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<p>Salary Range:&nbsp;&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 Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals &amp; Grievance (A&amp;G) program for L.A. Care Health Plan members under the direct supervision and management of the A&amp;G Nurse Specialist, RN and/or Medical Director. This position provides assistance to members with health care access and benefit coordination issues, ensuring that clinical grievances and complex issues are investigated and resolved to the member’s satisfaction consistent with L.A. Care Health Plan and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care Health Plan Lines of Business.</p><h4>Duties</h4><p>Work with Registered Nurses and Medical Directors to appropriately investigate, review and resolve clinical appeals and grievances. Prepares Nurse Summary for MD review and determination. Performs clinical review of medical records related to grievances and appeals. Responsible for handling member and provider appeals providing clinical reviews and write-ups and recommendations, mailing and faxing of resolution letters.</p><p>Reviews grievance cases that require immediate clinical quality of care, initial coding of member grievance and evaluation and/or require immediate pre-service authorization evaluation.</p><p>Investigate Provider Disputes/PDR and prepares clinical summary for Medical Director determination. </p><p>Work with the external providers and Participating Physician Group (PPGs) representatives to obtain relevant medical records and communication documentation.</p><p>Investigation and preparation of State Fair Hearing cases as assigned.</p><p>Prepare complaint files for Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DMHC), and external review organization (QIO or IRE).&nbsp; Process the case thru to effectuation and final case documentation in the A&amp;G system of record.</p><p>Work with Utilization Management and PNO to facilitate completion of resolution determination.</p><p>Investigate, prepare summary and work with Medical Directors to resolve expedited cases within regulatory timelines. Maintain knowledge of regulatory changes related to all grievances and appeals and meets regulatory requirements. Refers cases for further follow-up or notification as appropriate, e.g. fraud and abuse cases shall be forwarded to Compliance Department.</p><h4>Duties Continued</h4><p>Outreach to providers, vendors, hospitals, and members to request necessary information or to provide case status and/or next steps as needed.&nbsp; In instances where necessary, send written notifications to appropriate parties. All interactions including verbal outreach and written communication will be documented in the A&amp;G system of record. </p><p>Participates inter-rater reliability training and assessments.&nbsp; </p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p><strong>Required:</strong><br>At least 4 years of clinical nurse and managed care experience.</p><h4>Skills</h4><p><br><strong>Required:</strong><br>Excellent interpersonal and communication skills.&nbsp;</p><p>Good working knowledge of regulatory requirements/standards.&nbsp;</p><p>Computer literacy and adaptability to computer learning.&nbsp;</p><p>Time management and priority setting skills.</p><p>Must be organized and a team player, able to work effectively with various internal business units, Plan Partners, participating provider groups, and external agencies.</p><h4>Licenses/Certifications Required</h4>Licensed Vocational Nurse (LVN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p><strong>Required:</strong><br>License Vocational Nursing (LVN)</p><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>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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>                    LVN, Nursing, Medicaid, Medicare, Healthcare                                                    </p>

L.A. Care Health Plan

Customer Solution Center Appeals and Grievances Nurse Specialist LVN II

<p>Salary Range:&nbsp;&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>Required:</p><p>Minimum of 5 years of experience as a network administrator.</p><h4>Skills</h4><p>Required:</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>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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>

