field_job_employment_type

job_industry

field_job_occupational_field_parents_all

job_organization_name

<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>The Customer Solution Center (CSC) Even MORE Service Liaison I communicates to members in all lines of business (LOB) regarding: welcome and outbound calls, member Health Risk Assessment, and other related programs. The Liaison conducts and documents outreach activities (call, web, email) consistently and accurately. The Liaison proactively identifies, documents, investigates, and resolves member issues in a timely and appropriate manner. The Liaison also identifies potential areas of membership dissatisfaction and recognizes improvement areas. </p><p>The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:</p><p>&nbsp;&nbsp; * Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services (CMS), and for Seniors and Persons with Disabilities (SPD) population.</p><p>&nbsp;&nbsp; * Contact members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information is not provided on choice forms, enrollment applications, and 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. </p><p>&nbsp;&nbsp; * Collaborate 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.)</p><p>&nbsp;&nbsp; * Process and screen applications and renewals for Healthy Kids members, notify applicants of the disposition of their application/renewal, and conduct the appropriate follow-up (including review of vendor outreach efforts)</p><p>&nbsp;&nbsp; * Work with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.</p><p>&nbsp;&nbsp; * Collaborate with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, Personal Assistance Services Council (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 Medicare Plus DSNP 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>Track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. 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>Meet L.A. Care’s policy and procedure (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>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>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><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 1 year of customer service call center experience in a healthcare environment.&nbsp;</p><p>Data entry experience with ability to type a minimum of 40 wpm.&nbsp;</p><p>Preferred:</p><p>Previous automatic call distribution (ACD) experience.</p><h4>Skills</h4><p><br>Required:</p><p>Knowledge of medical terminology.</p><p>Good understanding of service to the disadvantaged population, seniors and/or people with chronic conditions or disabilities.&nbsp;</p><p>Must be a quick learner, excellent team player and customer service oriented.&nbsp;</p><p>Ability to answer a high volume of calls.</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>                    Data Entry, Medicare, Social Services, Medicaid, Call Center, Administrative, Healthcare, Service, Customer Service                                                    </p>

L.A. Care Health Plan

Customer Solution Center Even MORE Service Liaison I

<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 in five health plans, 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 (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the guidelines and protocols to ensure readiness for all regulatory audits. This position will develop, with the assistance of CSC management, a successful auditing strategy for the following end-to-end processes within CSC (i.e. Enrollment processing timeliness and accuracy of loading members, timeliness of I.D. Card and member materials, outbound health risk assessment (HRA) calls for Seniors and People with Disabilities (SPD) and Cal MediConnect (CMC) plus HIF for L.A. Care Medi-Cal Direct program (MCLA), call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is responsible for the ongoing progression and maintenance of CSC's compliance program efforts, including, but not limited to, policy and procedure development, training and education initiatives, and compliance programmatic developments and enhancements.</p><p>This position will complete targeted, focused and random audits related to member interactions and outcomes to ensure all elements are compliant. These results will be provided to management with recommendations and/or corrective actions required to remediate the deficiencies. This position will be responsible for the regulatory obligations for each line of business and their governing bodies; California Department of Health Care Services (DHCS), Department of Public Social Services (DPSS), Centers for Medicare and Medicaid Services(CMS), LACC - CalHers, and National Committee for Quality Assurance (NCQA) along with review and analysis of regulatory requirements for all product lines The position will take lead in all of the audit situations and be prepared to present and report full findings and ensure action plans are created, executed, and verified through reconciliation of end to end on all regulatory functions. &nbsp;&nbsp;</p><h4>Duties</h4><p>Audit readiness: Performs audit procedures for Customer Solution Center departments to ensure readiness; including identifying and defining issues, developing criteria, reviewing and analyzing evidence, and documenting business unit processes and procedures. Conducts interviews, reviews documents, develops and administers surveys, composes summary memos and prepares working papers. Identifies, develops, and documents audit issues and recommendations using independent judgement concerning areas being reviewed. Communicates or assists in communicating the results of audit and consulting projects via written reports and oral presentations to Customer Solution Center management. Collaborates with business units in audit universe preparation and validation. Assists in document preparation for regulatory and internal audits.<br><br>Regulatory compliance: Works closely with Customer Solution Center Management to determine and handle effectiveness/accuracy of operational processes. Collaborates with internal Subject Matter Experts (SMEs) to understand Customer Solution Center regulatory processes and assists with getting to the root cause of identified deficiencies. Evaluates policies and procedures with applicable regulations/guidelines and provides recommendations to management for continuous process improvements. &nbsp; &nbsp; &nbsp; &nbsp;</p><p>Collaborates with Customer Solution Center Business Analyst to track, trend, and analyze results of Quality Assurance (QA) scorecards for training and quality improvement. &nbsp;</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><h4>Experience</h4><p>Required:</p><p>A minimum of 5 years of experience in regulatory auditing (Appeals &amp; Grievances, Call Center, Enrollment) in a healthcare environment required. </p><p>Previous experience with Medi-Cal and Medicare in a managed care environment. </p><p>Preferred:&nbsp; </p><p>Tableau experience.</p><h4>Skills</h4><p>Required:<br>Advanced computer proficiency, Word, Excel; and Access is required.&nbsp;</p><p>Strong analytical and team building skills.&nbsp;</p><p>Ability to work effectively with diverse team members.&nbsp;</p><p>Ability to formulate recommendations to improve quality and service delivery, and develop effective system and process improvements.&nbsp;</p><p>Ability to multi-task and streamline day-to-day operations.&nbsp;</p><p>Ability to track and trend and create regulatory reporting.</p><p>Strong interpersonal and organization skills and is expected to work independently within the department's established guidelines, policies and procedures.&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>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>                    Medicare, Call Center, Social Services, Medicaid, Audit, Healthcare, Customer Service, Service, Finance                                                    </p>

