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<p>Salary Range:&nbsp;&nbsp;$45,760.00&nbsp;(Min.) -&nbsp;$45,760.00&nbsp;(Mid.) -&nbsp;$52,024.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>As the student intern enters the company, this position is expected to assume, as much as possible, the role of a regular staff member.&nbsp;</p><h4>Duties</h4><p>Assists with specialized project and administrative tasks to ensure the coordination and completion of all segments of the assigned project. Compiles and consolidates reports and prepares presentation based on findings or outcomes. </p><p>Assists with various administrative tasks to ensure the coordination and completion of all segments of the assigned project. </p><p>Completes the project timeline (if applicable) ensuring management reviews and approves it. </p><p>Conducts research and gathers data for reports and presentations. </p><p>Compiles and consolidate reports and prepare presentation based on findings or outcomes. </p><p>Works closely with assigned staff and varying levels of management. </p><p>Maintains cooperation and participation with key people involved in the project. </p><p>Adheres to company work hours, policies, procedures and rules governing professional staff behavior.</p><p>Adheres to company policies governing the observation of confidentiality and the handling of confidential information.</p><p>Assumes personal and professional responsibilities for actions and activities.</p><p>Maintains professional relationships with company employees, customers and so forth.</p><p>Utilizes a courteous, enthusiastic, open-minded, critical approach to policies and procedures within the profession.</p><p>Relates and applies knowledge acquired in the academic setting to the company setting.</p><h4>Duties Continued</h4><p>Develops a self-awareness in regard to attitudes, values, behavior patterns, and so forth that influence work.</p><p>Prepares for and utilizes conferences and other opportunities of learning afforded in the company.</p><p>Being consistent and punctual in the submission of all work assignments to the supervisor and faculty coordinator.</p><p>Provides the faculty coordinator with periodic progress reports. </p><p>Performs other relevant duties as assigned.</p><h4>Education Required</h4>Must be enrolled in an accredited undergraduate or graduate degree and field placement program.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>Must have general experience writing, meeting project deadlines and working with basic Microsoft Office Suite applications, such as word, excel and PowerPoint.</p><h4>Skills</h4><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>*Support with Health Needs Assessments of Long Beach CRC<br>*Assist with Data Entry, Data Analysis, and Data Reports<br>*Build relationships with local community-based organizations and partners<br>*Community Outreach Support in CRC events and CRC related outreach<br>*Assist with evaluation of Current classes<br>*Support with projects and events<br>*Support with social media: Support with research on trends and content creation<br>*Assists CRC Manager with special assignments for the benefit of the CRC operation and shared CRC goals. Assists with tables, chairs, and fitness equipment set-up to support health education and fitness classes. Provides support during community engagement events by disseminating information and engaging members and participants and/or events</p><p>Required:<br>*Master’s in public health related field preferred<br>*Bachelor’s in public health related field required<br>*Proficient with Microsoft Office Applications (including Word, PowerPoint, Excel) and with using the Internet as a research tool.<br>Ability to handle multiple tasks, prioritize and complete assignments on a timely basis.<br>Strong organizational, initiative taking and problem-solving skills *<br>Excellent writing and communication skills, and public speaking skills.<br>Ability to work independently and as part of a team.</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>Medical, Dental and Vision</li><li>Wellness Program</li><li>Paid Sick Leave</li></ul><p><br><strong>Nearest Major Market: </strong>Long Beach                                            <br><strong>Nearest Secondary Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Public Health, Data Entry, Healthcare, Administrative                                                    </p>

L.A. Care Health Plan

Student Intern (Community Resource Center, Long Beach)