Network Administrator III

<p>Salary Range:&nbsp;&nbsp;$77,265.00&nbsp;(Min.) -&nbsp;$100,445.00&nbsp;(Mid.) -&nbsp;$123,625.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Payment Integrity Analyst III is responsible for leading or assisting in vendor implementations and configuration, algorithm/edit customizations, overpayment remediation, as well as other Payment Integrity functions. The position is also responsible for supporting Payment Integrity solutions focused on trending overpayment and refund reasons to identify and fully develop pipeline of new Payment Integrity initiatives.&nbsp; These initiatives include additional overpayment project pipeline as well as development of cost avoidance practices. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Serves as vendor oversight monitoring to ensure proper submission of files and correct invoicing as well as monitoring QA metrics to meet all vendor estimates. Serves as SME for all Payment Integrity functions to include both Retrospective Data Mining as well as Pre-Payment cost avoidance.</p><p>Supports the creation and execution of strategies that determine impact of opportunity and recover overpayments as well as prospective internal controls preventing future overpayments of each applicable pipeline opportunity. Works with both internal and external groups to define and develop cost avoidance measures to ensure continued success.</p><p>Fields and responds to escalated requests (including research) for all inquiries both internal and external; Fields and responds to Provider Dispute Resolution (PDR) requests stemming from Payment Integrity activities; supports correspondence in identification of trends for overpayment opportunities resulting in future pipeline activity.</p><p>Identifies and defines Payment Integrity issues and reviews and analyzes evidence, utilizes data for the purpose of verifying errors and identifying systemic errors, works as an active team member during scheduled engagements and work collaboratively to achieve the goals of the team, and provides feedback to the team lead on any issues identified during research or claims review.</p><p>Serves as a subject matter expert and leads and/or assists in algorithm/edit customizations, as well as all vendor implementations as needed. 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 DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 3 years of experience in Cost Avoidance and/or Coordination of Benefits or in Payment Integrity.</p><p>At least 5 years participating in healthcare (Medicare, Medicaid, Commercial).</p><p>At least 5 years of experience with health care data.</p><p>Experience in project implementation.</p><h4>Skills</h4><p><strong>Required:</strong><br>Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare, and Medicaid rules and regulations.</p><p>Working knowledge of claims coding and medical terminology. Solid understanding of standard claims processing systems and claims data analysis.</p><p>Strong project leadership and management skills required; ability to prioritize, plan, and handle multiple tasks/demands simultaneously.</p><p>Expert knowledge of healthcare reimbursement concepts.</p><p>Excellent interpersonal, verbal, and written communication skills required with excellent analytical and problem-solving skills.</p><p>Must be collaborative ability to establish credibility quickly with all levels of management across multiple functional areas.</p><p>Must be able to present findings across all departments.</p><p>Must be familiar with coordinating benefits between health plan payers.</p><p>Advanced knowledge of Microsoft Office suite, including Word, Excel and PowerPoint.</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>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Medicaid, Medicare, Insurance, Healthcare                                                    </p>

Payment Integrity Analyst III (ALD)

