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<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 Provider Network Account Manager II 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 large provider organizations (i.e. PPGs; Hospitals; Ancillaries; etc.), or individual practitioners, in a single or multiple locations. The Account Manager II is responsible for representing LAC in their partnership with contracted and non-contracted providers, at all times. The Account Manager II is responsible for maintaining an understanding of LAC governing regulations, policies and procedures, operating standards, provider contracts, and provider performance and needs. The Account Manager II leverages that information to identify, develop, and conduct relevant and tailored provider orientation sessions, make educational visits about LAC practices, policies, and requirements, and work to resolve provider issues. The Account Manager II 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 II 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><h4>Duties</h4><p>Responsible for identifying, and contacting, providers and/or provider organizations that are interested in participating 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. Draft contract clauses/addenda, review, and negotiate new contracts/amendments and other contracting related documents based on LAC contracting guidelines, parameters, and standards, including leadership strategy discussions; implement contracts/amendments across LAC; and provide in-service orientation meetings with providers. Responsible for monitoring managed care contracts for renewals and expirations.</p><p>Act as the liaison between 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. Monitor timely receipt of contractually-required reporting. Acquire and maintain a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases, and routinely relay information about additions, deletions, or changes to the LAC Provider Network Management (PNM) Provider Data Management department.</p><p>Research and resolve contractual interpretation, operational and/or payment issues; Research and resolve incoming escalated provider inquiries within specified guidelines; Educate providers on new protocols, policies, and procedures. Ensure provider database and documentation is up-to-date, accurate, and complete.</p><p>Maintain an 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 relationship 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><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>Supporting all of the LAC PNM departments (Oversight and Monitoring; Engagement and Strategy; Data Management; and, Operations).&nbsp; 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.</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<h4>Experience</h4><p>Required:</p><p>At least 3 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry.</p><p>At least 3 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:</p><p>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>Possess a professional and mature demeanor at all times.</p><p>Ability to work in a fast-paced department independently and handle multiple tasks; work with interruptions and deal effectively with confidential information.</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><p>Preferred:<br>Knowledge of ICD-9, ICD-10, and CPT codes desired.</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>Required:</p><p>Travel to offsite locations for work.</p><p>TPI:&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. 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>