<p>Salary Range:&nbsp;&nbsp;$45,760.00&nbsp;(Min.) -&nbsp;$45,760.00&nbsp;(Mid.) -&nbsp;$52,024.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>As the student intern enters the company, this position is expected to assume, as much as possible, the role of a regular staff member.&nbsp;</p><h4>Duties</h4><p>Assists with specialized project and administrative tasks to ensure the coordination and completion of all segments of the assigned project. Compiles and consolidates reports and prepares presentation based on findings or outcomes. </p><p>Assists with various administrative tasks to ensure the coordination and completion of all segments of the assigned project. </p><p>Completes the project timeline (if applicable) ensuring management reviews and approves it. </p><p>Conducts research and gathers data for reports and presentations. </p><p>Compiles and consolidate reports and prepare presentation based on findings or outcomes. </p><p>Works closely with assigned staff and varying levels of management. </p><p>Maintains cooperation and participation with key people involved in the project. </p><p>Adheres to company work hours, policies, procedures and rules governing professional staff behavior.</p><p>Adheres to company policies governing the observation of confidentiality and the handling of confidential information.</p><p>Assumes personal and professional responsibilities for actions and activities.</p><p>Maintains professional relationships with company employees, customers and so forth.</p><p>Utilizes a courteous, enthusiastic, open-minded, critical approach to policies and procedures within the profession.</p><p>Relates and applies knowledge acquired in the academic setting to the company setting.</p><h4>Duties Continued</h4><p>Develops a self-awareness in regard to attitudes, values, behavior patterns, and so forth that influence work.</p><p>Prepares for and utilizes conferences and other opportunities of learning afforded in the company.</p><p>Being consistent and punctual in the submission of all work assignments to the supervisor and faculty coordinator.</p><p>Provides the faculty coordinator with periodic progress reports. </p><p>Performs other relevant duties as assigned.</p><h4>Education Required</h4>Must be enrolled in an accredited undergraduate or graduate degree and field placement program.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>Must have general experience writing, meeting project deadlines and working with basic Microsoft Office Suite applications, such as word, excel and PowerPoint.</p><h4>Skills</h4><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><ul><li>Provide analytical support to active Healthcare Fraud investigations.</li><li>Conduct case intake from various sources including hotline complaints, e-mail fraud referrals and reported fraud complaints from Planned Partners and PPGs.</li><li>Support investigation specialists in data analytics project.&nbsp;</li><li>Participate in Provider investigations (host dept. to provide what type of information is shared in the investigation. (i.e. HIPPA, PHI)&nbsp;</li><li>Shadow off-site law enforcement office visits (host dept. to provide what type of information is shared in the investigation. (i.e. HIPPA, PHI)&nbsp;</li><li>Participates in investigative team meetings with our Law Enforcement Investigative Partners to include the FBI, LASD and California Department of Justice.&nbsp;</li></ul><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 Sick Leave</li><li>457 (b) Retirement Plan</li><li>529 College Savings Plan</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

Student Intern (Special Investigations Unit)

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

Care Management Specialist II (D-SNP)