<p>Salary Range:&nbsp;&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Community Resource Center (CRC) Specialist III builds and maintains meaningful relationships with members of the community, L.A. Care departments, partner health plans, community based agencies, government agencies, and CRC vendors and instructors. The role leads community and provider outreach and engagement initiatives to increase member traffic at a CRC and bridges members of the community to physical and health education programs, classes and resources. Acts as a liaison to the L.A. Care on CRC marketing and promotional initiatives to meet operational needs. Implements processes including coordination of member service support across L.A. Care departments and promote positive health care outcomes. Provides extensive consultation on health care access issues, and identification of resource needs based on social drivers identified through a health assessment process. This position also conducts ongoing member assistance and follow-up in select cases. Collaborates with cross-functional L.A. Care health plan departments The CRCs serve anyone in the community in which they are located; and therefore, this role will provide expertise on referral processes to connect non-member cases to the appropriate external resources.</p><p>Participates in the planning, and development, implementation, and analysis of CRC services, programming, and vendor management. This role may serve as a lead on special projects through the development and implementation of a work plan, technical procedures, and relationship management ensuring successful implementation of CRC initiatives. &nbsp;Acts as a &nbsp;Subject Matter Expert, serves as a resource and mentor for other staff. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p><h4>Duties</h4><p>Outreach and Engagement: (25%) &nbsp;<br>Builds, maintains, and nurtures meaningful relationships with key internal and external stakeholders; and, is an ambassador to grow CRC partnership brand recognition. &nbsp;Identifies key community stakeholders, assesses community needs, and gathers and analyzes data to inform management with an integrated approach to outreach activities and targeted member engagement. &nbsp;Plan, develop, analyze and implement member and community engagement activities to increase member traffic at the CRCs. Makes recommendations for bridging members of the community to physical and health education programs and classes which will enhance health outcomes and member experience. &nbsp;Responsible for communications and marketing efforts through multiple platforms to increase member traffic at assigned CRC; and, engages and educates members of the community on L.A. Care and CRC programs. Responsible for CRC outreach and engagement opportunities relevant to the mission of L.A. Care and the CRCs; recommends to senior management in the development and implementation of &nbsp;work plans. &nbsp;Identifies and recommends what outreach activities to prioritize &nbsp;and implement tactics to attract new L.A. Care and partner health plan members to participate into the CRC services and programs. Responsible for collecting, transporting, and distributing CRC promotional items to community partners with the goal of generating brand awareness across various L.A. Care membership communities and geographical areas in Los Angeles County.</p><p>Cross-Collaboration: &nbsp;(25%)<br>Oversees the community initiatives leveraging relationships within L.A. Care, partner health plans, and with community stakeholders to promote access to health care programs, classes, and preventative services offered at the CRC. &nbsp;Educates other L.A. Care departments on the necessary steps to implement relevant services and activities that will resonate with and engage members of the CRC community. &nbsp; &nbsp;</p><p>Implementing Strategic Initiatives: &nbsp;(20%) &nbsp;<br>Leads &nbsp;the implementation of special projects and specific tasks that &nbsp;must be &nbsp;completed in order to ensure project, initiatives, and events are successfully implemented within the required timeframe. Proactively monitors risks and provides recommendations and implements mitigation plans to keep initiatives on-track. &nbsp;Maintains consistent documentation of project deliverables, tracks and reports project status. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</p><h4>Duties Continued</h4><p>High-Touch Customer Focus: (15%)&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Performs high quality in-person service and contributes to the extended-hour schedule of the CRC to support members and visitors that may need services outside of regular operating hours and days based on business needs. &nbsp;Provides support in the creating of child creating of activities and programs to support children development while parents and guardians attend a class or service appointment at the CRC.