L.A. Care Health Plan

Provider Network Account Manager II

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Regulatory Operations Project Manager II manages a portfolio of complex regulatory change management and compliance projects.&nbsp; This position will develop and manage project plans, schedule, resources, and project artifacts.&nbsp; This position will identify and monitor risks, assumptions, issues, and dependencies.&nbsp; The Project Manager will provide timely status reports and proactively escalates issues for resolution; drives continued progress for project success; develops strategies for achieving compliance with state and federal regulatory, contractual and accreditation requirements; and realigns activities to account for unforeseen challenges.&nbsp; </p><p>The Regulatory Operations Project Manager II will serve as a resource to lead stakeholders to successfully complete project deliverables on time, within scope, and on budget across multiple diverse, large-scale projects simultaneously and provide guidance to ensure understanding of requirements, assignments, priorities, and deadlines.&nbsp; </p><p>The Regulatory Operations Project Manager II closely collaborates with business owners, vendors, regulatory body representatives, and other organizational staff to understand the business needs for each project and make decisions based on what is best to ensure compliance. </p><p>A key function of this position is to serve as the lead for the development and implementation of Compliance initiates to comply with regulatory requirements. This position will oversee all aspects of the project, including quality control, risk management, and stakeholder engagement.</p><h4>Duties</h4><p>Plan, schedule, manage and track progress, including how the budget is used.&nbsp; Monitors and reports on budget status.&nbsp;&nbsp; Lead stakeholders to successfully complete project deliverables on time, within scope, and on budget across multiple diverse, large-scale projects simultaneously.</p><p>Set and manage project goals and objectives.&nbsp; Provides guidance to ensure understanding of requirements, assignments, priorities, and deadlines&nbsp; Guide stakeholders to develop project work plans that define the project purpose, scope, key milestones and tasks necessary to guide the project’s implementation</p><p>Design, develop and build program solutions to address regulatory and operational challenges that require collaboration with multiple external stakeholder senior management leaders. Maintains accurate project and regulatory change implementation data within Compliance systems and provide timely, accurate status reports. Ensure the timely submission of the executive summaries to the Compliance Leadership Team for review and approval.</p><p>Identify barriers to projects objectives and deliverables.&nbsp; Works with key stakeholders to resolve barriers and keep project on track.&nbsp; Monitor work plan updates to capture any changes that arise throughout the project implementation phase and manage progress and performance of project portfolio to track timely project execution.&nbsp; Steer and drive project direction to address and mitigate any anticipated project delays and escalate any issues/risks</p><p>Facilitate constructive dialogue among key internal and external stakeholders to ensure problems are properly assessed, analyzed and resolved. &nbsp;Manage political situations that arise when negotiating differences. &nbsp;</p><h4>Duties Continued</h4><p>Identifies and proactively escalates risks and issues for resolution.&nbsp; Ensure team members have the resources needed to meet their objectives.</p><p>Provide regular progress reports to senior management on all activities.</p><p>Oversee multiple complex projects to achieve compliance with regulatory requirements and continuous alignment with the organization’s strategic plans and objectives. Formulate and recommend solutions to address moderately complex operational and regulatory challenges in assigned projects.&nbsp; </p><p>Initiate and cultivate new relationships with external safety net stakeholders in order to build strong external partner support to facilitate completion of strategic and operational initiatives.</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 in Business Administration or Related Field<h4>Experience</h4><p>Required:</p><p>At least 4 years of experience in Program/Project Management in a managed care setting or Top 10 management consulting role in Healthcare industry.</p><p>Experience facilitating complex decision making among multiple executive stakeholders with different interests and priorities.</p><p>Experience in managing, motivating, mentoring staff and conflict resolution. </p><p>Experience in regulatory implementation and/or change management experience for a health plan or healthcare system.</p><h4>Skills</h4><p>Required:</p><p>Ability to effectively schedule, manage resources, hold project work teams accountable, and be responsible for appropriate change management practices.</p><p>Highly developed analytical and critical thinking skills. </p><p>Excellent written and oral communication skills are essential.</p><p>Knowledgeable of business operational/functional areas, best practices, and optimal procedures.</p><p>Working knowledge of Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services(CMS) and/or National Committee for Quality Assurance (NCQA) requirements.</p><p>Excellent written and verbal communication skills.</p><p>Demonstrated success in managing medium to large scale, diverse and complex projects executing simultaneously. </p><p>Critical thinking, problem solving, planning and implementation skills. </p><p>Knowledge in health care compliance.</p><p>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>Well versed in project management processes supporting project deliverables to facilitate the creation of standard project documents and artifacts.</p><p>Strong analytical, planning, and organizational skills. Strong facilitation and mentoring skills.</p><p>Excellent written and verbal communication skills; speaks clearly and persuasively in positive or negative situations.</p><h4>Licenses/Certifications Required</h4>Project Management Certificate<h4>Licenses/Certifications Preferred</h4>Project Management Professional (PMP)Program Management Professional (PgMP)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Skills Continuation:</p><p>Required:</p><p>Possesses excellent time management and organizational skills.</p><p>Ability to manage priorities across multiple teams/projects possesses ability to work in a fast-paced and changing environment.&nbsp; Ability to work well independently. </p><p>Strong understanding of state and federal laws and regulations and other state programs.</p><p>Proven ability to work collaboratively with business and technology communities to accomplish expected committed project outcomes.</p><p>Proficient skill in Microsoft Office Suite.</p><p>Persuasion Skills: Ensuring organizational compliance with all state and federal regulatory, contractual and accreditation requirements reduces L.A. Care's risk to state/federal sanctions and fines. Identify, report and monitor all areas of risk/noncompliance.</p><p>Preferred:</p><p>Advanced technological skills, including, but not limited to Excel, Visio, and Project. </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>

