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<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><br>The Customer Solution Center Even MORE Service Liaison I, will communicate to members in all line of business (LOB) regarding: welcome calls, outbound calls, member -Health Risk Assessment, related programs by LOB. Conduct and document outreach activities (call, web, email) consistently and accurately. The Liaison will proactively identify, document, investigate, &nbsp;and resolve member issues in a timely and appropriate manner. The Liaison will also identify potential areas of membership dissatisfaction and recognize improvement areas. The Liaison is responsible for facilitating member enrollment and outreach efforts, with a focus on:<br>&nbsp; &nbsp;* Health Risk Assessment- ensure to meet all regulatory requirements for Centers for Medicare and Medicaid Services(CMS), &nbsp;and for SPD population.<br>&nbsp; &nbsp;* Contacting members to obtain their selection of Primary Care Provider (PCP)/clinic, medical group, (and Plan Partner, where applicable) assignment if information was not provided on choice forms, enrollment applications, data transmissions from applicable sources, etc. as well as the preferred threshold language and/or alternative format for receiving their welcome kits, network-related member notification letters, etc.&nbsp;<br>&nbsp; &nbsp;* Collaborating with internal and external stakeholders and members to facilitate continuity of care and the related enrollments and assignments (based on enrollment information for Covered California, permission-to-enroll forms, daily updates from PASC, COBRA/ICP elections, etc.)<br>&nbsp; &nbsp;* Processing and screening applications and renewals for Healthy Kids members, notifying applicants of the disposition of their application/renewal, and conducting the appropriate follow-up (including review of vendor outreach efforts)<br>&nbsp; &nbsp;* Working with various internal, Plan Partner, medical group, etc. staff to address questions regarding member eligibility and demographic information.<br>&nbsp; &nbsp;* Collaborating with Department of Public Social Services (DPSS), Health Care Options, the Ombudsman, Covered California, PASC, third party liability constituency, etc. staff to address and resolve questions, issues, etc. regarding member demographic information (e.g., CIN, name, address, and other related information) so that it can be appropriately updated and reflected in the system. Liaison also attends and participates in various internal and external meetings in this regard.</p><h4>Duties</h4><p>Facilitate the timely contact of members regarding member outreach and retention programs for all lines of business via direct member communication, including welcome calls and meeting all regulatory requirement for Health Risk Assessments for CalMediConnect members and SPD members. Facilitate member choice assignment and fulfillment of materials in the appropriate language and/or alternative format. This is aligned with service level requirements. (40%)</p><p>Even MORE Service Liaison will track, document, and report member outreach and retention campaigns into SalesForce and QMEIS. Liaison will also assist with coordinating with other departments to follow up and resolve issues that arise through member contact, including potential care coordination/continuity of care issues. (20%)</p><p>Liaison to meet L.A. Care’s P&amp;P requirements for attendance and follow department guidelines and expectations. Collaborate with the CSC Departments regarding member enrollment efforts for all lines of business. (15%)</p><h4>Liaison will assist with identifying and assessing areas of potential member dissatisfaction (PQI) as well as focusing on opportunities for service/process improvement. This is in compliance with regulatory requirements for auditing purposes. (10%)</h4><h4>Liaison to assist Business Units and Product Lines with the implementation and completion of special projects, including member loyalty programs. Collaborate with internal and external peers to enhance the integrity of member information and ensure continuity of care and increase member retention. (5%)</h4><h4>Perform other duties as assigned. (10%)</h4><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 1 year of customer service experience in a corporate setting.</p><p>Demonstrated experience handling complex customer calls.</p><p>Preferred:</p><p>Managed care or healthcare experience.</p><h4>Skills</h4><p><br>Required:<br>Strong verbal and written and communication skills.</p><p>Strong organizational 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><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>                    Medicaid, Medicare, Social Services, Healthcare, Service                                                    </p>

L.A. Care Health Plan

Customer Solution Center Even MORE Service Liaison I

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

Health Education Dietetic Technician II (ALD)

