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<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>

L.A. Care Health Plan

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>

Customer Solution Center Even MORE Service Liaison I

<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>This position supports L.A. Care's four Registered Dietitians in provision of Medical Nutrition Therapy, Meals As Medicine (MAM), and Diabetes Self-Management Education services. The Health Education Dietetic Technician coordinates the delivery of the MAM program including navigating medical records and assessing member needs to prescribe the appropriate diet, working with meal provider vendors to confirm delivery and compliance, and ensuring accurate and timely documentation. This position also assists with health education services including group classes and one on one consults as needed to L.A. Care direct line of business members. Responsibilities include conducting member initial nutrition assessments and follow-up dietetic counseling, assisting with member charting, documentation and data entry, and scheduling members for phone counseling sessions.</p><h4>Duties</h4><ul><li>50%- Complete Meals as Medicine applications by conducting suitability assessments, approving service requests, and coordinating deliveries with meal providers (vendors) and members</li><li>20%- Coordinate individual health education consultations and documentation with members telephonically for Medical Nutrition Therapy and Diabetes Self-Care Management Education as referred by internal staff and external providers</li><li>10%- Provide basic nutritional counseling to members and facilitate education to members on nutrition-related topics using curriculum developed by L.A. Care Health Plan health education staff</li><li>10%- Assist with documentation and data entry for nutrition services</li><li>10%- Identify additional medical and social needs and coordinate with disease management staff, case management staff, and social workers through providing referrals and multidisciplinary communication</li><li>Perform other duties as assigned.</li></ul><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nutrition<h4>Education Preferred</h4>Bachelor's Degree in Nutrition<h4>Experience</h4><p>Required:</p><p>A minimum of 3 years of experience providing direct nutrition/diabetes/pediatric nutrition counseling services in either inpatient or outpatient setting. </p><p>Preferred:</p><p>Experience in medical meal preparation industry.</p><h4>Skills</h4><p>Required:</p><ul><li>Must be able to utilize various computer documentation platforms&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </li><li>Must be able to work independently on projects while soliciting help from internal or external sources as needed&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </li><li>Demonstrated ability to problem-solve and troubleshoot all project issues in a timely manner</li><li>Excellent interpersonal skills to work alongside other project employees to meet all client specifications and requirements</li><li>Excellent verbal, written, communication, and presentation skills</li></ul><p>Preferred: </p><p>Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese&nbsp;&nbsp; </p><h4>Licenses/Certifications Required</h4>Nutrition and Dietetics Technician, Registered (NDTR)<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>                    Nutrition, Data Entry, Diabetes, Special Medicine, Public Health, Healthcare, Administrative                                                    </p>