</p><p>Day-to-Day Representation: (15%)&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Guides the coordination of member-centric customer service to respond and resolve simple inquiries and complex questions and bridges members to appropriate resources. &nbsp;Creates resource guides and reference materials to identify available CRC, L.A. Care and Plan Partner benefits, resources, and programs to meet the member/visitor needs. &nbsp;Provides guidance and support staff to identify, understand, and master meaningful program and benefit information and resources to inform and educate members, community residents, and other stakeholders. Implements the appropriate approach to identify member or visitor resource needs in complex situations and takes action to link the member/visitor to those services, programs, or resources. &nbsp;Informs L.A. Care and Plan Partner members of health care tailored services including Care Management, Social Services, Health Education, and others. Actively identifies gaps in CRC services, resources, and programs, delivers recommendations for new programs and proposes solutions for the implementation of new services.</p><p>Performs other duties as assigned.&nbsp; (10%)&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</p><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p>Required:<br>At least 1 year of community work focused on health care, public health, or health education or</p><p>At least 1 year of operations work experience with community events, leading complex projects, and managing relationships with multiple stakeholders or experience related to health plan member services, health plan member benefits and knowledge of any of the following services: Care Management, Social Services, Health Education, or other social service or clinical teams.</p><p>Product experience including knowledge of at least one of the following health care programs: Medicaid/Medi-Cal, Covered California, Medicare, or Medicare Dual Special Needs Plan.&nbsp;</p><p>Minimum of 1 year experience related to marketing, brand awareness tactics, or social media&nbsp;</p><p>Experience with database software, data entry, and reporting process.&nbsp;</p><p>Preferred:<br>Minimum of 3 years experience with database software, data entry, and reporting processes. Salesforce knowledge.</p><h4>Skills</h4><p>Required:<br>Strong verbal and written communication skills</p><p>Excellent organizational skills.</p><p>Must be a detail-oriented, collaborative and enthusiastic team player.&nbsp;</p><p>Strong ability to garner consensus on and support for new partnerships and initiatives, particularly when projects rely on participation by multiple internal or external stakeholders.&nbsp;</p><p>Ability to solve complex issues and identify creative solutions to assist members and community stakeholders.</p><p>Must have the ability to troubleshoot problem areas and recommend effective alternative solutions and provide optimal customer service for internal and external customers.</p><p>Demonstrates action oriented leadership to take on new opportunities and rewarding challenges with a sense of urgency, high energy, and enthusiasm.</p><p>Ability to multi-task and meet competing deadlines while maintaining attention to detail and accuracy.</p><p>Must be able to work independently or as part of a diverse team while being business-minded as well as empathetic towards members.</p><p>Must show initiative and act on anticipated business needs without prompting from management.<br><br>Ability to adapt quickly to a fast-changing environment.</p><p>Advanced proficiency in MS Office including Outlook, Word, Excel, and PowerPoint</p><p>Strong interpersonal skills and ability to read non-verbal cues with a high level of situational adaptability.</p><p>Ability to make sound decisions with incomplete information.</p><p>Preferred:<br>Experience with the Salesforce CRM platform</p><p>Knowledge and understanding of the unique needs of the Medi-Cal beneficiary populations within a social service, healthcare, not-for-profit, or government setting.&nbsp;</p><p>Knowledge of public agencies, organizations, and other resources that support Community Resource Center visitors.</p><p>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.<br></p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p>Required:&nbsp;<br>Cardiopulmonary&nbsp;resuscitation (CPR) and California Mandated Reporter within 90 days-of-hire</p><p>Preferred:<br>Management of Aggressive Behavior (MOAB), de-escalation techniques training, safe lifiting practices training.</p><h4>Physical Requirements</h4>Moderate<h4>Additional Information</h4><p>Required:&nbsp;<br>Travel to offsite locations for work.</p><p>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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, Data Entry, Social Services, Medicaid, Relationship Manager, Healthcare, Administrative, Service, Customer Service                                                    </p>