<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 Business Insight Data and Solutions Analyst III is responsible for running analytic projects alongside customers, with minimal oversight or guidance required from Advanced Analytics Lab management. This position is accountable for intake, execution, and managing the oversight of strategic projects that span multiple functions and departments. This position is able to effectively communicate directly with customers and cross-functional teams to understand business needs, identify root cause issues, and propose recommendations for improvement. This role will work to deliver valuable insights and recommendations to improve operational performance.</p><p>The Business Insight Data and Solutions Analyst III is also responsible for leveraging best practices, monitoring and reporting the status of project to key stakeholders. Ensures that requirements are specific, testable and in alignment with business goals.&nbsp;</p><p>Acts as a &nbsp;Subject Matter Expert, serves as a resource and mentor for other staff. &nbsp;Coaches other Advanced Analytic Lab team members in technical and business subject areas, sharing knowledge of Business Intelligence best-practices and domain expertise to increase the competencies and efficiencies of their peers.</p><h4>Duties</h4><p>Lead analytic initiatives to develop strategic insights into key business decisions and recommendations to improve operational performance. Researches and analyzes data in support of business functions, process knowledge, and systems requirements. Creates dashboard/query analysis using primarily SQL, Python, and R for purposes of improving member outcomes and medical costs.&nbsp;</p><p>Design innovative analytic approaches to test hypotheses, extract actionable insights by identifying patterns in structured and unstructured data, and develop recommendations to drive business performance.&nbsp;</p><p>Creates and updates complex business analytics solutions to ensure data may capture for ongoing review and success. &nbsp;Documents business requirements needs and all related logic critical to ensure downstream measurements are performing for desired outcomes. &nbsp;</p><p>Determine the best tactic to develop solutions to the business questions as well as to frame, manage, drive and execute a project or initiative; and to visualize and present the data to the stakeholders in the most meaningful method. Operationalize solutions, refresh cadences, go back to the department's Subject Matter Expert (SME) to make sure they are aware of how this data may be captured for ongoing review for success.&nbsp;<br><br>&nbsp;Acts as a subject matter expert in Advance Analytics team 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(s) &nbsp;meets the needs of the department, organization and legislation's policies, standards, and best practices.</p><p>Operate in a highly matrixed environment, working closely with senior leaders, management, other departments and organizations to identify root cause of the issues, propose recommendations for improvement, and develop solutions on key business challenges.&nbsp;</p><h4>Duties Continued</h4><p>Tracks maintenance of business need and requirements to ensure they are not attenuated or discarded during the execution and delivery phases. Provides detailed project objectives; clear structured, and useable requirements; tradeoff analysis; requirement feasibility; and risk analysis to improve the execution of the project plan.</p><p>Perform other duties as assigned.&nbsp;</p><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 Data Analysis experience including eliciting and documenting business and systems requirements. </p><p>A minimum of 2 years of applying Operations Research practices to business problems.</p><p>A minimum of 2 years of health plan experience.</p><p>Experience with SQL, Python, and R.</p><h4>Skills</h4><p>Required:&nbsp;</p><p>Knowledge of SQL, Tableau, Python, MS Office, Impala, Hive, and GitHub.</p><p>Expert knowledge of relational databases, database structures.</p><p>Excellent communication skills, organization skills and data visualization skills.</p><p>Ability to work autonomously, with little guidance, often with ambiguous customer requirements in a highly matrixed organization.</p><p>Ability to communicate analysis including trends and opportunities to clients and the business in writing and verbally, includes strong presentation skills.</p><p>Ability to problem solve and research conflicting and/or inaccurate data.</p><p>Strong interpersonal skills, including the ability to influence management at various levels of the organization.</p><p>Proven ability to work with a diverse group of people, including leadership, support staff, coworkers and department management.</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>Demonstrated mentoring and coaching skills to develop other team members.</p><p>Proven ability to produce outstanding analysis deliverables on complex, multi-disciplinary projects and programs.</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                                                </p>