Regulatory Compliance Quality Audit Specialist

<p>Salary Range:&nbsp;&nbsp;$47,840.00&nbsp;(Min.) -&nbsp;$57,062.00&nbsp;(Mid.) -&nbsp;$68,474.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.</p><p>The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports.</p><p>In addition, the position performs data entry and processing of referrals/authorizations in the system, &nbsp;authorizes request consistent with auto authorization criteria, maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers, with other duties as assigned.</p><h4>Duties</h4><h4>Functional Elements: Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely processing referrals/authorizations and distribute a complete file to UM Specialist within 2 hours of receipt; identify duplicate requests using the claims and verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system; appropriately documenting what information was used in making this determination within 4 hours of receipt. Appropriate identification and timely notification of time sensitive requests; appropriately identifying for the staff which you support, request that are priority based on date of receipt and established Turnaround Time criteria for compliance. Accurate filing/maintenance of confidential member information. Creating secure, complete, files. Interface with members, medical personnel and other internal and external agencies; ensure&nbsp; all comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: ICD 10 codes, CPT, HCPC codes. (35%)</h4><h4>Assist in the preparation of communication for authorization determinations, including, but not limited to preparing template letters for members and providers (authorization approval, denial, deferral, modification and pay/education). (30%)</h4><h4>Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing: Set up GNA files for review, log and keep track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to Grievances Specialist on daily basis. (20%)</h4><h4>Support UM Committee and Audit activity via Department performance reporting. Assure the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames. (5%)</h4><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 6 months of health care experience.</p><p>Experience working in a cross functional work environment.</p><p>Preferred:</p><p>Experience in Medi-Cal managed care.</p><p>1 year of experience in UM/Prior Authorization.</p><h4>Skills</h4><p>Required:</p><p>Demonstrated proficiency in Medical Terminology required.</p><p>Strong verbal and written office communication skills.</p><p>Proficient with Microsoft Office Suite and Adobe PDF. and </p><p>Excellent organizational, interpersonal and time management skills. </p><p>Must be detail-oriented and an enthusiastic team player.</p><p>Preferred:</p><p>Knowledge of QNXT computer systems a plus.</p><p>Knowledge of the UM patient referral process.</p><p>Knowledge of member’s health plan eligibility.</p><p>Knowledge of member’s benefits coverage. </p><p>Knowledge of Health Plan regulations.</p><p>Knowledge of HMO/UM functions.</p><p>Knowledge of ICD-10/CPT coding. </p><p>Proficient utilizing electronic medical records and documentation programs.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Medical Coding Certification<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:</p><p>Weekends and holidays hours may be required, as well as OT based on a business need.</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>                    EMR, Medical Coding, Data Entry, Claims, Healthcare, Administrative, Insurance                                                    </p>