<p>Salary Range:&nbsp;&nbsp;$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 Supervisor of Transitional Care Services (TCS) is responsible for supervising the TCS clinical and non-clinical staff’s daily work and activities. The Supervisor ensures adequate staffing and coverage adherence to Department of Health Care Services (DHCS) TCS program and documentation requirements, and that eligible members receive timely and quality services. </p><p>This position is responsible for promoting the optimal clinical outcomes and improving quality of care through clinical priorities for members.&nbsp; This position utilizes independent clinical judgment to promote quality of care through collaboration with cross-functional teams at L.A. Care (LAC). The position assist in identifying and triaging member and operational issues/problems, and forming resolutions within the scope of work. </p><p>The position provides ongoing program support through active communication, education, and consultation of interdisciplinary staff.&nbsp; The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports,&nbsp; </p><p>This position is responsible for ensuring all functions are operating in accordance with the organization's mission, values and strategic goals.&nbsp; </p><h4>Duties</h4><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>Consult with management and Human Resources Business Partner (HRBP) to review performance improvement plans prior to meeting with staff. </p><p>Assist in developing written policies and procedures and practice protocols pertinent to the transitional care and regulatory program requirements. Plan and direct TCS activities to provide timely, quality care and services to members experiencing a care transition. Recommend process improvement measures to achieve program’s performance measures outcomes and goals. </p><p>Conduct and coordinate analysis of data to track and trend for the purpose of improving programmatic and performance on issues related to safe transitions, readmission reduction, and other programs as determined.&nbsp; .&nbsp; Monitor the progress of programs or services in relation to expected standards across the continuum of care.&nbsp; Benchmark best practices and identify measurable outcomes.&nbsp; Recommend innovative approaches to patient care. Collect, analyze, and communicate data related to transitions of care and other related metrics.</p><p>Conduct monthly audit activity via program’s performance reporting standards to maintain quality care of members and compliance to regulatory requirements. Collect and organize team performance data to identify trends and maintains all assigned reporting responsibilities. Ensure the accuracy of TCS reports and program proficiency in maintaining regulatory standards and schedules. Provide reports to management to identify trends and improve workflow process.</p><h4>Duties Continued</h4><p>Provide clinical leadership for Transitional Care and other related program goals. Consult with cross-functional teams concerning patient care issues Coordinate quality improvement activities in transitions of care as demonstrated through identifying clinical priorities and outcomes (e.g. HEDIS, etc.).&nbsp;&nbsp; </p><p>Assist in the development and implementation of communication strategies to keep internal and external stakeholders informed of Transitional Care initiatives. </p><p>Ensure program compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information (PHI). </p><p>Maintains knowledge of current trends and practices in Transitional Care, nursing, and health care through networking and other resources. Enhance professional and unit growth through active participation in professional organizations, department activities, and community groups. </p><h4>Perform other duties as assigned. </h4><h4>Education Required</h4>Associate's Degree in Nursing or Related FieldMaster's Degree in Social Work or Related Field<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p>Required:</p><p>Minimum of 5 years of recent care management, care coordination, and/or transition of care experience in a hospital or managed care setting, such as a health insurance environment and/or experience as care manager in hospital or home health environments. </p><p>At least 2 years of leading a process, program or staff or supervisory/management experience.</p><p>Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.</p><h4>Skills</h4><p>Required:</p><p>Knowledge of state, federal and regulatory requirements in care/disease management, care coordination, population health management, health education and Transitional Care Services.</p><p>Excellent interpersonal communication, problem solving, and conflict resolution skills.</p><p>Knowledge of complex health care systems and proficiency in performing medical record reviews.</p><p>Knowledge of professional nursing practice elements and evidence-based models of transitional care.</p><p>Computer literacy with proficiency with Microsoft Word, Excel, and core program systems.</p><p>Excellent organizational and time management skills.</p><p>Must be detailed oriented and an enthusiastic team player.</p><p>Ability to work independently and with internal and external customers. </p><p>Ability to solve complex issues, identify, and implement creative solutions.</p><p>Preferred:</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&nbsp;&nbsp; </p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California LicenseLicensed Clinical Social Worker (LCSW) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Certified Case Manager (CCM)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Please note that a Licensed Clinical Social Worker is only required when Master's Degree in Social Work. Licensed Clinical Social Worker not required with Associate's or Bachelor's Degree in Nursing.</p><p>Able to work flexible job hours.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Social Worker, Nursing, Registered Nurse, Patient Care, Service, Healthcare                                                    </p>