Business Insights Data and Solutions Analyst III

<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 Business Analyst III facilitates business process improvement via the methodical investigation, analysis, review and documentation of functional business specifications. This position manages the requirements development process through the elicitation, analysis, specification and verification of multiple levels of requirements from an end-to-end perspective and supports the ongoing management of the requirements. This position develops report and analysis for the department. It is responsible in communicating and coordinating with IT on a day-to-day department related efforts. The Business Analyst III manages and coordinates the implementation and/or integration of products or new features for clients including client training and provides subject matter expertise (SME) and support of the department's inbound and outbound functions. This position acts as mentor to Business Analysts I/ II.</p><h4>Duties</h4><p>Develop functional and user acceptance test plans and scenarios. Coordinate functional and user acceptance testing by executing the testing strategy, scheduling resources and tracking test performance. Perform data analysis to support evaluation of system defects or to develop requirements for new functionality; assist in various system trouble shooting and balancing and correction efforts including analysis, verification and validation of issues and fixes. Coordinate activities including on-time delivery, testing and production moves.</p><p>Collaborate with I.T. on all department &nbsp;related efforts, including submission of Service Requests and writing BRD's. Coordinate related data requests from internal departments, and/or assist I.T. with definition of criteria. Delegate data and reporting requests to business analysts. Facilitate collaborative system and data design sessions with the user community, technical architecture resources and development resources. Preparation of status updates to enterprise for distribution and communication.</p><p>Work as a technical support and liaison to designated I.T. personnel to provide testing, support and feedback on enhancement requests and regular updates/releases; adhere to release schedules. Provide analytical support for critical corporate initiatives including business function support for system migrations and consolidations, significant business area process improvement projects and complex product installations.</p><p>Demonstrate a high level of subject matter expertise in functional area to bridge business requirements and I.T. solutions; provide technical direction and ensure compliance with best practice solutions. Practice knowledge transfer and foster change management as the organization changes and new skills are required, focusing on team/individual development to be a valued contributor.</p><p>Participate and contribute on the development/ creation of data models and interface design specifications. Support internal/ external stakeholder's roadmap and audits as needed.</p><p><br>Oversee the business process support across multiple client engagements. Communication with internal/ external stakeholders for department's submission requirements. Review submission of data against established benchmarks and coordinate correction and improvement efforts. Monitor timely and accurate outbound data submission to state and federal recipients.</p><h4>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.</h4><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 5 years of successful experience in a quantitative role as a Business Analyst, Data Analyst, Programming Analyst, Claims processing, encounter processing.</p><h4>Skills</h4><p><strong>Required:</strong><br>Competent to work at the highest technical level of most phases of systems analysis.</p><p>Excellent verbal and written communication skills.</p><p>Coaching, Mentoring and Teaching skills.</p><p>Teamwork-focused/collaborative work style.</p><p>Demonstrated ability to work successfully on large projects.</p><p>Problem solving skills evidenced by demonstrated results in past positions.</p><p>Ability to work under tight deadlines and handle multiple/detail-oriented tasks.</p><p>Ability to influence at all levels of the organization.</p><p>Proficient in Microsoft Office and Vizio.</p><p><strong>Preferred:</strong><br>Ability to work on other programs such as SharePoint and/ or OneNote</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>Customer Solution Center Appeals and Grievances:</p><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>                    Business Analyst, Claims, Finance, Insurance                                                    </p>

