field_job_employment_type

job_industry

field_job_occupational_field_parents_all

job_organization_name

<p>Salary Range:&nbsp;&nbsp;$47,840.00&nbsp;(Min.) -&nbsp;$57,062.00&nbsp;(Mid.) -&nbsp;$68,474.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Community Resource Center (CRC) Specialist II supports in building relationships with members of the community, L.A. Care departments, and Blue Shield of California Promise Health Plan staff (under a collaborative partnership agreement), community based agencies, government agencies, and CRC vendors and instructors. The role supports community and provider communication and engagement initiatives to increase member traffic at a CRC and provides information to members of the community to physical and health education programs, classes and resources. Acts as a key partner to support the CRC marketing and promotional initiatives to meet operational needs. Follows workflows to refer members to receive services across L.A. Care departments that support a member's health care journey to promote positive health care outcomes. Helps connect members and community participants in understanding health care access issues, identifies resource needs based on social drivers resulting from member inquiries and health assessments, and refers to the appropriate source for subject matter assistance. Provides ongoing member assistance and follow-up in select cases. Works in partnership with L.A. Care health plan departments to provide customer service, social services support, care management, health education resources, behavioral health, member engagement marketing and communication, relies on line of business product knowledge and business insight. The CRCs serve anyone in the community in which they are located; and therefore, this role will provide support on referral processes to connect non-member cases to the appropriate external resources and collaborate with key stakeholders across L.A. Care in support of positive outcomes for members.</p><p>Supports the planning and development, implementation, and analysis of CRC services, programming, and vendor management. This role may support special projects following directions and instructions from a work plan, technical procedures, and relationship management ensuring successful implementation of CRC initiatives. </p><h4>Duties</h4><p>Day-to-Day Representation: (25%)<br>Supports the coordination of member-centric customer service to respond and resolve inquiries and questions and bridges members to appropriate resources. &nbsp;Provides guidance and support to inform, guide, and educate members, community residents, and other stakeholders regarding health education programs, benefit information, resources and support available at L.A. Care and partner health plan benefits, CRC resources to meet the member/visitor needs. Collaborates with team members to create resource guides and reference materials. &nbsp;Implements the appropriate approach to identify member or visitor resource needs in complex situations and takes action to link the member/visitor to the appropriate services, programs, or resources. Actively identifies gaps in CRC services, resources, and programs, delivers recommendations for new programs and proposes solutions for the implementation of new services. &nbsp;Participates in day-to-day work operations including opening and closing of the CRC, ordering and maintaining of office supplies, and inventory. Supports CRC vendors which deliver facility maintenance. Coordinates, maintains, and schedules CRC calendar and conference rooms, including management of appointments. Prepares conference/training rooms and assists with support services, as needed. Answers incoming calls in a timely and professional manner. &nbsp;</p><p>High-Touch Customer Focus: (25%)&nbsp;<br>Performs high quality in-person service and contributes to the extended-hour schedule of the CRC to support members and visitors that may need services outside of regular operating hours and days based on business needs. Implements child development activities and programs to support children development while parents and guardians attend a class or service appointment at the CRC. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p><p>Cross-Collaboration: (20%)<br>Supports community initiatives maintaining good relationships within L.A. Care and Blue Shield Promise Health Plan, and with community stakeholders to promote access to health care programs, classes, and preventative services offered at the CRC. &nbsp;Provides information to other L.A. Care departments on services and activities that resonate with and engage members of the CRC community based on hands-on experience at the Center.