Health Education Dietetic Technician II (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 of Transitional Care Services (TCS) is responsible for supervising the TCS clinical and non-clinical staff’s daily work and activities. The Supervisor ensures adequate staffing and coverage adherence to Department of Health Care Services (DHCS) TCS program and documentation requirements, and that eligible members receive timely and quality services. </p><p>This position is responsible for promoting the optimal clinical outcomes and improving quality of care through clinical priorities for members.&nbsp; This position utilizes independent clinical judgment to promote quality of care through collaboration with cross-functional teams at L.A. Care (LAC). The position assist in identifying and triaging member and operational issues/problems, and forming resolutions within the scope of work. </p><p>The position provides ongoing program support through active communication, education, and consultation of interdisciplinary staff.&nbsp; The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports,&nbsp; </p><p>This position is responsible for ensuring all functions are operating in accordance with the organization's mission, values and strategic goals.&nbsp; </p><h4>Duties</h4><p>Supervise staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.</p><p>Consult with management and Human Resources Business Partner (HRBP) to review performance improvement plans prior to meeting with staff. </p><p>Assist in developing written policies and procedures and practice protocols pertinent to the transitional care and regulatory program requirements. Plan and direct TCS activities to provide timely, quality care and services to members experiencing a care transition. Recommend process improvement measures to achieve program’s performance measures outcomes and goals. </p><p>Conduct and coordinate analysis of data to track and trend for the purpose of improving programmatic and performance on issues related to safe transitions, readmission reduction, and other programs as determined.&nbsp; .&nbsp; Monitor the progress of programs or services in relation to expected standards across the continuum of care.&nbsp; Benchmark best practices and identify measurable outcomes.&nbsp; Recommend innovative approaches to patient care. Collect, analyze, and communicate data related to transitions of care and other related metrics.</p><p>Conduct monthly audit activity via program’s performance reporting standards to maintain quality care of members and compliance to regulatory requirements. Collect and organize team performance data to identify trends and maintains all assigned reporting responsibilities. Ensure the accuracy of TCS reports and program proficiency in maintaining regulatory standards and schedules. Provide reports to management to identify trends and improve workflow process.</p><h4>Duties Continued</h4><p>Provide clinical leadership for Transitional Care and other related program goals. Consult with cross-functional teams concerning patient care issues Coordinate quality improvement activities in transitions of care as demonstrated through identifying clinical priorities and outcomes (e.g. HEDIS, etc.).&nbsp;&nbsp; </p><p>Assist in the development and implementation of communication strategies to keep internal and external stakeholders informed of Transitional Care initiatives. </p><p>Ensure program compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information (PHI). </p><p>Maintains knowledge of current trends and practices in Transitional Care, nursing, and health care through networking and other resources. Enhance professional and unit growth through active participation in professional organizations, department activities, and community groups. </p><h4>Perform other duties as assigned. </h4><h4>Education Required</h4>Associate's Degree in Nursing or Related FieldMaster's Degree in Social Work or Related Field<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p>Required:</p><p>Minimum of 5 years of recent care management, care coordination, and/or transition of care experience in a hospital or managed care setting, such as a health insurance environment and/or experience as care manager in hospital or home health environments. </p><p>At least 2 years of leading a process, program or staff or supervisory/management experience.</p><p>Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><h4>Skills</h4><p>Required:</p><p>Knowledge of state, federal and regulatory requirements in care/disease management, care coordination, population health management, health education and Transitional Care Services.</p><p>Excellent interpersonal communication, problem solving, and conflict resolution skills.</p><p>Knowledge of complex health care systems and proficiency in performing medical record reviews.</p><p>Knowledge of professional nursing practice elements and evidence-based models of transitional care.</p><p>Computer literacy with proficiency with Microsoft Word, Excel, and core program systems.</p><p>Excellent organizational and time management skills.</p><p>Must be detailed oriented and an enthusiastic team player.</p><p>Ability to work independently and with internal and external customers. </p><p>Ability to solve complex issues, identify, and implement creative solutions.</p><p>Preferred:</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>Registered Nurse (RN) - Active, current and unrestricted California LicenseLicensed Clinical Social Worker (LCSW) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Certified Case Manager (CCM)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Please note that a Licensed Clinical Social Worker is only required when Master's Degree in Social Work. Licensed Clinical Social Worker not required with Associate's or Bachelor's Degree in Nursing.</p><p>Able to work flexible job hours.</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>                    Social Worker, Nursing, Registered Nurse, Patient Care, Service, Healthcare                                                    </p>