Business Analyst III

<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 Clinical Data Analyst III supports Healthcare metrics, quality and process improvement activities by producing healthcare outcome measurements that are used for internal and external reporting, the tasks including data quality assurance, process programming, specification documentation and report developing.</p><p>The Clinical Data Analyst III designs, develops, and generates production and similar reports that may evolve into complex data analysis/data integration projects that this individual may be responsible for maintaining. The complex data analysis/integration projects are those, which may require periodic maintenance on a weekly, monthly, quarterly, biannual, or annual basis. This position works with Information Systems analysts when ongoing reports can be accurately transferred for production. </p><p>The Clinical Data Analyst III interprets and documents both written and verbal specifications. This position takes basic instructions or specifications and interviews with the client for complete details sufficient for writing data queries based for ad hoc and ongoing health care measures. This position must comprehend the relationships between the field elements in encounters and claims, membership, and provider databases. This position supports the functions related to quality improvement activities inclusive of quarterly reports that demonstrate health care outcomes in comparison to targets or national averages/percentiles published by recognized organizations such as National Committee for Quality Assurance (NCQA) and Center for Disease Control (CDC).&nbsp; Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Design, develop and maintain complex ongoing data projects. Design, develop, and generate ad hoc/production reports. Produce automatic, robust, timely and accurate results based on client specifications and as allowed by available resources. Produce complete documentation, QC reports and periodic results as scheduled. Identify and create work-around to generate valid results that meet the intent of the client's specifications.&nbsp;&nbsp; </p><p>Investigate and document organizational data flow and sources. Provide thorough documentation regarding current 1) data sources 2) data flow 3) current process and procedures to code, group, QC, link and seed the data. Develop automatic, robust and sharable Statistical Analysis System (SAS) or Structured Query Language (SQL) procedures and programs towards building a comprehensive clinical data repository.</p><p>Develop analytical programs, databases, routine procedures using SAS or SQL programming language. Create work tools that facilitate tasks by reducing paperwork and errors. Document assumptions, specification in a clear and sharable fashion.</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.&nbsp; Educate/Tutor clients/junior staff on maintenance/usage of database/solutions designed. Educate/Tutor junior staff on data/business knowledge and technical skills.</p><p>Communicate with stakeholders/clients/collaborators regarding project details and plans.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Public Health or Related Field<h4>Experience</h4><p>Required:</p><p>At least 4 years of experience in designing, developing, generating and analyzing ad hoc/production reports in Healthcare/Managed Care setting.</p><p>Preferred:</p><p>Experience as a Clinical Data Analyst.</p><h4>Skills</h4><p>Required:</p><p>Must be able to apply and/or develop technical specifications for health care measures such as those used by National Committee for Quality Assurance (NCQA), HEDIS, Centers for Medicare and Medicaid Services (CMS), and State. </p><p>Must demonstrate advanced SQL and/or SAS skills in developing programs and procedures for analytics and quality assurance.</p><p>Must be able to present data in a format that is appropriate for analysis. This includes the ability to determine select the correct information for calculating basic rates, table configuration, and graphical presentations. </p><p>Must demonstrate an aptitude in learning and expanding abilities to use new applications with basic training.</p><p>Must be a self-starter and can multi-task and can take charge of assigned projects.</p><p>Must be able to make recommendations to the clients that demonstrate strengths and limitations of the organization's ability to meet the request.</p><p>Preferred:</p><p>Working knowledge of SAS Proc SQL, SAS Macro and database related SAS skills are highly preferred.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Statistical Analysis System (SAS) CertificationCertified Healthcare Data Analyst (CHDA)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Dept Specific:</p><p>Health Equity:&nbsp; </p><p>This position is located in the Health Equity department. It supports the short and long term operational and L.A. Care’s Health Equity and Disparities Mitigation initiatives. This role will develop, enhance, and health and social service needs (food, housing, care management) information and models that will have an impact on vulnerable communities. Through the application of data analytics and analyzing various data sources, this role will work to deliver valuable insights and recommendations to improve health equity and reduce health disparities.</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>                    Public Health, Clinic, Equity, Medicaid, Medicare, Healthcare, Finance                                                    </p>

Clinical Data Analyst III (Tableau, SQL)

<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><br>The Claims Supervisor works with the Claims Manager to oversee the daily operations of the claims department. This position is responsible for ensuring that quality levels of performance are maintained throughout the Claims Department and that all functions remain in compliance with State and Federal regulations. This position will &nbsp;manage new program implementations and/or system implementations. This position must maintain an up-to date knowledge of national and state-wide standards and regulations pertaining to claims processes and will ensure that production standards meet quality guidelines are met throughout the department ensuring the Plan’s compliance. This position will work with &nbsp;department Supervisors and staff to develop procedures ensuring the achievement of goals and will continuously monitor the work performed within the Department.</p><p>The position supervises all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;</p><h4>Duties</h4><p>Provide an environment that allows staff members to flourish in their work duties. Quality levels of 99% maintained throughout the department. Continuous training of supervisors on supervisory responsibilities as well as staff training on all enhancements and updates to claims regulations and company policies. Develop procedure changes to improve results. Corrective action plans developed and implemented to remediate any shortcomings in goal achievement.</p><p>Maintain quality goals and production levels within the Department. Ensure that Claims Department Supervisors are working effectively with their staff to ensure quality and production goals associated with each work area are consistently met by staff during their regularly scheduled work hours.</p><p>Create, maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet the requirements of L.A. Care.</p><p>Track and trend the metrics associated with the claims adjudication. Prepare and present written and verbal reports. Research complex problem areas within the department or within the systems used by department, and identify the root cause of these issues and recommend corrective actions.</p><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>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Business or Healthcare Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business or Healthcare Related Field<h4>Experience</h4><p>Required:</p><p>At least 3 years of experience as claims examiner working with medical facility claims and high dollar claims.</p><p>At least 2 years of leading process, program, or staff or 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>Experienced in working with Provider Dispute Resolution (PDR's). </p><p>Must have extensive experience in handling claims appeals with experience in communicating with external providers.</p><h4>Skills</h4><p>Required:<br>Sound understanding of health care code sets including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), ICD-10 and revenue codes required. &nbsp;</p><p>Familiarity with Diagnosis Related Group (DRG) pricing.</p><p>Ability to multi-task in a high production environment.&nbsp;</p><p>Familiarity in working with and interpreting Provider and facility contracts and &nbsp;LOA's and MOU's. &nbsp; &nbsp;&nbsp;</p><p>Ability to draw conclusions from data analysis and to formulate corrective action plans when necessary. &nbsp;&nbsp;</p><p>Proficient in using Microsoft &nbsp;Word and Excel.&nbsp;</p><p>Must have strong coaching and mentoring skills and have the ability to build effective teams. &nbsp;</p><p>Must have excellent written and verbal communication skills with ability to work effectively with diverse team members.&nbsp;</p><p>Ability to research complex claims problems and to create clear and concise procedures for the handling of complex claims.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Insurance                                                    </p>

