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<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Product Solutions Manager II is responsible for working within the Product Strategy, Sales and Marketing (PSSM) service area to identify and implement projects, programs and initiatives that support achievement of product and enterprise goals. The position works with management, business owners and other key stakeholders to develop and manage the product go to market planning, prioritization, timelines, metrics/scorecards, budgets, Return of Investment (ROI) analysis, and working agreements for product initiatives.&nbsp; </p><h4>Duties</h4><p>Develops, designs, and implements of cyclical product life, cycle activities and specific strategic initiatives in support of optimizing the member experience while managing the ongoing evolution and strategic direction of the product line.</p><p>Support efforts to identify product management best practices. Identify impacted parties, business partners, and resources required. Develops and designs processes and product requirements that support business needs. Designs methods for integrating function and processes including applicable dependencies inclusive of enterprise initiatives.</p><p>Conducts analysis for roadmap creation, scope and execution for cross-functional execution of initiatives.&nbsp; Recognizes opportunities for product enhancements in a matrix environment and collaborative, cross functional execution.</p><p>Orchestrates, plans and executes end to end cycle strategy, development and implementation efforts for the product line.</p><p>Identifies potential risks, project charge, and scope. Recommends in design of appropriate mitigation and contingency plans. Supports in&nbsp; identifying best practices to drive product integrity, service excellence, and efficiency.&nbsp;</p><p>Provides product support to internal and external stakeholders for annual product launch. Including, sales, marketing, growth and retention efforts, delegated vendors and front line teams including assistance with benefit trainings, explanation of benefit design, member materials development and distribution, sales and marketing collateral, talking points and&nbsp; program education, configuration and benefit display requirements. Develops training materials and conduct annual and ongoing product training as required.</p><p>Manages daily processes related to the end-to-end development and fulfillment of required annual materials&nbsp; for welcome and sales kits. Oversees process and timelines from model document population, regulatory approval, design/layout, translation, and print &amp; fulfillment. Responsible for review and accuracy of approved benefits on published materials.</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Public Administration or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Public Administration or Related Field<h4>Experience</h4><p><br><strong>Required:</strong><br>Minimum of 5 years of relevant experience in product management.</p><h4>Skills</h4><p>Required:<br>Requires deep knowledge of product development life cycle (PDLC) discipline.</p><p>Must be familiar with regulatory guidelines governing product lines; leads regulatory filing process for new/custom product initiatives.</p><p>Able to use advanced features of MS Office including Excel, PowerPoint, Word, MS Project, Visio.</p><p>Excellent written and verbal communication and presentation skills.</p><p>Ability to serve as member on cross-functional implementation or project teams.</p><p>Ability to interpret data sets and forecast future revenue streams.</p><p>Excellent interpersonal, motivational, and communication skills; with success in leading cross functional collaborative projects.</p><p>Ability to collect, analyze and recommend solutions using data and experience driven decisions.</p><p>Working knowledge of the company’s healthcare products, functions and regulatory guidelines.</p><p>Working knowledge of policy and regulatory efforts.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Department Specifics:</p><p>Product, Strategy, Sales &amp; Marketing: (PSSM):&nbsp;</p><p>Preferred:&nbsp;<br>Knowledge of healthcare product types inclusive of managed care and insurance products.</p><p>Additional duties include:<br>Drives Intra-team development efforts for framework and delivery model ensuring alignment with Intra-team strategic goals and objectives set forward by CPO and Exec Owner. Supports and/or drive efforts for strategic planning on product agnostic initiatives as well as strategic partnerships.</p><p>Medicare:<br>Required<br>Medicare Advantage, with experience serving duals population. Direct experience in Medicare and Duals program administration including stars, quality, financial performance review, operational functions (claims, enrollment, readiness).</p><p>Preferred:<br>Direct experience with duals population and requirement.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medicare, Claims, Healthcare, Insurance                                                    </p>