</p><p>Outreach and Engagement: (15%)</p><p>Supports and nurtures relationships with key internal and external stakeholders; and, is an ambassador to promote CRC partnership brand recognition. &nbsp;Establishes relationships with key community stakeholders, informs management on community needs, and enters data to inform an integrated approach to outreach activities and targeted member engagement. &nbsp;Supports planning, development, implementation, and analysis, of member and community engagement activities to increase member traffic at the supports outreach and engagement activities to attract new L.A. Care and partner health plan members into the CRC to participate in services and programs. Provides feedback to bridge members of the community to physical and health education programs and classes which will enhance health outcomes and member experience. &nbsp;Supports communications and marketing efforts through multiple platforms to increase member traffic at assigned CRC.</p><h4>Duties Continued</h4><p>Implementing Strategic Initiatives: (15%)<br>Supports the implementation of special projects which include identifying the scope of work responsibilities, accountabilities, deliverables, key milestones, timelines, and specific tasks that &nbsp;must be completed in order to ensure project, initiatives, and events are successfully implemented within the required timeframe.<br>Supports in monitoring risks and provides recommendations for management to implement mitigation plans to keep initiatives on-track. &nbsp;Collaborates in the maintenance of consistent documentation of project deliverables, tracks and reports project status. &nbsp;&nbsp;</p><p>Performs other duties as assigned. (10%)</p><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p>Required:<br>At least 6 months of community work focused on health care, public health, or health education, OR at least 6 months of operations work experience, community events, leading projects, and supporting relationships with multiple stakeholders.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<br>Experience with data entry and reporting processes.&nbsp;</p><p>Preferred:<br>Previous experience in child development activities. &nbsp;</p><h4>Skills</h4><p>Required:<br>Ability to communicate verbally and in writing.</p><p>Organizational skills.</p><p>Detail-oriented, collaborative and enthusiastic team player.&nbsp;</p><p>Ability to assist with inquiries and identify creative solutions to assist members and community stakeholders.</p><p>Ability to troubleshoot problem areas and support effective alternative solutions and provide optimal customer service for internal and external customers.</p><p>Action oriented attitude to take on new opportunities and rewarding challenges with a sense of urgency, high energy, and enthusiasm.</p><p>Ability to multi-task and meet competing deadlines while maintaining attention to detail and accuracy.</p><p>Ability to work independently or as part of a diverse team while applying business-insight as well as empathy towards members.</p><p>Initiative to act on anticipated business needs in the operational and customer service areas.<br><br>Ability to adapt quickly to a fast-changing environment.</p><p>Knowledge of MS Office including Outlook, Word, Excel, and PowerPoint</p><p>Excellent customer service skills.</p><p>Interpersonal skills, ability to read non-verbal cues and apply situational adaptability skills.</p><p>Ability to make sound decisions with incomplete information.</p><p>Preferred:<br>Experience with the Salesforce Customer Relationship Management (CRM) platform</p><p>Knowledge and understanding of the unique needs of the Medi-Cal beneficiary populations within a social service, healthcare, not-for-profit, or government setting.&nbsp;</p><p>Knowledge of public agencies, organizations, and other resources that support Community Resource Center visitors.</p><p>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p>Required:&nbsp;<br>Cardiopulmonary&nbsp;resuscitation &nbsp;(CPR) and California Mandated Reporter within 90 days-of-hire</p><p>Preferred:&nbsp;<br>Management of Aggressive Behavior (MOAB), de-escalation techniques training, safe lifting practices training.</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:</p><p>Travel to offsite locations for work.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Long Beach                                            <br><strong>Nearest Secondary Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Relationship Manager, Behavioral Health, Data Entry, Social Services, Public Health, Customer Service, Healthcare, Administrative, Service                                                    </p>