Supervisor, Transitional Care Services

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

Supervisor, Authorization Technician

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

Enterprise Shared Services Program Manager II (ALD)

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

Provider Network Account Manager III

<p>Salary Range:&nbsp;&nbsp;$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>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Relationship Manager, Behavioral Health, Data Entry, Social Services, Public Health, Customer Service, Healthcare, Administrative, Service                                                    </p>

Community Resource Center Specialist II

<p>Salary Range:&nbsp;&nbsp;$164,614.00&nbsp;(Min.) -&nbsp;$222,230.00&nbsp;(Mid.) -&nbsp;$279,845.00&nbsp;(Max.)</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p>The Associate Counsel III Senior Director Health Legal Services is responsible for diverse legal activities.&nbsp; This position provides analysis of health care regulatory matters and assisting with the development and review of legislative bills and administrative regulations.&nbsp; The Associate Counsel III reviews policies and procedures to ensure compliance with all legal authorities and confers with outside attorneys, state or county officials, and other interested parties.&nbsp; This position supports L.A. Care’s product lines and operations by providing substantive legal counseling on complex matters. This position provides non-supervisory guidance for staff counsel, paralegals, support personnel. This position reports directly to the Associate General Counsel, should the Associate General Counsel position be vacant, this position reports to the General Counsel. </p><p>The Associate Counsel III Senior Director Health Care Legal Services collaborates on the improvement of communication between the department and key stakeholders to define opportunities, identify and prioritize programs and projects based on predefined criteria (e.g. return on investment, productivity, compliance). Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics.</p><h4>Duties</h4><p>Participates as a senior attorney member of the Legal Department’s Health Care Legal Services Unit (HCLS) supporting L.A. Care in a matrix management organizational structure by providing needed legal advice and counsel on the most complex and sensitive matters regarding various laws applicable to health care service plans, with an emphasis on California law.</p><p>Provides substantive counseling on complex provider contracting and other legal matters.</p><p>Manages outside counsel in connection with organization’s healthcare activities.</p><p>Provides significant effort for HCLS’s support of the provider and payer efforts.</p><p>Provides non-supervisory guidance for other HCLS staff.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p><p>Interfaces directly with L.A. Care leadership and acting on behalf of the Associate General Counsel as needed.</p><p>Provides expert advice to various business units on relevant topics within the organizational standards, national and statewide compliance.</p><p>Evaluates the effectiveness of program implementation, and provides guidance and recommend process improvement. </p><p>Communicates strategic planning outcomes and the agreed upon priorities across the organization, to include ongoing progress of priorities. </p><h4>Duties Continued</h4><p>Leads efforts to allow the company to mitigate risk such as regulatory or competitive risks through innovative business ideas and solutions.</p><p>Responsible for communicating decisions, priorities and relevant project information to appropriate levels of staff regarding business unit requests and projects and initiatives.</p><p>Responsible for sharing solution roadmaps and enterprise level strategies to drive efficiencies across the organization and with customers. Collaborates with management to develop annual budgets for respective business areas.&nbsp; </p><p>Provides support in delivering programs that meet the compliance needs of the organization</p><p>Performs other duties as assigned.</p><h4>Education Required</h4>Juris Doctor Degree or Doctor of Law Degree (J.D.)<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>Minimum of 6 years of experience as a practicing licensed attorney and has acted as senior counsel on legal projects and matters.</p><p>Experience in an HMO or as counsel to a health system, hospital, government unit, or a health care law firm practice.</p><p>Experience and knowledge of health care law.</p><p>Experience in supporting complex provider contracting activities including drafting and reviewing contracts, providing strategic advice regarding negotiations and operations on complex and sensitive matters.</p><p>Preferred:&nbsp; </p><p>Substantial experience in Medi-Cal or Medicaid and Knox-Keene Act.</p><p>Experience in Medicare, commercial lines of business and Health Insurance Portability and Accountability Act (HIPAA).</p><p>Supervisorial experience.</p><p>Experience in and knowledge of public entity laws including the Brown Act, Political Reform Act and Public Records Act.</p><h4>Skills</h4><p>Required:</p><p>Excellent interpersonal oral and written communication skills to facilitate open and clear dialogue with payers, regulators, providers, internal clients, contractors, vendors and L.A. Care leadership.</p><h4>Licenses/Certifications Required</h4>State Bar - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:</p><p>Successfully passed California bar exam and maintains valid license/ certificate and be in good standing.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medicaid, Medicare, Medical, Healthcare                                                    </p>