Supervisor, Transitional Care Services

<p>Salary Range:&nbsp;&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 Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.</p><p>This position provides but is not limited to:<br>Supervision for Authorization Technicians Leads, Authorization Technician and clerical staff in the UM department.<br>Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc.<br>Conduct 1.1 monthly sessions with staff to review performance.<br>Consistently track staff performance, and work with individuals to improve performance as needed.<br>Create, review, and administer corrective action forms.&nbsp;<br>Responsible for hiring, training, motivating, evaluating and counseling of assigned Associate Supervisors, Leads, and Representatives. &nbsp;<br>Ensure that Associates, Supervisors, Leads, and Representatives provide efficient and courteous service.&nbsp;<br>Oversee overtime work and will produce accurate accounting of each representative work performance.&nbsp;<br>Conducting evaluations of and implementing enhancements to the day-to-day operations of the unit.<br>Aid with product launches and expansions.<br>Execute tracking, and assessing member satisfaction efforts and identifying potential areas of the unit dissatisfaction and opportunities for improvement.<br>Facilitating the development, review, and revision, as appropriate, of organizational and departmental policies, procedures, and process flows to ensure compliance with relevant regulatory and organizational guidelines.<br>Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc.</p><p>This position collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports.</p><p>In addition, this position performs Supervisory roles including payroll, employee Paid Time-Off (PTO) time management, supporting the Leads providing direction and support. The Supervisor authorizes request consistent with auto authorization criteria, &nbsp;maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers. &nbsp;The position supervises all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;<br></p><h4>Duties</h4><p>Supervision of day to day activities of Authorization Technicians, including but not limited to: Providing direction, Monitoring of staff performance and skillsets for consistency and improvement for all lines of business, Handling all questions/issues raised by staff, Developing tools and procedures on training for staff, Recommending process improvement processes, Preparing and analyzing call center statistical reports, Monitoring of skillsets for consistency, Ensuring quantity/quality is met for overtime, Ensure that all &nbsp;comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: Diagnosis (DX) codes, Current Procedural Terminology (CPT) ,Healthcare Common Procedure Coding System (HCPCs) codes.</p><p>Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements.</p><p>Computer Input: Accurately and completely processing referrals/authorizations in the MHC system. &nbsp;And distributing a complete file &nbsp;to UM Specialist. Within 2 hours of receipt Identify duplicate requests using the claims and CSIM system to verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system. &nbsp;Appropriately documenting what information was used in making this determination. &nbsp;Within 4 hours of receipt: Appropriate identification and timely notification of time sensitive requests: Appropriately identifying for the staff which you support; request that are priority based on date of receipt and established TAT criteria for compliance.</p><p>Accurate Filing/Maintenance of confidential member information. Creating secure, complete files.</p><p>Assist in the preparation of &nbsp;communication for authorization determinations, including, but not limited to preparing &nbsp;template letters for members and providers (authorization approval, denial, deferral, modification and pay/education).</p><h4>Duties Continued</h4><p>Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing).</p><p>Support UM Committee and Audit activity via &nbsp;Department performance reporting. Assures the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames.</p><p>Employee training and development within all core systems. New employee orientation to the departments structure and work flow assignments. The Supervisor will support performance standards and develop performance improvement plans.&nbsp;</p><p>Monitoring policies and procedures including but not limited to time and attendance, monthly incentive and monthly performance audits&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>Bachelor's Degree<h4>Experience</h4><p>Required:</p><p>At least 2 years in Medi-Cal managed supervisory experience in a health plan/health insurance authorization processes and/or as a Medical Assistant. </p><p>At least 1 year of lead (process, program, or staff)/supervisory experience.</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:&nbsp; </p><p>Experience in working with the disadvantaged population, seniors, or people with chronic conditions or disabilities. Medi-Cal, Healthy Families, Healthy Kids and Medicare background preferred.</p><h4>Skills</h4><p>Required:</p><p>Strong verbal and written communication skills.</p><p>Proficient with Microsoft Word, Excel, and Access.</p><p>Excellent organizational, interpersonal and time management skills.</p><p>Must be detail-oriented and an enthusiastic team player.</p><p>Demonstrate proficiency in data entry and processing of referrals/authorizations in the system.</p><p>Knowledge of medical terminology and ICD-10 and CPT codes.</p><p>Persuasion Skills: Must be able to interface with members, medical personnel and other internal and external agencies and sometimes convince/persuade others to comply with L.A. Care requirements such as submitting requested information in a timely manner. Also to use the approved Authorization Request form with complete medical information i.e.: DX codes, CPT, HCPC codes.</p><p>Preferred:<br>Knowledge of MHC and CSIIM computer system.</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>                    Call Center Manager, Call Center Supervisor, Payroll, Data Entry, Call Center, Customer Service, Finance, Administrative                                                    </p>