Community Resource Center Specialist III

<p>Salary Range:&nbsp;&nbsp;$46,800.00&nbsp;(Min.) -&nbsp;$52,597.00&nbsp;(Mid.) -&nbsp;$62,270.00&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 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. 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. (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. (15%)</h4><p>Perform other duties as assigned. (5%)</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>Required:</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>Preferred:</p><p>Health Plan, provider practice, or health education experience. </p><h4>Skills</h4><p>Required:</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>Preferred:</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><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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>

Quality and Population Health Coordinator I (ALD)

<p>Salary Range:&nbsp;&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 Supervisor, Quality Configuration Assurance works with the Manager, Systems Configuration Performance Improvement and Director, Quality Configuration to oversee the daily operations of the Quality Configuration Assurance staff for the L.A. Care core and surround systems. &nbsp;This position is responsible to maintain a high performing team of Quality Configuration Assurance Analysts of various knowledge and technical skill levels by ensuring that each team member meets or exceeds all metrics and standards of quality. This position supervises all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;</p><p>The Supervisor, Quality Configuration Assurance engages, measures, and helps to facilitate improvements in the team's performance by conducting continual improvement activities such as training, coaching and quality assurance. This position will collaborate with the Quality Configuration Assurance leads to support new programs, system implementations and upgrades, quality measures to improve claims mass adjudication and configuration performance improvements, &nbsp;etc.</p><h4>Duties</h4><p>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;Hire, train, coach, and evaluate staff (under the guidance of the Manager, Systems Configuration Performance Improvement).&nbsp;</p><p>Maintain quality goals and production levels within the department. &nbsp;Develop procedure changes to improve results.</p><p>Track and trend the metrics associated with the systems configuration quality and production. &nbsp;Prepare and present written and verbal reports.</p><p>Maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet organizational requirements.</p><p>Serve as back-up for the Manager, Systems Configuration Performance Improvement and effectively interface with various personnel within and outside of the department and the organization. &nbsp;Collaborate timely and effectively with various internal and external staff to ensure the smooth execution of functions to support configuration best practices.</p><p>Assure the team completes related quality configuration work timely and in accordance with business requirements, testing methodologies, and systems specifications.</p><p>Provide direction with handling of questions, issues, etc. raised by staff. &nbsp; Serve as an informational resource for staff. &nbsp;</p><p>Lead and troubleshoot simple to moderate issues for the Quality Configuration Assurance Analysts and collaborate with the Quality Configuration Assurance leads on complex issues. &nbsp; Ensure that complex issues are resolved within established guidelines. &nbsp;Ensure that appropriate follow-through is completed timely.</p><p>Oversee and lead initiatives and projects. Ensure that tasks are completed within the specified timeframes.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Business Administration or Healthcare Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 5 years of experience in a quality configuration supporting a managed care system, especially related to quality measures for benefit, contract configuration, and mass adjudication in a healthcare or health plan environment.</p><p>At least 2 years of leading process, program, or staff or supervisory experience.</p><p>Experience with the quality review of the configuration of health services/population health as well as appeals and grievances systems, applications, etc.</p><p>Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><p>Preferred:</p><p>At least 5 years of experience working with a California Medi-Cal managed care plan or commercial health plan, medical group, or management services organization.</p><h4>Skills</h4><p>Required:</p><p>Advanced knowledge of QNXT or comparable claims processing system.</p><p>Advanced knowledge of the healthcare domain, focusing on claims processing, membership, contracts, and benefits.</p><p>Advanced knowledge of and experience with interpreting and analyzing complex pricing mechanisms.</p><p>Strong coaching and mentoring skills. Able to build teams and allocate staffing resources based on work priorities.</p><p>Strong written and verbal communication skills.</p><p>Proficient in using Microsoft Word and Excel.</p><p>Able to multi-task in a high production environment.</p><p>Able to streamline day-to-day operations, policies, and procedures.</p><p>Able to draw conclusions from data analysis and formulate corrective action plans, as warranted.&nbsp;&nbsp; </p><p>Able to troubleshoot problem areas and recommend, develop, and implement system and process improvements.</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>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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, Insurance                                                    </p>