L.A. Care Health Plan

Community Resource Center Specialist II

<p>Salary Range:&nbsp;&nbsp;$102,183.00&nbsp;(Min.) -&nbsp;$132,838.00&nbsp;(Mid.) -&nbsp;$163,492.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Business Insight Data and Solutions Analyst III is responsible for running analytic projects alongside customers, with minimal oversight or guidance required from Advanced Analytics Lab management. This position is accountable for intake, execution, and managing the oversight of strategic projects that span multiple functions and departments. This position is able to effectively communicate directly with customers and cross-functional teams to understand business needs, identify root cause issues, and propose recommendations for improvement. This role will work to deliver valuable insights and recommendations to improve operational performance.</p><p>The Business Insight Data and Solutions Analyst III is also responsible for leveraging best practices, monitoring and reporting the status of project to key stakeholders. Ensures that requirements are specific, testable and in alignment with business goals.&nbsp;</p><p>Acts as a &nbsp;Subject Matter Expert, serves as a resource and mentor for other staff. &nbsp;Coaches other Advanced Analytic Lab team members in technical and business subject areas, sharing knowledge of Business Intelligence best-practices and domain expertise to increase the competencies and efficiencies of their peers.</p><h4>Duties</h4><p>Lead analytic initiatives to develop strategic insights into key business decisions and recommendations to improve operational performance. Researches and analyzes data in support of business functions, process knowledge, and systems requirements. Creates dashboard/query analysis using primarily SQL, Python, and R for purposes of improving member outcomes and medical costs.&nbsp;</p><p>Design innovative analytic approaches to test hypotheses, extract actionable insights by identifying patterns in structured and unstructured data, and develop recommendations to drive business performance.&nbsp;</p><p>Creates and updates complex business analytics solutions to ensure data may capture for ongoing review and success. &nbsp;Documents business requirements needs and all related logic critical to ensure downstream measurements are performing for desired outcomes. &nbsp;</p><p>Determine the best tactic to develop solutions to the business questions as well as to frame, manage, drive and execute a project or initiative; and to visualize and present the data to the stakeholders in the most meaningful method. Operationalize solutions, refresh cadences, go back to the department's Subject Matter Expert (SME) to make sure they are aware of how this data may be captured for ongoing review for success.&nbsp;<br><br>&nbsp;Acts as a subject matter expert in Advance Analytics team in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable(s) &nbsp;meets the needs of the department, organization and legislation's policies, standards, and best practices.</p><p>Operate in a highly matrixed environment, working closely with senior leaders, management, other departments and organizations to identify root cause of the issues, propose recommendations for improvement, and develop solutions on key business challenges.&nbsp;</p><h4>Duties Continued</h4><p>Tracks maintenance of business need and requirements to ensure they are not attenuated or discarded during the execution and delivery phases. Provides detailed project objectives; clear structured, and useable requirements; tradeoff analysis; requirement feasibility; and risk analysis to improve the execution of the project plan.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>A minimum of 5 years of Data Analysis experience including eliciting and documenting business and systems requirements. </p><p>A minimum of 2 years of applying Operations Research practices to business problems.</p><p>A minimum of 2 years of health plan experience.</p><p>Experience with SQL, Python, and R.</p><h4>Skills</h4><p>Required:&nbsp;</p><p>Knowledge of SQL, Tableau, Python, MS Office, Impala, Hive, and GitHub.</p><p>Expert knowledge of relational databases, database structures.</p><p>Excellent communication skills, organization skills and data visualization skills.</p><p>Ability to work autonomously, with little guidance, often with ambiguous customer requirements in a highly matrixed organization.</p><p>Ability to communicate analysis including trends and opportunities to clients and the business in writing and verbally, includes strong presentation skills.</p><p>Ability to problem solve and research conflicting and/or inaccurate data.</p><p>Strong interpersonal skills, including the ability to influence management at various levels of the organization.</p><p>Proven ability to work with a diverse group of people, including leadership, support staff, coworkers and department management.</p><p>Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines.</p><p>Demonstrated mentoring and coaching skills to develop other team members.</p><p>Proven ability to produce outstanding analysis deliverables on complex, multi-disciplinary projects and programs.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