Authorization Technician II

<p>Salary Range:&nbsp;&nbsp;$135,136.00&nbsp;(Min.) -&nbsp;$175,676.00&nbsp;(Mid.) -&nbsp;$216,218.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p><br>The Director, Care Management &nbsp;will mainly be responsible for the operational component of the Care Management (CM) Department with the main goal of improving key L.A. Care members healthy and access appropriate services. The Director will also work with the CM Medical Directors and key staff in designing, enhancing and implementing programs, plan strategically and report on regulatory requirements. &nbsp;&nbsp;</p><p>One of the key initiatives is to increase our community CM presence. The Director is also responsible for providing evidence of ongoing compliance with all regulatory and accreditation requirements (i.e. health risk assessments and interdisciplinary care plan and care team programs, population health management. The Director is also responsible for outreaching and working with key stakeholders and provide subject matter expertise in support of the oversight, outreach and training of our Plan Partner Health Plans and Delegated Provider Groups.</p><p>This position will direct all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.</p><h4>Duties</h4><p>General Essential functions:&nbsp;<br>Collaborating with the Medical Director, responsible for the operations, programming and oversight of internal L.A. Care’s Care Management Department, collaborates with internal and external delegates and any operations associated with the Care Management department. &nbsp;Functions currently include all care management programs (Complex Care Management, Care Coordination and Disease Management). &nbsp;</p><p>Ensures the CM department performs the following: &nbsp;</p><p>All contracts [(i.e. Centers for Medicare and Medicaid Service (CMS), California Department of Health Care Services (DHCS)], California Department of Managed Health Care (DMHC) regulations, applicable state and federal regulations, National Committee on Quality Assurance (NCQA) CM Certification, Management Services Agreements &amp; Other Contracts. &nbsp;</p><p>Oversees and monitors operational compliance with organizational standards, policies and procedures and regulatory requirements. &nbsp;</p><p>Assures department meets all regulatory time frames on CM.</p><p>Develops and implements departmental policies and procedures. &nbsp;</p><p>Develops and maintains departmental statistical and performance reports. &nbsp;</p><p>Develops, implements and monitors performance standards.</p><p>Develops and maintains effective communication mechanisms at various levels of the organization and with external organizations.</p><p>Develop and maintain departmental budgets in line with organizational goals. &nbsp;Assure operational effectiveness to meet MCR targets and optimize health care resource utilization.&nbsp;</p><p>Assures appropriate staff support of Utilization Management and other relevant committees. &nbsp;</p><p>Supports the maintenance of positive relationships between L.A. Care and external groups.</p><p>Identifies and implements, with approval, programs that improve the provision of services to members. &nbsp;</p><p>Supports Clinical Assurance/Delegation Oversight in the measurement and analysis of delegated Participating Physician Group (PPG) functions.</p><h4>Duties Continued</h4><p>Internal Health Plan Operational Management:&nbsp;<br>Proactively identifies and implements operational modifications to enhance departmental performance. &nbsp;</p><p>Develops and implements operational business plans and departmental objectives to support organization strategies and tactics. &nbsp;</p><p>Interfaces with and collaborates with other service areas to assure optimal service delivery to members, compliance, and efficiency. Maintain compliance with all internal audits.</p><p>Human Resource Management:&nbsp;<br>Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.</p><p>Develops and maintains a culturally sensitive work environment that promotes staff growth and education.&nbsp;</p><p><br>Completes performance appraisals in accordance with established policies and based upon achievement of the L.A. Care mission, value, objectives and management expectations.&nbsp;</p><p>Assures staff have access to appropriate training and educational opportunities.</p><p>Oversees development of staff planning, including recruitment and retention.</p><p>Data System Development and Data Analysis:<br>Directs oversight and responsible for identifying and developing business needs for complex ongoing data projects and communicating with I.T. team on business needs.&nbsp;</p><p>Assesses and revises program goals and staff training based on data analysis and review.&nbsp;</p><p>Responsible for the Policies, Procedures, Budget and Program Documentation.</p><p>Develops and regularly reviews and maintains Care Management program documents to be in compliance with all regulatory and accreditation requirements and to be in line with current program activities. Prepares briefings, reports, consultation documents and presentations that clearly articulate L.A. Care's &nbsp;regulatory position and policy. &nbsp;Develop regulatory position and policy based on research and evidence.</p><p>Vendor Management and Oversight:<br>Oversees existing contracts invoice processing, budget maintenance and compliance with contract’s scope of work.</p><p>Assesses and evaluates contract extensions and development of new vendor contract partnerships in alliance with enterprise–wide and departmental goals, objectives and members’ needs to achieve quality healthcare services and improves members’ quality of life.</p><p>Performs other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Nursing<h4>Education Preferred</h4>Master's Degree in NursingIn lieu of degree, equivalent education and/or experience may be considered.<h4>Experience</h4><p>Required:</p><p>Minimum of 7 years of Care Management experience including progressively responsible leadership experience facilitating quality/process improvement, updating policies/procedures with the latest regulatory and accreditation standards.&nbsp; </p><p>At least 5 years of leading staff or supervisory/management experience</p><p>Minimum of 3 years of relevant Health Plan experience.</p><h4>Skills</h4><p><strong>Required:</strong><br>Excellent verbal, written and presentation skills.</p><p>Critical thinking skills.</p><p>Ability to efficiently and effectively assimilate information and communicate clearly and promptly to key stakeholders.</p><p>Ability to analyze and identify trends in reports to facilitate decision for enhancements to program.</p><p>Proven effective leadership skills.</p><p>Proficient with MS Office (Word, Excel, Outlook, PowerPoint, etc.)</p><p>Motivational interviewing skills.</p><p>Knowledge of compliance standards in the operational function.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Licensed Master of Social Worker (LMSW) - Active, current and unrestricted California LicenseRegistered Nurse (RN) - Active, current and unrestricted California License<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>                    Nursing, Registered Nurse, Social Worker, Medicaid, Medicare, Service, Healthcare                                                    </p>