Supervisor, Authorization Technician

<p>Salary Range:&nbsp;&nbsp;$117,509.00&nbsp;(Min.) -&nbsp;$152,762.00&nbsp;(Mid.) -&nbsp;$188,015.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Enterprise Shared Services Program Manager II is responsible for leading and managing a portfolio of strategic and transformational enterprise wide programs and projects that are generally complex and large in scope. In this capacity, the Program Manager works collaboratively with leadership, management and other stakeholders including Business Owner(s), Investment Review Board, intake and program/project teams and participates in program governance and administration meetings as appropriate. This position synchronizes the work of cross-functional project teams and provides direct or indirect oversight of Senior Project Managers and Project Managers across the organization. A key function of this position is to serve as the primary point of contact between executive leadership and the program team, engage all stakeholders and communicate the program’s progress. This position is accountable for working with and facilitating processes to accomplish complex program objectives, managing change and resolving issues that span project teams and departments by planning, organizing, directing and supervising program activities in a cost effective and productive manner to achieve strategic value and the organizational vision. </p><p>This position closely collaborates with business owners, vendors and other organizational staff to understand the business need for each project and makes decisions based on what is best for the organization. This position supports business owners in preparing the project executive summary of needs, solutions, costs, benefits, and implementation schedules. In addition, this position ensures executive summaries are submitted to the Investment Review Board/Leadership Team for review and approval in a timely manner. Upon Leadership approval, this position manages the creation of definitive project execution plans (Plan of Record) and business cases. In addition, this position has the ability to turn around any-size troubled project when necessary.</p><p>Integral to the success of this position is positive interaction with business owners and unit staff, management, third party contractors/vendors, cross-functional project team members and other department resources to ensure effective management and momentum of Enterprise Shared Services projects as well as organizational strategic initiatives. This position identifies PM-related training needs and conducts trainings. This individual is a role model for integrity and establishes and maintains effective professional work relationships, working collaboratively with all levels of management and business owners to help guide the discipline of planning, organizing, securing, managing, leading, and controlling resources to achieve specific goals.</p><h4>Duties</h4><p><br>Creates, develops, and maintains the program plan and supports development of program related project plans.</p><p>Manages quadruple constraints of scope, schedule, cost and quality and ensures that integrated master plans including: business, technical, reporting, training, testing, and implementation plans and schedules are followed.</p><p>Meets with Business Owner(s) and Project Managers/teams on a regular basis, weekly or more often, as needed.</p><p>Partners with Business Owner(s) to develop communications plan, test plan, training plan, risk management/mitigation plan, and plan of record.</p><p>Directs others to successfully complete projects on time, within scope and on budget by ensuring that all Project Managers supporting the program create, manage, and maintain their project schedules, resources, and project artifacts, support centralized document repository, identify risks, assumptions, issues, and dependencies, provide timely status reports and proactively escalate issues for resolution.</p><p>Accountable for scheduling, cost tracking/budget, resource management allocation and utilization, program component integration and supporting program performance.</p><p>Supervises multiple projects within a program to achieve continuous alignment with the organization’s strategic plans and objectives.</p><p>Supports Business Owner(s) with proposal development, vendor contract negotiation, program dashboard/weekly status reports, quality assurance, business process improvement, and other program documentation.