Business Insights Data and Solutions Analyst III

<p>Salary Range:&nbsp;&nbsp;$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><br>The Customer Solution Center Workforce Management (WFM) Analyst I is primarily responsible for real-time management of the call center queues, schedule maintenance and the management of exceptions.</p><h4>Duties</h4><p><br>Real-time monitoring and management of call center queues; to include, but not limited to: monitors for agent adherence to scheduled activities; excessive state durations; collaborates with call center leads and supervisors to manage agent behaviors; Recommend real-time schedule changes and identify efficiency opportunities. Skilling agents to respond to real time queue conditions and performing start and end of day skilling activities as assigned. (40%)</p><p>Optimizes scheduled breaks and lunches as resource requirements change, determine need for extra hours and/or leave early, assess availability for offline functions and approve/deny as required. Reviews and responds to schedule change requests. Updates schedules with last minute changes. Assists with the creation of all schedule runs and schedule bids/changes. (25%)</p><p>Uses established guidelines, process exception requests as submitted by call center agents and supervisors within the assigned timelines. Processes exceptions to schedules to support training, coaching and meeting requests while ensuring that there is adequate coverage for the call center queues. Evaluates and suggest alternate avenues for supporting off phone activities where queue coverage is limited. (25%)</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 or Bachelor's Degree<h4>Experience</h4><p>Required:<br>At least 2 years of contact center experience including real time adherence.</p><p>Demonstrated experience finding multiple solutions to complex problems.</p><p>Experience and understanding of staffing, queues, and performance measurements.</p><p>Practical, hands-on experience with workforce management tools.</p><p>Preferred:&nbsp;<br>Experience in a multi-lingual, culturally-sensitive environment a plus.</p><p>Hands on experience with WFM Nice IEX Software. Contact center analytics and experience with queue monitoring software (Cisco)</p><h4>Skills</h4><p><br>Required:<br>Strong real time Analytical skills.</p><p>Ability to interpret WFM data to assist with determining staffing needs.</p><p>Intermediate computer proficiency, specifically Word and Excel.</p><p>Familiarity with call center terminology.</p><p>Superior customer service, communication, and problem–solving skills.&nbsp;</p><p>Proven ability to learn new tools, techniques and skills.</p><p>Proven ability to meet goals and deadlines.</p><p>Adept at managing multiple priorities and tasks in a fast-paced environment.</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, HR, Customer Service, Human Resources                                                    </p>

Customer Solution Center Workforce Management Analyst I

<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 Health Educator II Registered Dietitian provides Medical Nutrition Therapy and Diabetes Self- Management Education via telehealth or in-person to L.A. Care Health Plan's members. This position uses science-based practice to assess, provide nutritional diagnosis, plan interventions based on member goals, monitor progress, and evaluate outcomes. This position documents and communicates interactions with pertinent partners and member's health care team. Additional responsibilities include identifying and collaborating with community based organizations to develop/coordinate and/or review health education programs. This position is responsible for leading nutrition education initiatives while working with other internal departments such as Quality Improvement and Cultural &amp; Linguistic Services and further assists the Health Education Director and Manager in fulfilling departmental goals.</p><h4>Duties</h4><p><br>Provide Medical Nutrition Therapy upon receiving a treating provider referral/diet prescription and Diabetes Self-Care Management Education for members referred by internal staff or external providers. This job function requires specialized expertise, knowledge, and training.<br><br>Provide input and consultations as a member of the Interdisciplinary Care Team. &nbsp; &nbsp; &nbsp;&nbsp;</p><p>Develop curricula and conduct education for community groups and members on nutrition-related topics and document outcomes using departmental protocol.<br><br>Review and/or create health and nutrition education materials and articles for members, providers, and employees to address various needs. &nbsp; &nbsp; &nbsp;&nbsp;</p><p>Research, identify and make recommendations regarding collaborations with external community based organizations and/or individuals on nutrition or diabetes education related matters. &nbsp;</p><p>Perform other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Master's Degree in NutritionIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>Minimum of 2 years providing direct diabetes and/or nutrition counseling services in either inpatient or outpatient setting.</p><h4>Skills</h4><p><br>Required:<br>An interest in and knowledge of the scientific aspects of food and nutrition.</p><p>Strong verbal and written communication skills.</p><p>Excellent interpersonal skills to help engage members and promote healthy food choices.</p><p>The ability to explain complex ideas simply.</p><p>A positive and enthusiastic attitude with the ability to motivate others.&nbsp;</p><p>Understanding and tactfulness in dealing with sensitive issues.</p><p>A willingness to keep up to date with current nutrition information and research.</p><p>Preferred:<br>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.</p><h4>Licenses/Certifications Required</h4>Registered Dietitian (RD)OrRegistered Dietitian Nutritionist (RDN)<h4>Licenses/Certifications Preferred</h4>Certified Health Coach (CHC)Certified Health Education Specialist (CHES)Certified Diabetes Care and Education Specialist (CDCES)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:<br>Master’s Degree in Nutrition/Dietetics or Bachelor's Degree in Nutrition/Dietetics with Post-baccalaureate Certificate (Dietetic Internship)</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>                    Nutrition, Diabetes Educator, Public Health, Special Medicine, Diabetes, Healthcare                                                    </p>