Regulatory Operations Project Manager II

<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>Pharmacy Technician I provides support for L.A. Care Pharmacy and Formulary programs across all lines of business, support key components of the pharmacy program operations, and assists with clinical programs.</p><h4>Duties</h4><p>Review rejected claims and perform outreach for cases where action is required. (20%)</p><p>Perform clinical programs projects as assigned by Lead Technician, including Stars In. (20%)</p><p>Receive and process pharmacy-related phone calls and emails directed to Pharmacy &amp; Formulary by other departments. (15%)</p><p>Actively participates in benefit testing and other activities related to the formulary. (10%)</p><p>Participate in data analysis and is able to organize and design spreadsheets to track progress (Excel and Access). (10%)</p><p>Assist in audit deliverables. (10%)</p><p>Update necessary call logs for calls received after hours. Actively participate in rotating on-call schedule. Actively participate in weekly meetings. (5%)</p><p>Perform other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p>Required:</p><p>At least 2 years of experience as a Pharmacy Technician with at least 1 year of experience in managed care pharmacy benefit administration.</p><h4>Skills</h4><p>Required:<br>Proficiency with Microsoft Word and Excel. &nbsp;</p><p>Must be customer-service oriented and possess good telephone skills.&nbsp;</p><p>Good verbal and written communication skills.</p><p>Preferred:<br>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.</p><h4>Licenses/Certifications Required</h4>Pharmacy Technician - 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>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>

Pharmacy Technician I

<p>Salary Range:&nbsp;&nbsp;$121,056.00&nbsp;(Min.) -&nbsp;$160,299.00&nbsp;(Mid.) -&nbsp;$199,742.00&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 Scrum Master III provides functional coordination for the PMO and Information Technology (I.T.) Project Managers to deliver technical solutions in the context of an Agile SDLC environment. The Scrum Master III conducts the daily scrum sessions, sprint planning, sprint grooming, product demonstrations and retrospective reviews as needed. The Scrum Master III is accountable for providing accurate forecasts and the on-going management of the team’s workload and progress via the Storyboards. Leads conflict resolution and drives the team forward to achieve the sprint goals leveraging business and interpersonal experience to remove project roadblocks. The Scrum Master III needs to understand current and planned business practices in each of the domains, and creates excellent relationships with the business stakeholders as well as technical staff. The Scrum Master III is responsible for delivering mission critical large scale projects for the enterprise. The Scum Master III acts as a bridge between the AGILE teams and traditional Project Managers. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.&nbsp;&nbsp; </p><h4>Duties</h4><p>Facilitates the current sprint daily scrum, storyboard maintenance, sprint demos and retrospective ceremonies.</p><p>Creates project outlines and timelines and distribute responsibilities to team members.</p><p>Forecasts sprint activities, backlog planning and coordinates with the Project Managers.</p><p>Oversee design, implementation, QA, and validation of programming code and products.</p><p>Ensures milestones are reached and deadlines are met throughout project lifecycle.</p><p>Resolves sprint issues and minimizes escalation to Enterprise Integration Services Leadership.</p><p>Builds excellent relationships with stakeholders, application users, and program owners.</p><p>Mentors less experienced Scrum Masters.</p><p>Supports and is an evalangelist for propagation of AGILE processes in the company.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Information Technology or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>Minimum of 6 years of Scrum Master experience in a multi-Scrum environment. &nbsp;</p><p>Minimum of 3 years of experience managing projects using OCTANE or JIRA.</p><p>Minimum of 2 years of experience working as a Project Manager.</p><p>Preferred:&nbsp; </p><p>Prior healthcare insurance payer experience.</p><p>Minimum of 7 years of experience working in a mixed AGILE and traditional I.T. environment.</p><p>Experience working with SQL Server and ORACLE databases.</p><p>Experience leading teams in the development of services software.</p><h4>Skills</h4><p>Required:</p><p>Excellent written and verbal communications skills.</p><p>Demonstrated strong leadership skills.</p><p>Ability to create a highly collaborative environment.</p><p>Ability to shape the team behavior through the Agile process as well as other scrum teams.</p><p>Must possess the ability to explain succinctly intricate and complicated concepts and ideas to business leaders and technical staff.</p><p>Must possess the ability to work well with many different kinds of people, departments, and divisions from executive business and technology leadership to the engineering staff.</p><p>Demonstrated ability to set-up OCTANE and/or JIRA to manage sprints.</p><p>Demonstrated ability to set-up Projects in MS Project Server.</p><p>Preferred:<br>Data Analytical skills, working with SQL Server and ORACLE databases.</p><h4>Licenses/Certifications Required</h4>Certification in Scrum Master (CSM) or Professional in Scrum Master (PSM) I or II<h4>Licenses/Certifications Preferred</h4>Project Management Professional (PMP)<h4>Required Training</h4><p>Preferred:</p><p>Additional Agile Roles (Product Manager, Product Owner)</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>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>