Associate Counsel III Senior Director Health Care Legal Services

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

Customer Solution Center Member Navigator II (Location- Metro Los Angeles)

<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 Care Management Coordinator II is responsible for outreach to members/caregivers, providers, Community Based Organizations (CBO), and others to help enroll our highest need members into the Care Management (CM), and Disease Management (DM) programs. The position is responsible to assess member’s strengths, challenges, needs, and barriers to care through conducting telephonic Health Risk Assessment (HRA). The position works with the member/caregiver, Care Management Specialist, Community Health Worker, and the Interdisciplinary Care Team (ICT) to support the development and implementation of the care plan and address unmet needs. </p><p>This position coordinates the flow of information between the CM team and the member/caregiver, provider, medical group, and other members of the ICT. The position supports the coordination of member care as instructed by the Care Management Specialist and outlined in the care plan including the reinforcement of health education and disease management information; coordinating benefits such as transportation and DME; and linking member to community resources to address the Social Determinants of Health (SDoH) of the member. The position is responsible to ensure the CM team meets the contractual and regulatory requirements and timelines by maintaining accurate documentation and following up with the member and provider as needed.</p><p>In addition, this position is assigned projects to support the department in meeting its regulatory and contractual requirements, such as running reports, data validation, quality checks and other projects. The position assists with the communication and coordination between programs and maintains confidentiality when communicating member information.</p><h4>Duties</h4><p><br>Responsible for the time sensitive processes for initiating cases, managing referrals to the department, appropriate documentation, routing of information, performing computer data input, faxing, emailing, filing of confidential member information, and maintaining logs of activity, etc. (40%)&nbsp;</p><p>Engages members to participate in the CM/Disease Management programs by reaching out and promoting the programs to address member’s unmet needs. (10%)</p><p>Completes telephonic calls to conduct the HRA with high risk members participating in the CM program. Assists the care team with developing and assessing health interventions. (10%)</p><p>Conducts telephonic outreach calls to members/caregivers regularly and evaluates and documents their progress towards their healthcare goals. Consults and collaborates with the Care Management Specialist to set up provider/specialist appointments and follow up on treatment plans. (10%)</p><p>Handles the incoming and outgoing calls to members/caregivers and providers to coordinate care as identified in the care plan. (10%)</p><p>Initiates follow up calls to members to administer screenings or confirm linkage to appropriate resources. Provides general information to members and providers about the CM and DM programs. &nbsp;(10%)</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>Associate's Degree<h4>Experience</h4><p>Required:<br>At least &nbsp;6 months of &nbsp;experience in an administrative and customer service role in a health care/health services setting .&nbsp;</p><p>Preferred: &nbsp;<br>1 year of Medical Assistant experience. &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>6 months of experience processing authorizations at a managed care/health plan setting.&nbsp;</p><h4>Skills</h4><p>Required:<br>Knowledge of medical terminology</p><p>Strong verbal and written communication skills</p><p>Proficiency in Microsoft Office with a high level of accuracy</p><p>Excellent organizational, and time management skills</p><p>Detail-oriented and a team player</p><p>Excellent customer service skills with compassion and empathy</p><p>Ability to demonstrate sensitivity and respect for the opinions, perspectives, customs, and individual differences of others.&nbsp;</p><p>Ability to value diversity of people and ideas, as well as interact &nbsp;with people from a wide range of backgrounds. &nbsp;</p><p>Ability to be &nbsp;flexible, open-minded, listen to and consider others’ viewpoints.&nbsp;</p><p>Ability to work well and develop effective relationships with diverse personalities.</p><p>Preferred:<br>Bilingual in one of L.A. Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Medical Assistant (CMA)<h4>Required Training</h4><p>Preferred:<br>Motivation Interviewing&nbsp;</p><p>Trauma Informed Care</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><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Medical Assistant, Public Health, Healthcare                                                    </p>

67 L.A. Care Health Plan Jobs