Supervisor, Quality Configuration Assurance

<p>Salary Range:&nbsp;&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 Product Solutions Manager II is responsible for working within the Product Strategy, Sales and Marketing (PSSM) service area to identify and implement projects, programs and initiatives that support achievement of product and enterprise goals. The position works with management, business owners and other key stakeholders to develop and manage the product go to market planning, prioritization, timelines, metrics/scorecards, budgets, Return of Investment (ROI) analysis, and working agreements for product initiatives.&nbsp; </p><h4>Duties</h4><p>Develops, designs, and implements of cyclical product life, cycle activities and specific strategic initiatives in support of optimizing the member experience while managing the ongoing evolution and strategic direction of the product line.</p><p>Support efforts to identify product management best practices. Identify impacted parties, business partners, and resources required. Develops and designs processes and product requirements that support business needs. Designs methods for integrating function and processes including applicable dependencies inclusive of enterprise initiatives.</p><p>Conducts analysis for roadmap creation, scope and execution for cross-functional execution of initiatives.&nbsp; Recognizes opportunities for product enhancements in a matrix environment and collaborative, cross functional execution.</p><p>Orchestrates, plans and executes end to end cycle strategy, development and implementation efforts for the product line.</p><p>Identifies potential risks, project charge, and scope. Recommends in design of appropriate mitigation and contingency plans. Supports in&nbsp; identifying best practices to drive product integrity, service excellence, and efficiency.&nbsp;</p><p>Provides product support to internal and external stakeholders for annual product launch. Including, sales, marketing, growth and retention efforts, delegated vendors and front line teams including assistance with benefit trainings, explanation of benefit design, member materials development and distribution, sales and marketing collateral, talking points and&nbsp; program education, configuration and benefit display requirements. Develops training materials and conduct annual and ongoing product training as required.</p><p>Manages daily processes related to the end-to-end development and fulfillment of required annual materials&nbsp; for welcome and sales kits. Oversees process and timelines from model document population, regulatory approval, design/layout, translation, and print &amp; fulfillment. Responsible for review and accuracy of approved benefits on published materials.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Public Administration or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Public Administration or Related Field<h4>Experience</h4><p><br><strong>Required:</strong><br>Minimum of 5 years of relevant experience in product management.</p><h4>Skills</h4><p>Required:<br>Requires deep knowledge of product development life cycle (PDLC) discipline.</p><p>Must be familiar with regulatory guidelines governing product lines; leads regulatory filing process for new/custom product initiatives.</p><p>Able to use advanced features of MS Office including Excel, PowerPoint, Word, MS Project, Visio.</p><p>Excellent written and verbal communication and presentation skills.</p><p>Ability to serve as member on cross-functional implementation or project teams.</p><p>Ability to interpret data sets and forecast future revenue streams.</p><p>Excellent interpersonal, motivational, and communication skills; with success in leading cross functional collaborative projects.</p><p>Ability to collect, analyze and recommend solutions using data and experience driven decisions.</p><p>Working knowledge of the company’s healthcare products, functions and regulatory guidelines.</p><p>Working knowledge of policy and regulatory efforts.</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>Department Specifics:</p><p>Product, Strategy, Sales &amp; Marketing: (PSSM):&nbsp;</p><p>Preferred:&nbsp;<br>Knowledge of healthcare product types inclusive of managed care and insurance products.</p><p>Additional duties include:<br>Drives Intra-team development efforts for framework and delivery model ensuring alignment with Intra-team strategic goals and objectives set forward by CPO and Exec Owner. Supports and/or drive efforts for strategic planning on product agnostic initiatives as well as strategic partnerships.</p><p>Medicare:<br>Required<br>Medicare Advantage, with experience serving duals population. Direct experience in Medicare and Duals program administration including stars, quality, financial performance review, operational functions (claims, enrollment, readiness).</p><p>Preferred:<br>Direct experience with duals population and requirement.</p><p>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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, Healthcare, Insurance                                                    </p>