L.A. Care Health Plan

Medicare Advantage Product Solutions Manager II

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

Business Analyst II (ALD) 2 year

<p>Salary Range:&nbsp;&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>This position supports L.A. Care's four Registered Dietitians in provision of Medical Nutrition Therapy, Meals As Medicine (MAM), and Diabetes Self-Management Education services. The Health Education Dietetic Technician coordinates the delivery of the MAM program including navigating medical records and assessing member needs to prescribe the appropriate diet, working with meal provider vendors to confirm delivery and compliance, and ensuring accurate and timely documentation. This position also assists with health education services including group classes and one on one consults as needed to L.A. Care direct line of business members. Responsibilities include conducting member initial nutrition assessments and follow-up dietetic counseling, assisting with member charting, documentation and data entry, and scheduling members for phone counseling sessions.</p><h4>Duties</h4><ul><li>50%- Complete Meals as Medicine applications by conducting suitability assessments, approving service requests, and coordinating deliveries with meal providers (vendors) and members</li><li>20%- Coordinate individual health education consultations and documentation with members telephonically for Medical Nutrition Therapy and Diabetes Self-Care Management Education as referred by internal staff and external providers</li><li>10%- Provide basic nutritional counseling to members and facilitate education to members on nutrition-related topics using curriculum developed by L.A. Care Health Plan health education staff</li><li>10%- Assist with documentation and data entry for nutrition services</li><li>10%- Identify additional medical and social needs and coordinate with disease management staff, case management staff, and social workers through providing referrals and multidisciplinary communication</li><li>Perform other duties as assigned.</li></ul><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nutrition<h4>Education Preferred</h4>Bachelor's Degree in Nutrition<h4>Experience</h4><p>Required:</p><p>A minimum of 3 years of experience providing direct nutrition/diabetes/pediatric nutrition counseling services in either inpatient or outpatient setting. </p><p>Preferred:</p><p>Experience in medical meal preparation industry.</p><h4>Skills</h4><p>Required:</p><ul><li>Must be able to utilize various computer documentation platforms&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </li><li>Must be able to work independently on projects while soliciting help from internal or external sources as needed&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </li><li>Demonstrated ability to problem-solve and troubleshoot all project issues in a timely manner</li><li>Excellent interpersonal skills to work alongside other project employees to meet all client specifications and requirements</li><li>Excellent verbal, written, communication, and presentation skills</li></ul><p>Preferred: </p><p>Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese&nbsp;&nbsp; </p><h4>Licenses/Certifications Required</h4>Nutrition and Dietetics Technician, Registered (NDTR)<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.</p><p><br>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nutrition, Data Entry, Diabetes, Special Medicine, Public Health, Healthcare, Administrative                                                    </p>

Health Education Dietetic Technician II (ALD)