Health Educator II Registered Dietitian (ALD)

<p>Salary Range:&nbsp;&nbsp;$50,216.00&nbsp;(Min.) -&nbsp;$62,770.00&nbsp;(Mid.) -&nbsp;$75,324.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Enhanced Care Management (ECM) Coordinator II provides a broad range of project and operational support to the Enhanced Care Management team.&nbsp; This position is responsible for coordinating and organizing Enhanced Care Management activities, by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up. This position supports the Enhanced Care Management administration team in the monitoring and oversight process by collecting information, communicating with members, providers, and internal departments, and tracking program and compliance reports.</p><h4>Duties</h4><p>The Enhanced Care Management Coordinator II supports all administrative and technical functions of the Enhanced Care Management authorization process including intake, logging, tracking and status follow-up. </p><p>Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely process referrals/authorizations in the UM system of record; Identify duplicate requests using claims to verify existing authorization. Independently identifying and appropriately returning any file that is a duplicate to one already processed in the system; Appropriately documenting what information was used in making this determination within 4 hours of receipt. Appropriate identification and timely notification of time sensitive requests; Accurate Filing/Maintenance of confidential member information. Creating secure, complete, files. Interface with members, Enhanced Care Management personnel and other internal and external agencies; Ensure all referrals and authorizations comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete information i.e.: Population of Focus criteria, DX codes, CPT, HCPC codes. (40%)</p><p>Provide organizational and administrative support for Enhanced Care Management activities to help achieve desired goals.&nbsp; </p><p>Plan and coordinate meetings, events, and related project activities to facilitate the optimal performance of Enhanced Care Management. Handles scheduling and coordination for stakeholder and provider meetings; correspondence, and follow up reports; compiles meeting materials; and maintains updated information on Enhanced Care Management. Assist with disseminating program communications to internal and external stakeholders. Provides assistance to team members as needed to achieve department goals. (30%)</p><p>Supports the Enhanced Care Management program administration team in the monitoring and oversight process. </p><p>Maintains the regular reporting responsibilities for Enhanced Care Management; tracks report timeliness, and notifies team of delays. Assists with soliciting information from providers concerning member cases and program operations for grievance and appeal requests. Provides non-clinical support to the Enhanced Care Management Clinical Specialist to support the provider oversight and review process (20%)</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>Minimum of 1 year of coordinator experience in health care/health services, with at least 1 year of experience in Medi-Cal managed care and/or as a Medical Assistant.</p><h4>Skills</h4><p>Required:</p><p>Knowledge of medical terminology, ICD-10, HCPCS and CPT codes.</p><p>Strong verbal and written communication skills.</p><p>Proficiency with Microsoft Outlook, Word, Excel, PowerPoint.</p><p>Excellent organizational, interpersonal and time management skills.</p><p>Must be detail-oriented and a team player.</p><p>Persuasion Skills: Must be able to interface with members, medical personnel, and other internal and external agencies. This includes persuading others to comply with L. A. Care requirements, and providing information in a timely fashion.</p><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><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>                    Administrative Assistant, Claims, Medical Assistant, Administrative, Insurance, Healthcare                                                    </p>

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

Clinical Data Analyst III (Tableau, SQL)

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>PLEASE NOTE:&nbsp; This position will work&nbsp;Monday - Friday, 8 a.m. to 5 p.m. PST, with rotating holidays.</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.</p><h4>Job Summary</h4><p><br>The Customer Solution Center Appeals and Grievances (A&amp;G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care products, Fee for services (FFS )Medi-Cal/Medicare, or commercial insurance.&nbsp;</p><h4>Duties</h4><p>Conducts intake/triage and appropriate classification of Clinical A&amp;G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department.</p><p>Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements.&nbsp; Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA). Identification of Expedited Cases and resolution within 72 hours.</p><p>Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation.</p><p>Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE).&nbsp; Process the case thru to effectuation and final case documentation in the A&amp;G system of record.</p><p>Investigation and preparation of State Fair Hearing cases as assigned. Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE).</p><p>Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews. Prepares authorizations, after approval by the Medical Director.</p><p>When necessary, outreaches to providers, vendors, hospitals, and members to request necessary information or to provide case status and/or next steps.&nbsp; In instances where necessary, sends written notifications to appropriate parties. All interactions including verbal outreach and written communication will be documented in the A&amp;G system of record. </p><p>Participates inter-rater reliability training and assessments.</p><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p>Required:</p><p>At least 5 years of experience in Clinical Nursing and 2 years in Medicare/ Medicaid in a managed care/ health plan environment. </p><h4>Skills</h4><p><br>Required:</p><p>Excellent interpersonal and communication skills. </p><p>Computer literacy and adaptability to computer learning. </p><p>Time management and priority setting skills.</p><p>Must be organized and a team player </p><p>Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.</p><p>Good working knowledge of regulatory requirements/standards.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - 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>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nursing, Registered Nurse, Medicare, Medicaid, Pharmacy, Healthcare                                                    </p>