Director, Care Management

<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 Healthcare Financial Analyst I will assist with gathering medical cost data to support the production of internal routine healthcare reports, ad hoc studies, as well as regulatory request required by Department of Health Care Services (DHCS) such as Rate Development Template, Supplemental Data Request, Audit Request. &nbsp;Support of all Actuarial functions and needs. Create and maintain Excel workbook to compare monthly, quarterly, and yearly membership, medical cost and utilization data, Identify and track data anomalies. This position will work closely with Financial Analyst II and &nbsp;III to provide assistance and perform routine &nbsp;task.</p><h4>Duties</h4><p>Support in gathering data to feed regulatory request required by Department of Health Care Services (DHCS) such as Rate Development Template, Supplemental Data Request, Audit Request. &nbsp;Accurately and timely completion of regulatory data request.</p><p>Updating ad hoc and routine monthly/quarterly/yearly reports, identify and research variance.</p><p>Update integrated revenue/medical care expense (FFS + RX Claims/Provider Capitation/other medical cost) analysis. &nbsp;Update financial reconciliation and data validation workbooks,</p><p>Generate reports from accounting system and convert to useable format.&nbsp;</p><p>Supports higher level financial analyst with audits and projects.&nbsp;</p><p>Meets deadlines with accurate data and support the legal department's arguments.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Business AdministrationIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p>Required:&nbsp;<br>At least 2 years of finance or managed healthcare experience.</p><h4>Skills</h4><p>Required:<br>Understanding of financial/accounting concepts. &nbsp;</p><p>Basic knowledge of SQL programming. Demonstrated knowledge in data analysis, MS Excel and SQL programming.</p><p>Must be able to create and manage Excel spreadsheets.&nbsp;</p><p>Must have solid and effective verbal, written and interpersonal communication skills. &nbsp;&nbsp;</p><p>Must have strong analytical and problem solving skills.&nbsp;</p><p>Preferred:<br>Understanding of health care cost structures (fee schedules, health care cost categories, and health care service utilizations, and medical codes).</p><p>Medical/Medicare/Commercial Health Insurance knowledge.</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, Medical, Financial, Medicare, Accounting, Finance, Healthcare                                                    </p>