<p>Salary Range:&nbsp;&nbsp;$60,778.00&nbsp;(Min.) -&nbsp;$75,950.00&nbsp;(Mid.) -&nbsp;$91,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.</p><p>This position provides but is not limited to:<br>Supervision for Authorization Technicians Leads, Authorization Technician and clerical staff in the UM department.<br>Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc.<br>Conduct 1.1 monthly sessions with staff to review performance.<br>Consistently track staff performance, and work with individuals to improve performance as needed.<br>Create, review, and administer corrective action forms.&nbsp;<br>Responsible for hiring, training, motivating, evaluating and counseling of assigned Associate Supervisors, Leads, and Representatives. &nbsp;<br>Ensure that Associates, Supervisors, Leads, and Representatives provide efficient and courteous service.&nbsp;<br>Oversee overtime work and will produce accurate accounting of each representative work performance.&nbsp;<br>Conducting evaluations of and implementing enhancements to the day-to-day operations of the unit.<br>Aid with product launches and expansions.<br>Execute tracking, and assessing member satisfaction efforts and identifying potential areas of the unit dissatisfaction and opportunities for improvement.<br>Facilitating the development, review, and revision, as appropriate, of organizational and departmental policies, procedures, and process flows to ensure compliance with relevant regulatory and organizational guidelines.<br>Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc.</p><p>This position collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports.</p><p>In addition, this position performs Supervisory roles including payroll, employee Paid Time-Off (PTO) time management, supporting the Leads providing direction and support. The Supervisor authorizes request consistent with auto authorization criteria, &nbsp;maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers. &nbsp;The position supervises all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;<br></p><h4>Duties</h4><p>Supervision of day to day activities of Authorization Technicians, including but not limited to: Providing direction, Monitoring of staff performance and skillsets for consistency and improvement for all lines of business, Handling all questions/issues raised by staff, Developing tools and procedures on training for staff, Recommending process improvement processes, Preparing and analyzing call center statistical reports, Monitoring of skillsets for consistency, Ensuring quantity/quality is met for overtime, Ensure that all &nbsp;comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: Diagnosis (DX) codes, Current Procedural Terminology (CPT) ,Healthcare Common Procedure Coding System (HCPCs) codes.</p><p>Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements.</p><p>Computer Input: Accurately and completely processing referrals/authorizations in the MHC system. &nbsp;And distributing a complete file &nbsp;to UM Specialist. Within 2 hours of receipt Identify duplicate requests using the claims and CSIM system to verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system. &nbsp;Appropriately documenting what information was used in making this determination. &nbsp;Within 4 hours of receipt: Appropriate identification and timely notification of time sensitive requests: Appropriately identifying for the staff which you support; request that are priority based on date of receipt and established TAT criteria for compliance.</p><p>Accurate Filing/Maintenance of confidential member information. Creating secure, complete files.</p><p>Assist in the preparation of &nbsp;communication for authorization determinations, including, but not limited to preparing &nbsp;template letters for members and providers (authorization approval, denial, deferral, modification and pay/education).</p><h4>Duties Continued</h4><p>Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing).</p><p>Support UM Committee and Audit activity via &nbsp;Department performance reporting. Assures the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames.</p><p>Employee training and development within all core systems. New employee orientation to the departments structure and work flow assignments. The Supervisor will support performance standards and develop performance improvement plans.&nbsp;</p><p>Monitoring policies and procedures including but not limited to time and attendance, monthly incentive and monthly performance audits&nbsp;</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p>Required:</p><p>At least 2 years in Medi-Cal managed supervisory experience in a health plan/health insurance authorization processes and/or as a Medical Assistant. </p><p>At least 1 year of lead (process, program, or staff)/supervisory experience.</p><p>Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><p>Preferred:&nbsp; </p><p>Experience in working with the disadvantaged population, seniors, or people with chronic conditions or disabilities. Medi-Cal, Healthy Families, Healthy Kids and Medicare background preferred.</p><h4>Skills</h4><p>Required:</p><p>Strong verbal and written communication skills.</p><p>Proficient with Microsoft Word, Excel, and Access.</p><p>Excellent organizational, interpersonal and time management skills.</p><p>Must be detail-oriented and an enthusiastic team player.</p><p>Demonstrate proficiency in data entry and processing of referrals/authorizations in the system.</p><p>Knowledge of medical terminology and ICD-10 and CPT codes.</p><p>Persuasion Skills: Must be able to interface with members, medical personnel and other internal and external agencies and sometimes convince/persuade others to comply with L.A. Care requirements such as submitting requested information in a timely manner. Also to use the approved Authorization Request form with complete medical information i.e.: DX codes, CPT, HCPC codes.</p><p>Preferred:<br>Knowledge of MHC and CSIIM computer system.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Call Center Manager, Call Center Supervisor, Payroll, Data Entry, Call Center, Customer Service, Finance, Administrative                                                    </p>

Supervisor, Authorization Technician

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

Enterprise Shared Services Program Manager II (ALD)