</p><p>Functions as the lead expert in Enterprise Shared Service, leading a team or multiple teams and performs liaison activities with leadership, management, and other stakeholders.</p><p>Optimizes program governance by working with the over-arching infrastructure, processes, and procedures to accomplish objectives including establishing metrics of success and deliverables.</p><p>Supports PACE methodology and ensures projects are executed using the appropriate Project Management tools and techniques to successfully implement projects.</p><p>Promotes cultural and organizational change to achieve strategic outcomes and a corporate vision.</p><p>Performs 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><br>Required:<br>At least 6 years of relevant Project Management, Program Management, Health Care Administration, Research or Clinical field work experience in an organizational setting.</p><p>Experience facilitating complex decision making among multiple executive stakeholders with different interests and priorities.</p><p>Experienced in vendor/contract management and negotiations.</p><h4>Skills</h4><p><br>Required:<br>Demonstrated success managing multiple, large scale, diverse and complex projects simultaneously.</p><p><br>Ability to work well independently or leading a project team/efforts with limited supervision; strong team collaboration.</p><p>Ability to manage priorities across multiple teams/projects, platforms.</p><p>Ability to coach and mentor colleagues. Strong facilitation and mentoring skill.</p><p>Ability to understand business or clinical strategies and plans, and their relationship to organizational strategies.</p><p>Excellent written and oral communication skills, speaks clearly and persuasively in positive or negative situations; strong interpersonal and leadership skills.</p><p>Excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated.</p><p>Strong interpersonal and leadership skills with ability to interact with cross functional project teams; reacts professionally under pressure.</p><p>Ability to work independently in a fast-paced and changing environment.</p><p>Proficiency in Microsoft Office Suite (Word, Excel, Access, PowerPoint, Project, Outlook, Visio, Publisher); HTML.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Project Management Professional (PMP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Electronic Data Interchange (EDI) Specifics:&nbsp; </p><p>Summary:</p><p>This position synchronizes the work of cross-functional project teams, specifically those that are technical in nature, and provide direct or indirect oversight of Senior Project Managers and Project Managers across the organization, as well as technical resources assigned to projects and programs being managed by this position. This position also identifies technical gaps in existing systems and potential new implementations.</p><p>Duties and Responsibilities:</p><p>Leads all system upgrades, enhancements, and new deployments for Enterprise Shares Services and is a subject matter expert in EDI and Claims transactions. </p><p>Works collaboratively with Information Technology leadership (Architecture, Solutions Delivery, Technical Delivery, etc.) to prioritize, evaluate, and deploy solutions which contribute to the accurate receipt, loading, and exchange of claims data managed by the Claims Data &amp; Support Services teams.</p><p>Functions as the Lead Technical expert in Enterprise Shared Service, leading a team or multiple teams and performs liaison activities with leadership, management, and other stakeholders.</p><p>Experience: </p><p>Required:</p><p>Extensive knowledge and experience working on EDI transactions – 827, 835, RA, 277CA, 834, and 278&nbsp;</p><p>Experience and knowledge working with FHIR standards on Patient Access API, Provider Directory API, Payer to Payer API, Pre Authorization API</p><p>Experience working on: Claims – Intake, adjudication, premium billing, capitation and FFS check runs, batch jobs, accumulators, Coordination of Benefits (including MOoP and TrOOP), EOBs, NDC/RxNorm Codes, DOFR, Pre-Authorizations, Reversal and Adjustments, Share of Cost, MOU; Membership – Enrollment, Medicare, Medi-Cal, Covered California, Dual eligibility, retro-active membership; Varied applications – QNXT, CCA, Syntranet, Mulesoft, SQL, EPIC, PCT, Salesforce.</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>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, EMR, Medicare, Healthcare Administration, Risk Management, Insurance, Healthcare, Finance                                                    </p>