Medicare Advantage Product Solutions Manager II

<p>Salary Range:&nbsp;&nbsp;$77,265.00&nbsp;(Min.) -&nbsp;$100,445.00&nbsp;(Mid.) -&nbsp;$123,625.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Business Analyst II works closely with business units to gain in-depth business understanding of customer’s business strategy processes, services, roadmaps and the content in which the business operates. The Business Analyst is focus-driven, focusing on strategy, collaboration, prioritization based on value off internal and external customers. The position consults and collaborates with internal and external customers to address any issues that are contributing to inaccurate or inefficient procedures/ processes within the Department. This position is key to understanding the documenting capabilities needed to address business challenges. It is responsible for reviewing end-to-end business processes to identify, address, and remediate operational and functional risks. This position conducts a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify opportunities to improve operational efficiency. It is responsible for a full range of activities leading small to large size projects, assist project managers on complex projects related to operational business functions affecting internal departments and external customers at market level.&nbsp; </p><h4>Duties</h4><p>Participate and contribute in multiple projects by completing and updating project documentation; managing project scope; adjusting schedules when necessary; determining daily priorities; ensuring efficient and on-time delivery of project tasks and milestones; follow escalation process; and managing customer relationships. Ensure data is valid and reliable; develop business process improvement; monitor and update software as needed; partner with internal and external customers to accomplish long-term business strategies and goals. &nbsp;Identify, create, and facilitate process design changes by conducting business and systems process analysis and design at a complex level; focusing on quality improvement and data management. &nbsp;Identify improvement opportunities (proactive and reactive).</p><p>Oversee customer relationships and expectations through communication process; updating others through project paths. &nbsp;Support and align efforts to meet business and customer needs. Facilitate meetings, projects, and presentations to diverse audiences. &nbsp;Provide leadership to team members and peers, collaborating cross-functionally with others; articulate ideas and viewpoints to Senior Management, peers, and others; identify and initiate projects; manage resources; implement resolutions; and hold self-accountable for completing tasks and results. &nbsp;Provide a strategic asset to decompose strategy into value change initiatives.</p><p>Maintain an up-to date knowledge of Information Systems to develop, execute, and improve corrective action plans by providing subject matter expertise and guidance to best business practices. &nbsp;Stay current with customer needs and strategies; utilize formal and informal written communication methods (BRDs, emails, PowerPoint presentations, Visio workflows, executive summaries, and project logs). &nbsp;Provide and support business solutions; build relationships with internal/external customers and key stakeholders; monitor project progress and results; provide project analysis and root-cause of operational issues.</p><p>Demonstrate leadership and interpersonal communication skills by working collaboratively and effectively with peers, superiors and subordinates to accomplish objectives. Able to concisely, clearly and formally communicate complex concepts and formulate process solutions. Work as a subject matter expert and review all submitted problem and improvement reports; identify priority issues; evaluates opportunities for improvement, presents findings to supervisors for evaluation and prepares resolution work plan as directed. Develop and execute test plans. Monitor all solutions through to resolution.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p>Required:<br>At least 3 years of experience in data analysis in a health or managed care environment.</p><h4>Skills</h4><p>Required:</p><p>Proven ability to significantly impact process improvement and process management.</p><p>Ability to document scope, project tasks in a clear and concise manner.</p><p>Thorough understanding of relevant industry practices, techniques and standards.</p><p>Must have a comprehensive understanding of business process/ life cycle management principles, theories and concepts.</p><p>Strong problem-solving/ analysis skills.</p><p>Proficiency in Microsoft Office applications, database management.</p><p>Articulates relevant information and directions in an organized and concise manner.</p><p>Strong interpersonal, verbal, and written communication skills; Understanding of effective communication concepts tools and techniques.</p><p>Ability to conform to shifting priorities, demands, and timelines through analytical and problem-solving capabilities.</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>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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>                    Business Analyst, Finance                                                    </p>

Business Analyst II (ALD) 2 year

<p>Salary Range:&nbsp;&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 Financial Planning and Analysis Financial Analyst III is involved in the preparation of the annual budget and forecast. This position is a key contact for operating budget matters and supports Division Chiefs and Directors on operational spending analysis. This position prepares, consolidates, and analyzes budgets for L.A. Care Health Plan; including Operating Budget, Forecasts, Monthly Variance Reports, Strategic Reports and Long Range Plans. Other duties include assistance with financial statement analysis, preparing reports for presentation, and other ad hoc reports. The position interacts with members of the management team and other department staff to assist in the development of the annual budget/forecast.</p><p>Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Develop budget/ forecast data models (for projecting membership, estimating revenue and cost of healthcare expense categories, and calculating administrative costs). Consolidate revenue, cost of healthcare and administrative expenses. Compile annual budget book and narratives for approval by senior staff and governing bodies. Assist individual cost centers in developing the budget. Timely development of a manageable and reasonable budget. </p><p>Create, analyze, and disseminate variance reports to aid Senior Management with decision making. Support Division Chiefs and Directors on monitoring departmental spending and actual vs. budget variance analysis.&nbsp; Actively participate and lead assigned areas for the development of the budget, monthly and quarterly financial review, and long-range financial forecast based on expected operations and business conditions. Perform complex financial analysis of specific capital and extraordinary projects and make recommendations to management. Serve as a Finance liaison with other departments. Prepare and present staff reports and other necessary documents. Support and act as consultant to other departments and managers. </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 Economics or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>At least 5 years of experience analyzing data in a financial context.</p><p>Experience with financial data for Medi-Cal population.</p><p>Preferred:<br>Previous experience in accounting, budgeting and forecasting is a strong plus.</p><h4>Skills</h4><p>Required:<br>Extensive knowledge and demonstrated ability to analyze complex issues and present findings and recommendations to senior management in a logical and understandable manner.</p><p>Excellent analytical, organizational, and presentation skills.</p><p>Superior attention to detail</p><p>Strong understanding of GAAP and Finance Concepts.</p><p>Understanding of accruals, operating costs vs. capital costs<br>Advanced/Expert skills in Excel on V-Lookup and pivot tables.</p><p>Proficient in SharePoint maintenance.</p><p>Ability to multitask and meet constant deadlines.</p><p>Proven ability to work effectively with others in a team-oriented environment.</p><p>Preferred:<br>SQL skills and budget system development skills.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</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>                    Financial Analyst, Financial, Accounting, Finance                                                    </p>