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Provider Network Account Manager III is responsible for all aspects of the L.A. Care (LAC) provider contracting and relationship management process, including drafting, reviewing, negotiating and implementing phases of contracts, and building, nurturing, and maintaining positive working relationships between LAC and its network of providers. Assigned accounts include multiple large provider organizations (i.e. Participating Physician Group (PPGs); Hospitals; Ancillaries; etc.), or individual practitioners, in a single or multiple locations. The Account Manager III is responsible for representing LAC in their partnership with contracted and non-contracted providers, at all times. The Account Manager III is responsible for maintaining an in-depth understanding of LAC governing regulations, policies and procedures, operating standards, provider contracts, and provider performance and needs. The Account Manager III leverages that information to identify, develop, and conduct relevant and tailored provider orientation sessions, makes educational visits about LAC practices, policies, and requirements, and works to resolve provider issues. The Account Manager III is responsible for monitoring and managing network adequacy by assuring appropriate access to services throughout L.A. County, and beyond as necessary, to comply with State and Federal requirements for all product lines of business (Medicaid, Medicare, and Commercial). The Account Manager III is responsible for the initial on-board training of new managed care contract provider partners, and for ensuring their provider accounts maintain appropriate trainings and credentials to care for LAC members.</p><p>Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Responsible for identifying, contacting, and actively soliciting qualified providers and/or provider organizations to participate with LAC; assuring the financial integrity of LAC is maintained through rate negotiation; and, ensuring contract requirements are adhered to, including language, terms, and reimbursement requirements. Responsible for the project management of all contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards, while ensuring a smooth transition of services for members. Responsible for drafting contract clauses/addenda, review, and negotiating new contracts/amendments and other contracting related documents based on LAC contracting guidelines, parameters, and standards, including leadership strategy discussions; implementing contracts/amendments across LAC; and providing in-service orientation meetings with providers. Responsible for monitoring managed care contracts for renewals and expirations.</p><p>Acts the liaison between Provider Network Management (PNM) and other internal Plan departments, as necessary, to resolve complex issues, and to effectively deliver accurate, timely, and appropriate information to their assigned accounts. Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting LAC in investigating any potential quality issues. Monitors timely receipt of contractually required reporting. Acquires and maintains a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases, and routinely relays information about additions, deletions, or changes to the LAC PNM and Provider Data Management (PDM) department. </p><p>Researches and resolves contractual interpretation, operational and/or payment issues; researches and resolves incoming escalated provider inquiries within specified guidelines; educates providers on new protocols, policies, and procedures. Ensures provider database and documentation is up-to-date, accurate, and complete.</p><p>Maintains a complete understanding of LACs reports and metrics to evaluate the performance of assigned providers and/or provider organizations, and use the data to develop and implement methods to improve </p><p>relationships with all providers. Responsible to assist in all corrective actions required, up to and including termination, following LAC policies and procedures, and applicable contractual and regulatory requirements.&nbsp; </p><h4>Duties Continued</h4><p>Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting LAC in investigating any potential quality issues.&nbsp; </p><p>Serve as a communication link between provider accounts and LAC. Complete regularly scheduled meetings (site visits, or conference calls) with all accounts. Translate information exchange, ideas, requests and other inquiries into actionable items for improved contracting/relationship management and enhanced operational service delivery.</p><p>Support all of the LAC PNM departments (Oversight and Monitoring; Engagement and Strategy; Data Management; and, Operations). Support all of the LAC PNM groups; assist in the development and distribution of provider engagement material (trainings, notices, newsletters); assist in oversight and monitoring efforts; implement LAC provider strategies; and assist in improving the quality of provider data, as needed.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree<h4>Experience</h4><p>Required:<br>Minimum of 4 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry.</p><p>At least 4 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting.</p><h4>Skills</h4><p>Required:<br>Good organizational skills and demonstrate excellent attention to detail and follow up skills.</p><p>Knowledgeable financial and financial risk analysis.</p><p>Competent computer skills; MS Office skills required.</p><p>Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines.</p><p>Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel, and LAC provider network physicians.</p><p><br>Possess a professional and mature demeanor at all times.</p><p><br>Ability to work in a fast-paced department independently and handle multiple tasks; work with interruptions and deal effectively with confidential information.</p><p>Preferred:</p><p>Knowledge of ICD-9, ICD-10, and Current Procedural Terminology (CPT) codes desired.</p><p>Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.</p><p>Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Medical Coding Certification<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:</p><p>Travel to offsite locations for work.</p><p>Total Provider Management (TPM):&nbsp; Ensures that the LAC standard provider dataset is complete, accurate, and current. Provides network adequacy analysis and data to the Network Account Managers for the purpose of monitoring and evaluating existing contracts and the need for additional providers based on ongoing network adequacy analysis. Ensures timely submission of provider data, facilitates remediation of data errors, monitors provider data submission and data quality, and performs necessary data analysis.&nbsp; Responsible for the data management of assigned accounts from data collected prior to contracting, through activation, and the ongoing submission of provider data in accordance with regulatory requirements and LAC contractual requirements. </p><p>Required: Experience in provider data regulatory reporting and provider directory management.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Relationship Manager, Medical Coding, Medicare, Medicaid, Customer Service, Healthcare                                                    </p>