Customer Solution Center Appeals and Grievances Nurse Specialist RN 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><br>The Claims Supervisor works with the Claims Manager to oversee the daily operations of the claims department. This position is responsible for ensuring that quality levels of performance are maintained throughout the Claims Department and that all functions remain in compliance with State and Federal regulations. This position will &nbsp;manage new program implementations and/or system implementations. This position must maintain an up-to date knowledge of national and state-wide standards and regulations pertaining to claims processes and will ensure that production standards meet quality guidelines are met throughout the department ensuring the Plan’s compliance. This position will work with &nbsp;department Supervisors and staff to develop procedures ensuring the achievement of goals and will continuously monitor the work performed within the Department.</p><p>The position supervises all aspects of running an efficient &nbsp;team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.&nbsp;</p><h4>Duties</h4><p>Provide an environment that allows staff members to flourish in their work duties. Quality levels of 99% maintained throughout the department. Continuous training of supervisors on supervisory responsibilities as well as staff training on all enhancements and updates to claims regulations and company policies. Develop procedure changes to improve results. Corrective action plans developed and implemented to remediate any shortcomings in goal achievement.</p><p>Maintain quality goals and production levels within the Department. Ensure that Claims Department Supervisors are working effectively with their staff to ensure quality and production goals associated with each work area are consistently met by staff during their regularly scheduled work hours.</p><p>Create, maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet the requirements of L.A. Care.</p><p>Track and trend the metrics associated with the claims adjudication. Prepare and present written and verbal reports. Research complex problem areas within the department or within the systems used by department, and identify the root cause of these issues and recommend corrective actions.</p><p>Supervise staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.</p><p>Perform other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Business or Healthcare Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Business or Healthcare Related Field<h4>Experience</h4><p>Required:</p><p>At least 3 years of experience as claims examiner working with medical facility claims and high dollar claims.</p><p>At least 2 years of leading process, program, or staff or supervisory experience.</p><p>Equivalency:&nbsp; Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><p>Experienced in working with Provider Dispute Resolution (PDR's). </p><p>Must have extensive experience in handling claims appeals with experience in communicating with external providers.</p><h4>Skills</h4><p>Required:<br>Sound understanding of health care code sets including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), ICD-10 and revenue codes required. &nbsp;</p><p>Familiarity with Diagnosis Related Group (DRG) pricing.</p><p>Ability to multi-task in a high production environment.&nbsp;</p><p>Familiarity in working with and interpreting Provider and facility contracts and &nbsp;LOA's and MOU's. &nbsp; &nbsp;&nbsp;</p><p>Ability to draw conclusions from data analysis and to formulate corrective action plans when necessary. &nbsp;&nbsp;</p><p>Proficient in using Microsoft &nbsp;Word and Excel.&nbsp;</p><p>Must have strong coaching and mentoring skills and have the ability to build effective teams. &nbsp;</p><p>Must have excellent written and verbal communication skills with ability to work effectively with diverse team members.&nbsp;</p><p>Ability to research complex claims problems and to create clear and concise procedures for the handling of complex claims.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Claims, Insurance                                                    </p>