Financial Planning and Analysis Financial Analyst III

<p>Salary Range:&nbsp;&nbsp;$50,216.00&nbsp;(Min.) -&nbsp;$62,770.00&nbsp;(Mid.) -&nbsp;$75,324.00&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 Even MORE Service Liaison I, will communicate to members in all line of business (LOB) regarding: welcome calls, outbound calls, member -Health Risk Assessment, related programs by LOB. Conduct and document outreach activities (call, web, email) consistently and accurately. The Liaison will proactively identify, document, investigate, &nbsp;and resolve member issues in a timely and appropriate manner. The Liaison will also identify potential areas of membership dissatisfaction and recognize improvement areas. The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:<br>&nbsp; &nbsp;* Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services(CMS), &nbsp;and for SPD population.<br>&nbsp; &nbsp;* Contacting members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information was not provided on choice forms, enrollment applications, data transmissions from applicable sources, etc. as well as the preferred threshold language and/or alternative format for receiving their welcome kits, network-related member notification letters, etc.&nbsp;<br>&nbsp; &nbsp;* Collaborating with internal and external stakeholders and members to facilitate continuity of care and the related enrollments and assignments (based on enrollment information for Covered California, permission-to-enroll forms, daily updates from PASC, COBRA/ICP elections, etc.)<br>&nbsp; &nbsp;* Processing and screening applications and renewals for Healthy Kids members, notifying applicants of the disposition of their application/renewal, and conducting the appropriate follow-up (including review of vendor outreach efforts)<br>&nbsp; &nbsp;* Working with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.<br>&nbsp; &nbsp;* Collaborating with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, PASC, third party liability constituency, etc. staff to address and resolve questions, issues, etc. regarding member demographic information (e.g., CIN, name, address, and other related information) so that it can be appropriately updated and reflected in the system. Liaison also attends and participates in various internal and external meetings in this regard.</p><h4>Duties</h4><p>Facilitate the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirement for Health Risk Assessments for CalMediConnect members and SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This is aligned with service level requirements. (40%)</p><p>Even MORE Service Liaison will track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. Liaison will also assist with coordinating with other departments to follow up and resolve issues that arise through member contact, including potential care coordination/continuity of care issues. (20%)</p><p>Liaison to meet L.A. Care’s P&amp;P requirements for attendance and follow department guidelines and expectations. Collaborate with the CSC Departments regarding member enrollment efforts for all lines of business. (15%)</p><h4>Liaison will assist with identifying and assessing areas of potential member dissatisfaction (PQI) as well as focusing on opportunities for service/process improvement. This is in compliance with regulatory requirements for auditing purposes. (10%)</h4><h4>Liaison to assist Business Units and Product Lines with the implementation and completion of special projects, including member loyalty programs. Collaborate with internal and external peers to enhance the integrity of member information and ensure continuity of care and increase member retention. (5%)</h4><h4>Perform other duties as assigned. (10%)</h4><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 1 year of customer service experience in a corporate setting.</p><p>Demonstrated experience handling complex customer calls.</p><p>Preferred:</p><p>Managed care or healthcare experience.</p><h4>Skills</h4><p><br>Required:<br>Strong verbal and written and communication skills.</p><p>Strong organizational skills.</p><p>Preferred:<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><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: 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>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medicaid, Medicare, Social Services, Healthcare, Service                                                    </p>

65 L.A. Care Health Plan Jobs