Supervisor, Claims

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

Community Resource Center Specialist III

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

Payment Integrity Analyst III (ALD)

<p>Salary Range:&nbsp;&nbsp;$91,536.00&nbsp;(Min.) -&nbsp;$121,286.00&nbsp;(Mid.) -&nbsp;$151,034.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Network Administrator III is responsible for providing network support for the mission critical network systems for L.A. Care. This involves troubleshooting IP equipment/LAN/WAN problems, routine administration tasks, and performance tuning. This position acts as an escalation point for the junior network staffs regarding network related problems.</p><p>Performs troubleshooting of LAN/WAN equipment i.e. CISCO, etc. Conduct daily routine administration and maintenance of all network devices. Monitors network to ensure constant uptime. Supports and maintains firewall and network security policies and IDS. Implements new technologies platforms for the network environment. Must be able to troubleshoot issues quickly to resolve the problem. Participate in Disaster&nbsp;Recovery Exercises to demonstrate the capability of establishing network connectivity in the event of an outage. Provide support in a 7x24 operation. Prioritization, Multitasking, Training, I.T. projects, and writing SOPs. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Work closely with other technical teams to determine future network needs and plan for network changes.</p><p>Develop methods and tools to be used to test to implement new LAN/WAN equipment.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Configure routing protocols such as EIGRP, OSFP, and BGP.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Engage in regular network troubleshooting and resolve network connectivity issues.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Analyze the current network structure and submit comprehensive reports to manager on how to make the network more efficient.&nbsp;&nbsp;&nbsp; </p><p>Create projects that are designed to either add functionality required by the company or to address ongoing network failure issues.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Maintain network performance by performing network monitoring and analysis, and performance tuning, troubleshooting network problems and escalating problems to vendor or lead network administrator.&nbsp;&nbsp;&nbsp;&nbsp; </p><p>Secure network by developing network access, monitoring, control, and evaluation, maintaining documentation. </p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>Minimum of 5 years of experience as a network administrator.</p><h4>Skills</h4><p>Required:</p><p>Must have critical thinking skills and a team player. </p><p>Must have strong written and verbal communication, project management, and organization skills.</p><p>Demonstrate the ability to lead the network team on technical issues and act as a backup to the manager.</p><p>Demonstrate working knowledge of network equipment and software (Cisco Routers, Switches, firewalls, F5 Bigip, IPS/IDS, LAN/WAN).</p><p>Demonstrate working knowledge in routing protocols such as BGP, EIGRP and OSFP.</p><p>Demonstrate working knowledge in Layer 2 network switching such as VLAN, Trunking, VTP and others.</p><p>Demonstrate working knowledge in advance network troubleshooting and work with other teams or departments to resolve complex issues.</p><h4>Licenses/Certifications Required</h4>Cisco Certified Network Professional (CCNP)<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

86 L.A. Care Health Plan Jobs