Supervisor, Claims

<p>Salary Range:&nbsp;&nbsp;$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 Manager, Analytics is responsible for planning and managing the activities of a team of seasoned analysts that provide reports, insights, and analytics to L.A. Care’s enterprise reporting and analytics needs.</p><p>The Manager is responsible for developing the analytics solutions that meet the customer needs and deliver actionable insights to Enterprise Risk Adjustment and Encounters (ERAE) and Finance leadership, as well as to L.A. Care executive leaders.</p><p>This position is responsible for supporting Encounters and Risk Adjustment programs through the metric and key performance indicator (KPI) development, data modeling, investigative analytics, reporting, implementation, and coordination of initiatives and operational programs.&nbsp; This position is the primary contact for encounter data and reporting to the Encounter Governance Committee (EGC).</p><p>The Manager is responsible for identifying, addressing, socializing and championing efforts to fix issue impacting encounter data cleanliness.&nbsp; This position will develop and maintain relationships with key stakeholders across the enterprise to increase transparency to encounter data and the encounter process and access and appropriately use the most critical, actionable data to achieve their objectives.</p><p>This position manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.</p><h4>Duties</h4><p>Manage multiple tasks, adapt to change, and meet project deadlines in a dynamic environment</p><p>Design, produce, quality review, and support cross-functional teams in analytics to populate dashboards and KPI reports.&nbsp; Manages and develops interventions to reconcile encounter submissions to minimize errors and data loss and perform root cause analysis.&nbsp; Supports the performance of investigative analytics and root cause analysis in support of improving performance outcomes</p><p>Identify patterns and emerging trends based on aggregate data to find risks or opportunities and make performance change recommendations.</p><p>Work with key internal stakeholders to share important information and increase company awareness of relevant data.&nbsp; Collaborates with key internal stakeholders to update, track, and report KPI for all Risk Adjustment programs and processes through reporting and dashboard development.&nbsp; </p><p>Develops and maintains quality controls and validation reporting for relevant Risk Adjustment activities, submissions, and reports.&nbsp; Prepares presentations, reports, process documentation, for internal and external stakeholders to support successful programmatic outcomes.</p><p>Acts as a resource for other members of the department on technical issues and identify ways to leverage technology, processes, and tools to solution for desired program outcomes.</p><p>Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.</p><h4>Duties Continued</h4><p>Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.</p><p>Develop goals, objectives and actions plans for assigned staff. </p><p>Lead the analytics and reconciliation team and ensure that all team members have the resources and support the need to meet objectives and succeed.</p><p>Perform other duties as assigned.</p><h4>Education Required</h4>Bachelor's Degree in Data Analytics or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Data Analytics or Related Field<h4>Experience</h4><p>Required:</p><p>At least 6 or more years of experience in data analysis and information reporting.</p><p>At least 4 or more years of experience leading, supervising or managing staff.</p><p>3 or more years of interaction with Enterprise Data Warehouses (EDW).</p><p>3 or more years of individual contributor experience performing analysis on healthcare data (especially encounters).</p><p>Preferred:</p><p>Experience with Risk Adjustment methodologies.</p><p>Experience with claims, clinical, and/or financial data.</p><p>Experience with clinical documentation, medical records, and electronic medical record systems.</p><p>Analytics experience in management, actuarial/healthcare economics, risk adjustment and quality improvement programs.&nbsp; </p><p>Analytics experience with Medicare Advantage, Medicare Fee-For-Service (FFS), Multipurpose Senior Services&nbsp;Program (MSSP) and Accountable Care Organization (ACO) programs, and commercial populations.</p><h4>Skills</h4><p>Required:</p><p>Understand and demonstrated ability to develop metrics used by regulators to monitor encounter and risk adjustment performance.</p><p>Understand and demonstrated ability to develop key performance indicators (KPI) and performance metrics </p><p>Proven ability to analyze and identify performance drivers as well as present key insights to management.</p><p>Proficiency in communicating analytic insights for stakeholder consumption in formats such as Tableau, Power BI, or other relevant tools.</p><p>Proficient skills on SQL, Python, R, SAS, SPSS</p><p>Experience in working with large, complex, disparate data sets</p><p>Experience with data interpretation, analysis, visualization, and reporting</p><p>Advanced level MS Excel for data analysis</p><p>Excellent verbal and written communication skills</p><p>Excellent presentation skills</p><p>Preferred:</p><p>Knowledge of managed care and health care claims</p><p>Knowledge of Risk Adjustment models (e.g. CMS Medicare Advantage, HHS-HCC, Medicaid DxCG)</p><p>Extensive knowledge of healthcare industry, Medicare Advantage, and Traditional Medicare</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>                    EMR, Medicare, Claims, Accounting, Medicaid, Healthcare, Insurance, Finance                                                    </p>