Enterprise Shared Services Program Manager II (ALD)

<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 Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for L.A. Care members. Utilizes assessments, member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available Health Plan, Home and Community Based Services (HCBS), and MLTSS resources, optimal member functioning, and cost-effective outcomes. Scope of work includes care coordination functions and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM). &nbsp;</p><p>Collaborate with Skilled Nursing Facilities (SNF), &nbsp;Intermediate Care Facility - Developmentally Disabled (ICF-DD), Congregate Living Health Facility (CLHF), Community Based Adult Services (CBAS) Centers, Preferred Provider Groups (PPG), CalAIM providers (i.e. Community Supports, ICF-DD, Regional Center), cross functional units Behavioral Health to facilitate authorization of services. &nbsp;Coordinate the identification, documentation, and resolution of related issues in a timely manner.</p><h4>Duties</h4><p>Responsible for performing assessments of members referred to core MLTSS and other MLTSS administered programs for the identification, evaluation, coordination and management of members' needs, including physical health, behavioral health, social services, and MLTSS. Responsible for UM authorization functions for services requiring prior auths.&nbsp;</p><p>Provides direction to non-clinicians who assist members with accessing services. Conducts additional assessments as necessary, to monitor, evaluate and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum. &nbsp;Arranges for all services required while coordinating with the health care team to eliminate duplication of services.&nbsp;</p><p>Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS and other MLTSS administered &nbsp;programs.&nbsp;</p><p>Establishes relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PPGs, and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements.</p><p>Facilitates care coordination with internal and external entities to improve member's short and long term goals in collaboration with member, caregivers, family, support systems, and physicians. &nbsp;A person-centered approach will minimize member confusion, and ensure that the best care is delivered in the most appropriate setting.&nbsp;</p><p>Performs clinical review of SNF and CBAS services and determines if the request is appropriate level of care. Reviews requests for PCHS and Respite to determine appropriateness of the request. &nbsp;Evaluates if needs can be addressed through other avenues, such as, community services, HCBS and covered health plan benefits, and makes referrals to appropriate programs.</p><p>Documents accurately and comprehensively based on the standards of practice and current organization policies.</p><p>Performs other duties as assigned. &nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p><br>Required:</p><p>At least 5 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care. At least 3 years of relevant Licensed Vocational Nurse (LVN) experience may be substituted for 2 years of RN experience.</p><p>Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment. </p><p>Preferred:</p><p>Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.</p><h4>Skills</h4><p>Required:<br>Excellent verbal and written communication skills.</p><p>Excellent organizational and time-management skills.</p><p>Proficient in Microsoft Office.</p><p>Preferred:<br>Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p><strong>Required:</strong><br>Registered Nurse (RN)</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p><br>Required:<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>                    LVN, Nursing, Registered Nurse, Travel Nurse, Behavioral Health, Healthcare                                                    </p>