Provider Network Account Manager III

<p>Salary Range:&nbsp;&nbsp;$164,614.00&nbsp;(Min.) -&nbsp;$222,230.00&nbsp;(Mid.) -&nbsp;$279,845.00&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 Associate Counsel III Senior Director Health Legal Services is responsible for diverse legal activities.&nbsp; This position provides analysis of health care regulatory matters and assisting with the development and review of legislative bills and administrative regulations.&nbsp; The Associate Counsel III reviews policies and procedures to ensure compliance with all legal authorities and confers with outside attorneys, state or county officials, and other interested parties.&nbsp; This position supports L.A. Care’s product lines and operations by providing substantive legal counseling on complex matters. This position provides non-supervisory guidance for staff counsel, paralegals, support personnel. This position reports directly to the Associate General Counsel, should the Associate General Counsel position be vacant, this position reports to the General Counsel. </p><p>The Associate Counsel III Senior Director Health Care Legal Services collaborates on the improvement of communication between the department and key stakeholders to define opportunities, identify and prioritize programs and projects based on predefined criteria (e.g. return on investment, productivity, compliance). Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics.</p><h4>Duties</h4><p>Participates as a senior attorney member of the Legal Department’s Health Care Legal Services Unit (HCLS) supporting L.A. Care in a matrix management organizational structure by providing needed legal advice and counsel on the most complex and sensitive matters regarding various laws applicable to health care service plans, with an emphasis on California law.</p><p>Provides substantive counseling on complex provider contracting and other legal matters.</p><p>Manages outside counsel in connection with organization’s healthcare activities.</p><p>Provides significant effort for HCLS’s support of the provider and payer efforts.</p><p>Provides non-supervisory guidance for other HCLS staff.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p><p>Interfaces directly with L.A. Care leadership and acting on behalf of the Associate General Counsel as needed.</p><p>Provides expert advice to various business units on relevant topics within the organizational standards, national and statewide compliance.</p><p>Evaluates the effectiveness of program implementation, and provides guidance and recommend process improvement. </p><p>Communicates strategic planning outcomes and the agreed upon priorities across the organization, to include ongoing progress of priorities. </p><h4>Duties Continued</h4><p>Leads efforts to allow the company to mitigate risk such as regulatory or competitive risks through innovative business ideas and solutions.</p><p>Responsible for communicating decisions, priorities and relevant project information to appropriate levels of staff regarding business unit requests and projects and initiatives.</p><p>Responsible for sharing solution roadmaps and enterprise level strategies to drive efficiencies across the organization and with customers. Collaborates with management to develop annual budgets for respective business areas.&nbsp; </p><p>Provides support in delivering programs that meet the compliance needs of the organization</p><p>Performs other duties as assigned.</p><h4>Education Required</h4>Juris Doctor Degree or Doctor of Law Degree (J.D.)<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>Minimum of 6 years of experience as a practicing licensed attorney and has acted as senior counsel on legal projects and matters.</p><p>Experience in an HMO or as counsel to a health system, hospital, government unit, or a health care law firm practice.</p><p>Experience and knowledge of health care law.</p><p>Experience in supporting complex provider contracting activities including drafting and reviewing contracts, providing strategic advice regarding negotiations and operations on complex and sensitive matters.</p><p>Preferred:&nbsp; </p><p>Substantial experience in Medi-Cal or Medicaid and Knox-Keene Act.</p><p>Experience in Medicare, commercial lines of business and Health Insurance Portability and Accountability Act (HIPAA).</p><p>Supervisorial experience.</p><p>Experience in and knowledge of public entity laws including the Brown Act, Political Reform Act and Public Records Act.</p><h4>Skills</h4><p>Required:</p><p>Excellent interpersonal oral and written communication skills to facilitate open and clear dialogue with payers, regulators, providers, internal clients, contractors, vendors and L.A. Care leadership.</p><h4>Licenses/Certifications Required</h4>State Bar - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:</p><p>Successfully passed California bar exam and maintains valid license/ certificate and be in good standing.</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, Medical, Healthcare                                                    </p>