Scrum Master III

<p>Salary Range:&nbsp;&nbsp;$121,000.00&nbsp;(Min.) -&nbsp;$150,000.00&nbsp;(Mid.) -&nbsp;$180,000.00&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 Portfolio Management Office (ePMO) is accountable for intake, execution, and managing the oversight of strategic programs and projects approved and budgeted by L.A. Care (LAC) Leadership and the Board of Governors. These programs and projects span multiple functions and departments, and are enterprise investments in infrastructure and process excellence. The portfolio, program, and project management resources within the ePMO are uniquely positioned to support business units in the planning and delivery of large-scale programs and projects.</p><p>The Portfolio Delivery team is responsible for ensuring the timely execution of programs and projects on the enterprise portfolio and developed in support of LACs strategic direction. &nbsp;The Program Manager III, Portfolio Delivery (Program Manager III), is responsible for managing a portfolio of programs and projects, and maximizing ROI and value delivery. &nbsp;In addition to managing the portfolio, the Program Manager III is expected to manage programs and projects assigned to the portfolio and will have oversight responsibilities for the work product of the project management team assigned to execute programs and projects on the portfolio, ensuring overall performance quality and adherence to scope, schedules, resources and portfolio budgets. &nbsp;The Program Manager III is accountable for leading complex program objectives, managing change and resolving issues that span project teams and departments.&nbsp;</p><p>The Program Manager III ensures high quality, consistent, and standardized documentation of programs and projects across the assigned portfolio, leveraging best practices identified by the ePMO Shared Services function and aligned to meet the needs of the ePMO Portfolio Management functions. The Program Manager III is accountable to ensure required artifacts are submitted accurately, timely, and to a sufficient level of detail needed to define program deliverables (what, why, how, when, how much).&nbsp;</p><h4>Duties</h4><p>Sets priorities related to assigned program enterprise portfolio projects and associated project timelines, oversight of capital and operating delivery budgets. Responsible for efficient execution of assigned program &amp; projects in alignment with established strategy. Manages program level constraints of scope, schedule, cost and quality ensuring integrated program master plans including all functional impacts.</p><p>Drive successful portfolio outcomes in support of strategic business initiatives. Synchronize the work of cross-functional project teams to ensure assigned program(s) and associated project(s) are completed on time, within scope and on budget. Define and implement program governance in alignment with stakeholder expectations and ePMO best practices.</p><p>Accountable for managing program schedule, cost/budget, resources, quality, scope, and business benefit. &nbsp;Oversees the execution of multiple programs and projects within an assigned program to achieve continuous alignment with the organization’s strategic plans and objectives.</p><p>Responsibility for special projects and company initiatives. Presents information on strategic initiatives or other subjects to peers, teams and upper management. Provide ongoing reconciliation between long-term goals and short-term actions. &nbsp;Assumes a leadership role in educating the business and technical community on PACE, Project and Program management processes and areas of expertise.</p><p>Responsible for holding project work teams accountable for on-time delivery of assigned scope within baselined schedule, and costs/effort in alignment of program strategy.</p><p>Responsible for appropriate change management practice in partnership with stakeholders and delivery work teams to accurately and timely reflect program/project change controls and process timely within L.A. Care's governance framework.&nbsp;</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>Master's Degree<h4>Experience</h4><p>Required:<br>At least 6-8 years of relevant 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. Experienced in collaborating with team members on project related items that impact the ability to meet program objectives. &nbsp;This would include answering questions and providing support related to stakeholder management, issue resolution, risk management, scheduling and all other project management involved topics.</p><p>Preferred:<br>At least 4 years of experience in Program Management within a Managed Care Organization or Top 10 management consulting role in Healthcare industry. Strong experience in Medicaid and Medicare managed care.<br></p><h4>Skills</h4><p>Required:<br>Demonstrated success managing programs with multiple, large scale, diverse and complex projects executing simultaneously.&nbsp;</p><p>Knowledge of managed care health insurance programs with preference given to applicants.</p><p>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 and maintain program controls.&nbsp;</p><p>Strong knowledge of program management processes facilitating the creation of standard program documents and artifacts supporting program tracking &amp; deliverables.</p><p>Strong analytical, planning, and organizational skills. Strong facilitation and mentoring skills.</p><p>Excellent written and oral communication skills; speaks clearly and persuasively in positive or negative situations; Strong interpersonal and leadership skills with ability to interact with various IT and business client departments /project teams.</p><p>Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting and self-motivated. &nbsp;Uses time effectively, &nbsp;reacts professionally under pressure.</p><p>Ability to manage priorities across multiple teams/projects, Possesses ability to work in a fast-paced and changing environment. &nbsp;Ability to work well independently.</p><p>Proven ability to work collaborately with leadership, business, and technology communities to accomplish expected committed program outcomes.</p><p>Strong analytical, planning, and organizational skills. Strong facilitation and mentoring skills.</p><p>Excellent written and oral communication skills; speaks clearly and persuasively in positive or negative situations; Strong interpersonal and leadership skills with ability to interact with various IT and business client departments /project teams.</p><p>Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting and self-motivated. &nbsp;Uses time effectively, &nbsp;reacts professionally under pressure.</p><p>Ability to manage priorities across multiple teams/projects, Possesses ability to work in a fast-paced and changing environment. &nbsp;Ability to work well independently.</p><p>Proven ability to work collaborately with leadership, business, and technology communities to accomplish expected committed program outcomes.</p><p>Proven ability to understand healthcare technology architecture and application landscape by functional area,&nbsp;</p><p>Proven ability to apply an enterprise project management methodology and framework (i.e. PACE).</p><p>Ability to engage all program/project stakeholders and work teams within L.A. Care's established delivery methodology framework (PACE).</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Program Management Professional (PgMP)<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>