Healthcare Financial Analyst I

<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 Manager, Compliance Monitoring serves as a leader within the Corporate Compliance Monitoring Department. This position provides leadership and oversight of compliance monitoring, focusing on the effective implementation of corrective action plans (CAPs) and the mitigation of compliance risks throughout the organization. A key component of the role is to enhance monitoring processes, ensuring that federal, state, contractual, accreditation, and internal Plan requirements are met consistently and accurately.</p><p>The primary responsibility of this role is to oversee the comprehensive monitoring of compliance activities, with particular attention to corrective action plans arising from regulatory or audit findings. By ensuring CAPs are effectively tracked, implemented, and mitigated, the role plays a crucial part in the resolution of non-compliance issues. The Manager collaborates with cross- functional business units essential in optimizing the success and sustainability of corrective actions, thereby enhancing the organization’s compliance posture.</p><p>The Manager advises and supports the senior management on other duties as assigned to support the mission and responsibilities of the Corporate Compliance Monitoring Department, and to support the mission and business operations of L.A. Care Health Plan. </p><p>The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.</p><h4>Duties</h4><p>Responsible for developing and implementing a comprehensive monitoring program to track and assess the effectiveness of corrective actions addressing identified deficiencies. Develops policies, procedures, and tools to ensure systematic and consistent monitoring throughout the organization. Maintains a centralized tracking system to document deficiencies, assign ownership, and establish clear timelines for resolution.</p><p>Responsible for developing and maintaining key performance indicators (KPIs) and monitoring systems to proactively detect compliance risks. Develops regulatory reports, summaries, and agendas to communicate to the Internal Compliance Committee (ICC) and the Compliance and Quality Committee of the Board of Governors, as needed. Prepares executive summaries and monitoring reports to share with L.A. Care business units.&nbsp; Responsible for running and maintaining regular reports that includes dashboards, charts, and graphs.&nbsp; Present reports to senior leadership and relevant committees. </p><p>Collaborate with key internal and external stakeholders and with cross-functional units/ departments to ensure cohesive monitoring of compliance across both delegated and non-delegated functions. Facilitates the preparation for internal and external regulatory audits, providing detailed data analyses of audit findings, addressing deficiencies, and ensuring corrective actions are tracked and completed effectively.</p><p>Manage staff, including, but not limited to hiring staff, monitoring of day-to-day activities of staff, monitoring of staff performance, performance reviews, 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, disciplinary matters for direct reports, among others.</p><h4>Duties Continued</h4><p>Lead, guide and mentor teams in the collection, analysis, and interpretation of compliance data. Ensure that staff are effectively trained, and cross-trained, while being empowered to suggest system and process enhancements. </p><p>Develop and timely revise policies and procedures, desktop manuals and other guidance for effective and efficient administration of team functions. Lead special projects as needed.</p><p>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</p><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.</p><p>Staying aligned with regulatory requirements and industry standards, the Manager of Internal Monitoring will adjust practices as needed to reflect changing expectations. Escalates to appropriate staff and management unresolved or recurring deficiencies that pose significant risks, prioritizing resource allocation, and leveraging technology to enhance monitoring capabilities. </p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business Administration or Related Field<h4>Experience</h4><p>Required:</p><p>At least 5years of progressive experience in internal or external auditing/monitoring, regulatory compliance, or related fields. </p><p>At least 3 years of leading, supervising or managing staff experience.&nbsp; </p><p>Demonstrated experience leading and managing audits, preferably in a regulated industry such as banking, finance, healthcare, pharmaceuticals, or manufacturing.</p><p>Experience with implementing or supporting the implementation of managed Medicare, Medicaid or commercial regulations.</p><p>Equivalency:&nbsp; </p><p>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>In-depth understanding of relevant regulatory requirements, standards, and frameworks applicable to the managed health care industry. Familiarity with regulatory bodies such as the Centers for Medicare and Medicaid Services (CMS), the Department of Managed Healthcare (DMHC), and the Department of Health Care Services (DHCS).&nbsp; </p><p>Strong organizational and planning skills, including flexibility to handle multiple assignments, changing priorities, and compressed deadlines.&nbsp; </p><p>Proficient in MS Office, including with Word, Excel and PowerPoint</p><p>Excellent interpersonal, verbal and written communication skills.</p><p>Strong analytical and problem-solving skills, with the ability to analyze data, evaluate controls, and identify trends, patterns, and anomalies. </p><p>Proficiency in using data analytics tools and techniques to enhance audit effectiveness and efficiency.</p><p>Proficiency in project management methodologies, tools, and techniques, with experience in planning, executing, and monitoring audit projects within established timelines and budgets.</p><p>Ability to drive results and balance management of organizational risk and meeting goals of the business.</p><p>Preferred:</p><p>Deep understanding of the healthcare industry, regulatory model, products, services, and regulatory agencies. Familiarity with industry-specific regulations, challenges, and emerging trends is beneficial.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Internal Auditor (CIA)Certified Regulatory Compliance Manager (CRCM)Certified HealthCare Compliance (CHC)<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, Internal Audit, Healthcare, Finance                                                    </p>