Manager, Analytics

<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><br>The Lead Customer Solution Center Service Representative is responsible for the development of a successful and cohesive Call Center unit, with a high level of productivity to achieve the department's overall performance metrics, and to meet and/or exceed member satisfaction. Assist Call Center Supervisors with the supervision of Member Services Representatives by closely monitoring performance, which includes but not limited to: coaching, mentoring, motivating, counseling, etc. to ensure they are providing optimal customer services and meeting and/or exceeding department goals.&nbsp;Responsible for the daily workflow and leading the work of assigned staff.</p><h4>Duties</h4><p>Leadership of day to day activities of Member Services Representatives, including but not limited to: Providing direction. Monitoring of staff performance including attendance. Handling all questions/issues raised by staff. Recommending process improvement processes. Preparing and analyzing call center statistical reports. Monitoring/Adjusting of skill-sets for consistency. Ensuring quantity/quality is met for overtime. Handle escalated calls. Back-up to calls as needed. Assist Supervisor to ensure that Representatives provide accurate, timely and quality service to our members/providers. Ensure that all departmental policies, procedures and standards are being met, as well as the organization's mission. Assist Supervisor to ensure that deviations in performance are identified in advance and process changes are made to redirect performance to acceptable levels. Assist Supervisor to ensure that we provide accurate, timely and professionally written, statistical and verbal reports to management for historical, current status and forecasting purposes. Assist Supervisor in reviewing the Representatives overall quality accuracy. Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval. (40%)</p><p>Trains and motivates staff. Ensures appropriate service standards are developed and maintained. Leads the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training and feedback on performance to department management.&nbsp; Oversees the daily office workflow, develops and recommends enhancements to process and procedures.&nbsp;&nbsp; (5%)</p><p>Work with training staff to ensure that training practices support staffing and performance standards, takes responsibility for identifying on-going training needs and integrating training and performance expectations as well as work closely with Supervisors to create and/or modify Desk top procedures. (5%)</p><p>Work closely with management to review performance and quality standards on an ongoing basis and to assist with development and implementing incentive programs. As well as motivational programs needed to achieve service standards. (10%)</p><p>Ensures that front line service personnel are capturing information and providing feedback to Supervisors that will enable L.A. Care to improve its product and internal process. (10%)</p><h4>Duties Continued</h4><h4>Represents the Department when requested at meetings. Assist Supervisor with meetings and provides necessary feedback when requested. (5%)</h4><h4>Ensure department remains in compliant with HIPAA regulations relating to protected health information (PHI). (10%)</h4><h4>Maintains attendance expectations. (5%)</h4><h4>Perform other duties as assigned. (10%)</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 customer service experience.</p><p>At least 6 months of lead experience in a health plan/ healthcare customer service call center environment.</p><p>Preferred:</p><p>Experience in working with the disadvantage population, Covered California, and Cal MediConnect.</p><h4>Skills</h4><p>Required:<br>Must have knowledge in direct line of business.&nbsp;<br><br>Must know Medical Terminology.</p><p>Must have excellent written and verbal communication skills.</p><p>Strong analytical, coaching/mentoring skills, team building.<br><br>Ability to work effectively with diverse team members.<br><br>Must also have the ability to troubleshoot problem areas and recommend effective alternative solutions to handle irate callers, and provide optimal customer service for internal and external customers.</p><p>Must be flexible with time and be able to work overtime including weekends.&nbsp;</p><p>Must be able to multitask and to streamline day to day operations, policies and procedures.</p><p>Must have advance PC skills including Excel and Access.</p><p>Preferred:<br>Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese</p><h4>Licenses/Certifications Required</h4><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 Representative, Customer Service Representative, Call Center, Customer Service                                                    </p>

67 L.A. Care Health Plan Jobs