Portfolio Delivery Program Manager III

<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 Customer Solution Center Appeals and Grievances (A&amp;G) Specialist II &nbsp;will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. This position will provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance (NCQA) regulatory requirements. This position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations, and complex provider claim disputes. &nbsp;The position is further responsible for tracking, trending and reporting complaints and appeals, as well as participating in internal and external oversight activities.</p><p>The position is responsible for maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, adhering to company policy and procedures, including accreditation requirements, applicable federal, state and local laws and regulations.</p><h4>Duties</h4><p>Identifies, investigates, and resolves administrative complaints, complex provider appeals and State Fair Hearing adhering to CMS, DHCS, DMHC, MRMIB and NCQA standards and regulations.</p><p>Intakes, acknowledges, prepares case files and routes complaints to appropriate internal department for investigation and resolution, exercising strong independent judgment.&nbsp;</p><p>Ensures integrity of A&amp;G database by thorough, timely and accurate assignment of cases. &nbsp;Monitors closure of complaints and works with Quality Control Supervisor to resolve all database issues.&nbsp;</p><p>Prepare and analyze monthly appeal and grievance reports to meet internal and external reporting requirements.</p><p>Participates in internal and external oversight activities, inter-rater reliability reviews and focused audits. &nbsp;Recommends opportunities for improvement</p><p>Perform other duties as assigned.</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>Required:</p><p>At least 2 years of experience in Managed Care with specific experience in resolving member and provider complaint and appeals issues, including eligibility, access to care, claims, benefit, and quality of care concerns.&nbsp;</p><p><br>Experience working with firm deadlines, able to interpret and apply regulations. &nbsp;</p><p>At least 5 years of experience in Managed Care working with Medicare, Medi-Cal and other State Sponsored programs. &nbsp;</p><p>Knowledge of Medical terminology and strong advocacy experience.</p><h4>Skills</h4><p>Required:<br>Must be organized, detail oriented, able to exercise strong independent judgment; poses conflict resolution and persuasion skills. &nbsp;</p><p>A team player with excellent communication and presentation skills, able to work effectively with various internal departments/service areas, plan partners, participating provider groups and other external agencies.<br><br>Proficient in MS Office applications, Word, Excel and Power Point.&nbsp;</p><p>Requires strong knowledge of regulatory standards and claims processing; strong analytical, oral, written and presentation skills, able to monitor and be compliant with strict regulatory deadlines.&nbsp;</p><p>Preferred:<br>Proficient in MS Office applications, Access, Visio.</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>

86 L.A. Care Health Plan Jobs