Manager, Compliance Monitoring

<p>Salary Range:&nbsp;&nbsp;$110,279.00&nbsp;(Min.) -&nbsp;$146,120.00&nbsp;(Mid.) -&nbsp;$181,961.00&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 Advisor for Regulatory Operations plays a pivotal role in shaping and executing compliance and regulatory strategies across L.A. Care. This position involves leading cross-functional initiatives to ensure alignment with federal, state, and industry-specific regulatory requirements, driving process optimization, and enhancing the organization’s compliance framework.</p><p>The Regulatory Operations Advisor partners with internal stakeholders to provide expert guidance on implementing regulatory changes, executing the compliance workplan, and fostering a culture of compliance.</p><p>This position collaborates with key stakeholders to review programs, projects, processes, procedures, and policies; and to conduct end-to-end root cause analysis to enhance and improve outcomes and remediate issues to comply with the national and statewide standards and regulations.</p><p>Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics.</p><h4>Duties</h4><p>Develops reports, analyzes data, and provides presentation on status of areas of responsibilities on an as needed basis in support of department operations.</p><p>Partners with the management to communicate compliance and operational priorities and provide feedback or follow-ups to key stakeholders.</p><p>Acts as the point of contact for key strategic initiatives.&nbsp; </p><p>Provides expert advice to various business units on relevant topics within the organizational standards, national and state-wide compliance.</p><p>Conducts research and analysis of business performance and improvements with key stakeholders to document current state, identify gaps and present remediation plan/options to leadership.&nbsp; Leads the implementation of initiatives and monitor for successful outcomes.</p><h4>Collaborate closely with senior management to identify, assess, and address compliance risks, ensuring solutions are aligned with organizational goals and regulatory requirements. Facilitate cross-functional discussions to develop proactive strategies and implement sustainable controls that mitigate risks while driving operational efficiency.</h4><h4>Responsible for advising on the regulatory implications of emerging business opportunities, ensuring that strategic initiatives are aligned with evolving industry and regulatory standards. Oversees the development and execution of training programs to elevate regulatory awareness and competence at all organizational levels. Collaborates with cross-functional departments to ensure compliance programs are seamlessly integrated with organizational priorities and operational goals.</h4><h4>Provides expert guidance on regulatory matters, addressing inquiries and offering solutions for both immediate and long-term compliance challenges. Responsible for designing and implementing data analytics tools and dashboards to track performance, monitor compliance trends, and inform strategic decision-making.</h4><h4>Duties Continued</h4><h4>Works closely with senior leadership to anticipate regulatory shifts, advocate for necessary changes, and position the organization as a leader in compliance excellence. Influences decision-making and deliver measurable outcomes by a blend of strategic foresight, operational acumen, and exceptional communication. </h4><h4>Serve as a key advisor to executive leadership, translating regulatory complexities into actionable strategies that enhance organizational compliance and foster a culture of accountability and integrity.</h4><h4>Perform other duties as assigned.</h4><h4>Education Required</h4>Bachelor's Degree<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p>At least 5 years of experience designing, enhancing, and implementing comprehensive compliance programs and managed care operations for Medicare, Medicaid, and commercial health plans. </p><p>Experienced in generating executive-level compliance reports and leveraging data-driven insights to inform strategic decisions and drive continuous improvement efforts.</p><p>Experienced with Governance, Risk, and Compliance (GRC) tools, project management platforms, and data analytics tools, including SharePoint, Smartsheet, Tableau, and Alteryx/SQL</p><p>Experienced in navigating complex regulatory landscapes, engaging with regulators, auditors, and external stakeholders to promote transparency and achieve compliance success.</p><p>Experienced in managing high-performing teams with a strong emphasis on coaching, mentoring, and professional development. </p><h4>Skills</h4><p>Required:</p><p>Deep understanding of the regulatory landscape, operational workflows, and strategic principles, combined with strong leadership and analytical capabilities.</p><p>Demonstrated ability to create scalable compliance strategies that effectively mitigate risks, optimize processes, and ensure adherence to evolving regulatory requirements across complex healthcare landscapes.</p><p>Proven ability to foster a culture of accountability and innovation, ensuring teams adopt leading industry practices, leverage advanced tools and technology, and align with organizational compliance objectives.</p><p>Exceptional skills in identifying and addressing regulatory and compliance risks.</p><p>Demonstrated knowledge and ability in developing actionable corrective plans and implementing monitoring systems to track issues from detection through remediation. </p><p>Proven ability to remain agile in a fast-paced environment, addressing emerging risks and adapting strategies to meet evolving business and regulatory needs.</p><p>Exceptional verbal and written communication skills, with the ability to present complex regulatory concepts clearly and effectively to diverse audiences, including executives, regulators, and board members. </p><p>Proven ability to partner with legal, finance, operations, and IT teams to align compliance initiatives with broader organizational strategies. </p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified HealthCare Compliance (CHC)Project Management Professional (PMP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Additional Required &amp; Preferred Skills:</p><p>Strong proficiency in data analysis, compliance tracking, and reporting to executive leadership. &nbsp;Exceptional skills in preparing detailed reports, dashboards, and presentations to communicate compliance metrics and trends.</p><p>Familiarity with compliance management software, analytics tools, and dashboard creation is preferred.</p><p>Proficient in utilizing compliance tools to manage projects, perform analytics, and streamline operational processes.</p><p>Preferred:</p><p>Comprehensive understanding of state and federal regulations, including Centers for Medicare and Medicaid Services (CMS) guidelines, Health Insurance Portability and Accountability Act (HIPAA), Affordable Care Act (ACA), Knox-Keene Act, and other applicable laws. Experience in applying regulatory requirements to operational processes and designing scalable solutions to ensure ongoing adherence.</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>                    Medicaid, Medicare, Healthcare                                                    </p>