Associate Counsel III Senior Director Health Care Legal Services

<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 Claims Data Entry Clerk II is responsible for the accurate and timely data entry of claims and other documents, which includes: Keying claims for all lines of business, including complex claims. Data Entry of Claims in Core adjudication system. Checking the eligibility of members of services in order to sort claims by product. Scanning and sorting medical records. Reviewing claims for required information, returning claims to the provider when necessary. Preparing reports and ensuring that reports are accurate and generated within specified timeframes.</p><h4>Duties</h4><p>Creates and sends Rejection letters to the providers for the rejected Claims with 98.5% accuracy. Follows L.A. Care (LAC) policies and procedures. Keeps current with incoming daily receipts. Meets production standards. (50%)</p><p>Accurately sorts based on department procedures. Keeps current with incoming daily receipts. (25%)</p><p>Performs special projects and ad-hoc reporting as necessary. Projects are complete and reports are generated within the specific time frame agreed upon at the time of assignment. (15%)</p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>At least 6&nbsp;months&nbsp;of accurate, high-volume claims data entry or claims processing experience.</p><p>Preferred: <br>Managed care or Medi-Cal claims experience.</p><h4>Skills</h4><p><br>Proficient in Microsoft Office</p><p>Strong verbal and written communication skills</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p><strong>Preferred:</strong><br>Claims Examiner Training</p><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>Medical, Dental and Vision</li><li>Wellness Program</li><li>Paid Sick Leave</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Data Entry, Claims, Clerical, Administrative, Insurance                                                    </p>

Claims Data Entry Clerk II (Temporary)

<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><br>A key member of a cross-functional communications team, the Digital Designer II is responsible for conceptualizing and developing digital design solutions that meet a stated strategy or goal, telling the L.A. Care story in an effective and creative way, while aligning with our corporate identity guide, digital style guide and industry best practices. Reporting to the Supervisor of Digital Communications; this position will manage multiple digital design projects simultaneously, ranging in scope, priority, and complexity. This position supports a range of L.A. Care’s digital vehicles; including websites, portals, videos, e-newsletters, social media and more. &nbsp;</p><h4>Duties</h4><p><br>Works closely with the Digital Team to execute L.A. Care’s digital strategy, ensuring we can effectively tell the L.A. Care story through web, video and other digital vehicles.</p><p>Delivers design projects, including but not limited to websites, microsites, e-newsletters, applications, mobile products, motion graphics, videos and social media, while meeting project goals, scope, and timeline.</p><p>Works collaboratively on teams with project managers, web developers, content owners, software developers, and internal technical teams at multiple levels across the organization.</p><p>Develops creative design solutions that are in alignment with design, digital, and accessibility guidelines.</p><p>Maintain knowledge of new design standards and best practices, verbally communicate design sensibilities, research new technologies and how they relates to digital design; continually update design and technical skills, keeping abreast of emergent industry trends.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree<h4>Education Preferred</h4>Bachelor's Degree in Related Field<h4>Experience</h4><p><strong>Required:</strong><br>At least 4 years of experience working full-time in an organizational setting on digital design projects including but not limited to web design, e-newsletters, social media content, and info-graphics, as demonstrated by a portfolio.</p><p>Strong experience using industry-standard programs such as Adobe Photoshop and Adobe Illustrator is mandatory, plus experience using the entire range of Adobe Creative Cloud Suite.</p><h4>Skills</h4><p><br><strong>Required:</strong><br>Knowledge of MAC and PC standards for file conversion.</p><p>Background working on a collaborative, multi-disciplinary team and developing positive working relationships with internal and external partners.</p><p>Ability to excel creatively while still meeting design, digital, and accessibility guidelines.</p><p>Excellent communications and presentation skills.</p><p>Strong attention to detail.</p><p>Handles constructive feedback well with the ability to shift direction based upon the feedback.&nbsp;</p><p>Working knowledge of HTML/CSS, as demonstrated by a portfolio.</p><p>Working knowledge of web/mobile UX standards; working knowledge of motion graphics, as demonstrated by a portfolio.</p><p>Requires independent decision-making, and strong matter expertise.&nbsp;<br></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>

