows, and environment provisioning).&nbsp; </p><p>Solid background in database management for Oracle, SQL Server, or similar databases, including performance tuning, troubleshooting, and optimization within Delphix environment.&nbsp; Knowledge of backup, recovery and version management.</p><p>Advance troubleshooting skills for resolving issues within Delphix environments and associated databases.</p><p>Skilled in developing Standard Operating Procedures. </p><p>Proficient in managing virtual database environments and ensuring date masking compliance.&nbsp; Expertise in configuring Delphix for various relational databases such as Oracle, SQL Server, and others.</p><p>Preferred:</p><p>Ability to develop and execute strategic plans for database virtualization, automation, aligning with organizational goals and business needs.</p><p>Knowledge of other databases such as MySQL and PostgreSQL.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Delphix Certification<h4>Required Training</h4><p>Preferred Training:</p><p>Delphix Badges – Data Masking Services and or Data Virtualization Services, Advance Automation, and/or Compliance and Security.</p><h4>Physical Requirements</h4><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>

37 L.A. Care Health Plan Jobs