Advisor Regulatory Operations

<p>Salary Range:&nbsp;&nbsp;$45,760.00&nbsp;(Min.) -&nbsp;$47,823.00&nbsp;(Mid.) -&nbsp;$55,818.00&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 Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.&nbsp;</p><p>The Customer Solution Center Service Representative I handles first level calls involving member eligibility verification, general program and administration questions, benefits and services, member requests for I.D. cards and Primary Care Provider (PCP) changes, and triage of calls to appropriate units or outside entities.&nbsp;</p><h4>Duties</h4><p>Answers incoming first level calls from members, potential members, providers and advocates. Handles and resolves member issues, assists members in connecting with internal units or external parties such as Plan Partners, Primary Care Physician (PCP) offices, pharmacists, etc. Provides essential information to members regarding access to care issues, coordination of care issues, benefits, Evidence of Coverage (EOC), Member Handbook, etc. Assists providers in using the Interactive Voice Response (IVR) web portal and verifying member eligibility. Documents all calls via the member data base system, QMEIS.&nbsp;<br>Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information. Troubleshoots and directs calls to the appropriate departments or outside entities. (75%)</p><p>Supports robocall and ad-hoc member outreach activities as determined by business need. (15%)</p><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>At least 6 months of customer service call center experience.&nbsp;</p><p>Data entry experience with ability to type a minimum of 40 words per minute.&nbsp;</p><p>Preferred:<br>Managed care or health plan experience.</p><h4>Skills</h4><p>Required:<br>Ability to answer a high volume of calls.</p><p>Knowledge of medical terminology.&nbsp;</p><p>Must be a strong team player, punctual, and has excellent attendance record.&nbsp;</p><p>Good understanding of service to the disadvantaged population, seniors and or people with chronic conditions or disabilities.&nbsp;</p><p>Must be a quick learner, excellent team player and customer service oriented.</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. &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>L.A. Care Health Plan Call Center is available 24 hours a day, 7 days a week, including holidays. Call Center work shifts are assigned based on business need and may include, but not be limited to, evenings, weekends and holidays.</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>                    Customer Service Representative, Call Center Representative, Call Center, Data Entry, Customer Service, Administrative                                                    </p>