Digital Designer II

<p>Salary Range:&nbsp;&nbsp;$60,778.00&nbsp;(Min.) -&nbsp;$75,950.00&nbsp;(Mid.) -&nbsp;$91,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p><br>The Customer Solution Center Member Navigator II is responsible for resolving member inquiries. Coordination of care for complex cases which may involve benefit coordination, continuity of care, access to care, quality of care issues, member eligibility, assignment, disenrollment's issues and interpreting requests for all product lines (Medi-Cal, L.A. Care Covered, Cal MediConnect (CMC)). It will be expected that the main focus is to provide member satisfaction. In addition, this position is responsible for handling disenrollment's in coordination with U.M. department and Plan Partners: Department of Health Services (DHS), Centers for Medicare and Medicaid Services (CMS) National Committee Quality Assurance (NCQA) as well as L.A. Care guidelines. The Navigator ensures the proper handling of member issues whether presented by members, the Ombudsman's, state contractors, member advocates, Executive Community Advisory Committee (ECAC), L.A. Care Board Members or providers are resolved expeditiously. The Navigator handles and coordinates the identification, documentation, investigation and resolution of complex cases, in a timely and culturally-appropriate manner. Coordinates multi-departmental (Member Services, Product Network Operations (PNO), Claims, Utilization Management (UM), Pharmacy, Medicare Enrollment/Disenrollment, Sales and Quality Management (QM)) processes to ensure identification of member's claims of gaps in coverage and resolution of cases for members' satisfaction and of referral cases to plan partners when applicable. The Navigator will be stationed and available to assist our members at any of our designated Community Resource Center/Walk-In Center. Will provide Navigator support at other Community &nbsp;Resources Center locations as needed.</p><h4>Duties</h4><p>Coordinate multi-departmental (Member Services, PNO, Claims, UM, Sales, Medicare enrollment and QM) processes to resolve members 'issues and complex cases to the members' satisfaction. This process may include referrals to plan partners to ensure compliance with regulatory and L. A. Care guidelines. Ensure to follow departmental guidelines/matrixes for all processes. Urgent Complex cases will be handled within 24hrs. All others within 48hrs. (30%)</p><p>Work as a navigator to our Medicare Line Of Business (LOB): A. Ensure to meet deadline for completion of Welcome Calls; B. Ensure to follow through on all cases forwarded to other areas for assistance; C. Document all transportation services provided to each member. Ensure to confirm appointment and authorization; D. Coordinate/assist with all other departments regarding Medicare Services; E. Thorough Reinstatement of enrollment of members whose disenrollment are questionable; F. Identify and complete Organization and Coverage Determination for timeliness and resolution; G. Ensure proper Guidelines are followed for Medicare disenrollment request; H. Ensure to complete all BAE and/or LIS request. (25%)</p><p>Identify potential quality of care issues and referral to QM Department, through calls received from our Call Center and other internal customers. (10%)</p><p>Handle disenrollment's requests from members, providers and plan partners: 1) Long Term Care (Exhaustion of Benefits); 2) Move out of County; 3) Major Organ Transfers; 4) Incarceration; 5) Foster Care. (5%)</p><h4>Work with Compliance Department regarding suspected fraudulent activities received through the L.A. Care hot line and the Call Center personnel. (5%)</h4><h4>Communicate with collection agencies, billing business offices regarding delinquent and problematic member accounts which includes claims issues from L.A Care Medi-Cal Direct Program (MCLA), Healthy Families (HF), Healthy Kids (HK), and Special Needs Populations (SNP) members. (5%)</h4><h4>Work with Cultural &amp; Linguistic (C&amp;L) to provide translations for members' correspondence into the appropriate languages. As requested review documents submitted by C&amp;L to ensure proper translation and culturally sensitive materials for distribution to our members (brochures pamphlets and educational materials). (5%)</h4><h4>Meet general L.A. Care requirements for attendance and punctuality and follow department guidelines. (5%)</h4><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p><br>Required:</p><p>At least 2 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services and /or public services or public benefits programs with claims and Medicare experience.</p><p>Preferred:</p><p>Health Plan background a plus along with strong advocacy background.</p><h4>Skills</h4><p><br><strong>Required:</strong><br>Strong customer service skills.</p><p>Excellent oral and written communication skills.</p><p>Strong analytical and conflict resolutions skills as well as persuasion skills.&nbsp;</p><p>Proficient in MS Office applications, Word, Excel, Power Point, and Access.</p><p><strong>Preferred:&nbsp;</strong><br>Medical terminology a plus.</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.</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>                    Medicare, Claims, Call Center, Medicaid, Pharmacy, Healthcare, Insurance, Customer Service                                                    </p>

86 L.A. Care Health Plan Jobs