Managed Long Term Services and Supports Nurse Specialist RN II

<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 Provider Network Account Manager III is responsible for all aspects of the L.A. Care (LAC) provider contracting and relationship management process, including drafting, reviewing, negotiating and implementing phases of contracts, and building, nurturing, and maintaining positive working relationships between LAC and its network of providers. Assigned accounts include multiple large provider organizations (i.e. Participating Physician Group (PPGs); Hospitals; Ancillaries; etc.), or individual practitioners, in a single or multiple locations. The Account Manager III is responsible for representing LAC in their partnership with contracted and non-contracted providers, at all times. The Account Manager III is responsible for maintaining an in-depth understanding of LAC governing regulations, policies and procedures, operating standards, provider contracts, and provider performance and needs. The Account Manager III leverages that information to identify, develop, and conduct relevant and tailored provider orientation sessions, makes educational visits about LAC practices, policies, and requirements, and works to resolve provider issues. The Account Manager III is responsible for monitoring and managing network adequacy by assuring appropriate access to services throughout L.A. County, and beyond as necessary, to comply with State and Federal requirements for all product lines of business (Medicaid, Medicare, and Commercial). The Account Manager III is responsible for the initial on-board training of new managed care contract provider partners, and for ensuring their provider accounts maintain appropriate trainings and credentials to care for LAC members.</p><p>Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Responsible for identifying, contacting, and actively soliciting qualified providers and/or provider organizations to participate with LAC; assuring the financial integrity of LAC is maintained through rate negotiation; and, ensuring contract requirements are adhered to, including language, terms, and reimbursement requirements. Responsible for the project management of all contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards, while ensuring a smooth transition of services for members. Responsible for drafting contract clauses/addenda, review, and negotiating new contracts/amendments and other contracting related documents based on LAC contracting guidelines, parameters, and standards, including leadership strategy discussions; implementing contracts/amendments across LAC; and providing in-service orientation meetings with providers. Responsible for monitoring managed care contracts for renewals and expirations.</p><p>Acts the liaison between Provider Network Management (PNM) and other internal Plan departments, as necessary, to resolve complex issues, and to effectively deliver accurate, timely, and appropriate information to their assigned accounts. Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting LAC in investigating any potential quality issues. Monitors timely receipt of contractually required reporting. Acquires and maintains a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases, and routinely relays information about additions, deletions, or changes to the LAC PNM and Provider Data Management (PDM) department. </p><p>Researches and resolves contractual interpretation, operational and/or payment issues; researches and resolves incoming escalated provider inquiries within specified guidelines; educates providers on new protocols, policies, and procedures. Ensures provider database and documentation is up-to-date, accurate, and complete.</p><p>Maintains a complete understanding of LACs reports and metrics to evaluate the performance of assigned providers and/or provider organizations, and use the data to develop and implement methods to improve </p><p>relationships with all providers. Responsible to assist in all corrective actions required, up to and including termination, following LAC policies and procedures, and applicable contractual and regulatory requirements.&nbsp; </p><h4>Duties Continued</h4><p>Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting LAC in investigating any potential quality issues.&nbsp; </p><p>Serve as a communication link between provider accounts and LAC. Complete regularly scheduled meetings (site visits, or conference calls) with all accounts. Translate information exchange, ideas, requests and other inquiries into actionable items for improved contracting/relationship management and enhanced operational service delivery.</p><p>Support all of the LAC PNM departments (Oversight and Monitoring; Engagement and Strategy; Data Management; and, Operations). Support all of the LAC PNM groups; assist in the development and distribution of provider engagement material (trainings, notices, newsletters); assist in oversight and monitoring efforts; implement LAC provider strategies; and assist in improving the quality of provider data, as needed.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>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>Minimum of 4 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry.</p><p>At least 4 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting.</p><h4>Skills</h4><p>Required:<br>Good organizational skills and demonstrate excellent attention to detail and follow up skills.</p><p>Knowledgeable financial and financial risk analysis.</p><p>Competent computer skills; MS Office skills required.</p><p>Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines.</p><p>Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel, and LAC provider network physicians.</p><p><br>Possess a professional and mature demeanor at all times.</p><p><br>Ability to work in a fast-paced department independently and handle multiple tasks; work with interruptions and deal effectively with confidential information.</p><p>Preferred:</p><p>Knowledge of ICD-9, ICD-10, and Current Procedural Terminology (CPT) codes desired.</p><p>Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.</p><p>Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Medical Coding Certification<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:</p><p>Travel to offsite locations for work.</p><p>Total Provider Management (TPM):&nbsp; Ensures that the LAC standard provider dataset is complete, accurate, and current. Provides network adequacy analysis and data to the Network Account Managers for the purpose of monitoring and evaluating existing contracts and the need for additional providers based on ongoing network adequacy analysis. Ensures timely submission of provider data, facilitates remediation of data errors, monitors provider data submission and data quality, and performs necessary data analysis.&nbsp; Responsible for the data management of assigned accounts from data collected prior to contracting, through activation, and the ongoing submission of provider data in accordance with regulatory requirements and LAC contractual requirements. </p><p>Required: Experience in provider data regulatory reporting and provider directory management.</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>                    Relationship Manager, Medical Coding, Medicare, Medicaid, Customer Service, Healthcare                                                    </p>

65 L.A. Care Health Plan Jobs