Customer Solution Center Service Representative I

<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>The Customer Solution Center (CSC) Even MORE Service Liaison I communicates to members in all lines of business (LOB) regarding: welcome and outbound calls, member Health Risk Assessment, and other related programs. The Liaison conducts and documents outreach activities (call, web, email) consistently and accurately. The Liaison proactively identifies, documents, investigates, and resolves member issues in a timely and appropriate manner. The Liaison also identifies potential areas of membership dissatisfaction and recognizes improvement areas. </p><p>The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:</p><p>&nbsp;&nbsp; * Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services (CMS), and for Seniors and Persons with Disabilities (SPD) population.</p><p>&nbsp;&nbsp; * Contact members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information is not provided on choice forms, enrollment applications, and 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. </p><p>&nbsp;&nbsp; * Collaborate 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.)</p><p>&nbsp;&nbsp; * Process and screen applications and renewals for Healthy Kids members, notify applicants of the disposition of their application/renewal, and conduct the appropriate follow-up (including review of vendor outreach efforts)</p><p>&nbsp;&nbsp; * Work with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.</p><p>&nbsp;&nbsp; * Collaborate with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, Personal Assistance Services Council (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 Medicare Plus DSNP 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>Track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. 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>Meet L.A. Care’s policy and procedure (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>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>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><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 1 year of customer service call center experience in a healthcare environment.&nbsp;</p><p>Data entry experience with ability to type a minimum of 40 wpm.&nbsp;</p><p>Preferred:</p><p>Previous automatic call distribution (ACD) experience.</p><h4>Skills</h4><p><br>Required:</p><p>Knowledge of medical terminology.</p><p>Good understanding of service to the disadvantaged population, seniors and/or people with chronic conditions or disabilities.&nbsp;</p><p>Must be a quick learner, excellent team player and customer service oriented.&nbsp;</p><p>Ability to answer a high volume of calls.</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>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>                    Medicare, Call Center, Data Entry, Social Services, Medicaid, Healthcare, Customer Service, Administrative, Service                                                    </p>

Customer Solution Center Even MORE Service Liaison I (ALD) 12 Month Contract

<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 Help Desk Technician II provides workstation phone, off site and onsite support for users, vendors and/or clients, resolving computer issues and help desk-related requests. This position plans, analyzes, configures, and installs new personal computer systems, determining user specifications for hardware and software upgrades; maintains and repairs existing computers; and deals with most issues that are simple or routine, escalating more complex or involved issues to Level II staff. This position composes documentation and communication regarding help desk/telephone support operations, and focuses on customer relations, achieving user comfort level on computer applications and equipment. This position may be required to travel on an as needed basis in order to fulfill user support responsibilities.</p><h4>Duties</h4><p><strong>Help Desk Coordination:</strong> Track all help desk issues and ensure that all are assigned to a staff member, are completed, and that users are kept informed of the status of their requests. (30%)</p><p><strong>User Support:</strong> Provide 1st-tier user support for all simple or routine user issues. Help users resolve system problems, utilize standard software, and maintain standard hardware. The Help Desk Technician may be required to travel on an as needed basis in order to fulfill user support responsibilities. (30%)</p><p><strong>Account Creation:</strong> Create standard accounts for new users for workstation login or email. Assign users to established groups and assign standard file permissions on appropriate servers. (15%)</p><p><strong>Maintain Supplies:</strong> Responsible for maintaining computer-related supplies (toner cartridges, floppy disks, backup tapes, etc.). Keep track of use, research prices, submit expenditure requests when needed, and ensure that consumables don't run out. Ensure that new hardware is accurately entered into the FAS accounting system. Workstation Roll out/Patching: Provide manpower for workstation rollouts and applying patches to workstations. (15%)</p><p>Perform other duties as assigned. (10%).</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p>Required:</p><p>At least 2 years of experience in configuring &amp; administering networked computer systems in a Windows environment.</p><p>Strong experience with TCP/IP, Microsoft Outlook Email, Laptops and PDAs such as blackberry.</p><p>Experience in providing support to telecommute &amp; mobile laptop users required. </p><h4>Skills</h4><p>Required:</p><p>Familiar in configuring remote LAN access for VPN. </p><p>Excellent team work ethic.</p><p>Excellent communication and customer service skills. </p><p>Working knowledge of the Microsoft Office Suite, Windows XP/7 and Active Directory.</p><p>Preferred:<br>Strong PC and desktop application knowledge.</p><p>Strong computer troubleshooting and problem solving skills.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Computing Technology Industry Association (CompTIA) A+ CertificationHelp Desk Institute (HDI) Certification<h4>Required Training</h4><h4>Physical Requirements</h4>Moderate<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>Medical, Dental and Vision</li><li>Wellness Program</li><li>Paid Sick Leave</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

86 L.A. Care Health Plan Jobs