L.A. Care Health Plan

Manager

• Provides leadership, strategic direction, relationship management and oversight of the L.A. Care CRC facility operations
• Aligns CRC programming and services to the organization’s strategic priorities and community needs
• Manages relationships with onsite Plan Partner staff and contributes to the strategic plan and implementation of joint programs for Medi-Cal members
• Facilitates activities of L.A. Care staff assigned to work remotely at an CRC
• Promotes strategic and informed CRC programming and activities that include health education, physical fitness, wellness, and social supports
• Oversees marketing and promotional event activity to build awareness and understanding of CRC programs and benefits
• Identifies, assesses, and manages vendor contracts and the related logistical coordination to ensure high quality services aligned with the CRC mission
• Collaborates closely with internal stakeholders, including the Sales and Marketing team to promote L.A. Care’s brand identity
• Manages CRC staff, establishes clear responsibilities and processes for monitoring work and measuring results
• Serves as leader in exploring, building and supporting new partnerships that will prove strategic to enhance local health initiatives

Manager, Community Resource Centers

IT Support

• Manages complex issues escalated from Level 2 Service Desk Technicians, serving as a key liaison between the I.T. Service Desk and internal business units.
• Collaborates with other I.T. teams to resolve critical incidents, ensuring high-level customer service and quick resolution.
• Takes the lead and/or assists I.T. Management with the completion of department related projects.
• 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 adherence to all I.T. policies, with a particular focus on those related to security, risk management, and data protection.
• Participates in the after-hours on-call rotation, assisting Level 2 technicians with escalated issues.

Help Desk Technician III

Technical Product Manager

• Serves as a strategic bridge between business stakeholders and IT teams
• Owns primary domains while supporting other TPMs with cross-domain initiatives
• Manages the delivery of digital and operational solutions
• Drives creation of clear problem statements and defines desired outcomes
• Collaborates with key stakeholders to ensure product backlog is effectively prioritized
• Monitors product performance and drives continuous enhancement

Senior Technical Product Manager

• Serves as a strategic bridge between business stakeholders and solution delivery teams
• Owns a primary domain and ensures IT solutions deliver measurable improvements in business outcomes
• Drives the creation of clear problem statements and desired outcomes from business needs
• Supports backlog prioritization with Business Owners and participates in sprint planning and review sessions
• Monitors product performance within the domain and identifies improvement opportunities
• Collaborates with IT and business partners to ensure solutions comply with regulations

Actuary

• Responsible for the overall management and oversight of staff for all Actuarial tasks
• Determine the priorities of requests to Actuarial from within the company and from government agencies
• Lead and support lead rates negotiations with Plan Partners and L.A. Care subcontractors
• Respond to Government requests for data and analyses
• Work with the Accounting/Finance senior management to meet financial reporting and budgeting deadlines
• Provide timely assistance to various departments in need of Actuarial support
• Summarize difficult and complex financial situations and present them to the Chief Financial Officer (CFO)
• Direct all aspects of running an efficient team including hiring, supervising, coaching, training, and motivating direct reports

Director, Actuarial Services

Financial Planning and Analysis

• Involved in the preparation of the annual budget and multiple forecasts
• Prepare, consolidate, and analyze budgets for L.A. Care Health Plan
• Assist with financial statement analysis and reporting
• Interact with management team and department staff for budget development
• Act as a Subject Matter Expert and mentor other staff
• Develop budget/forecast data models
• Support Division Chiefs and Directors on monitoring departmental spending

Financial Analyst III

Medical Director

• Provides clinical strategic direction for the behavioral health, social services, health equity, and community supports.
• Provides clinical oversight of our behavioral health vendor.
• Assures maintenance of positive relationships with other departments, PPGs, other Local Initiatives and Community Based Organization.
• Coordinates and facilitates interactions between the Community Based Organizations, Department of Mental Health and Public Health and L.A. Care as well as social service initiatives like L.A. Care Community Link Platform and Transition of Care Program.
• Implements and works with the State, Department of Mental Health and LA County school districts on the new series of school-based behavioral health programs.
• Implements and responsible for key in lieu of service areas as relates to the CalAim 1115 and 1915(b) Medicaid Waivers.
• Provides strategic leadership to ensure that organizational culture, practice and leadership development programming are anchored in the DEI vision.
• Engages and collaborates with staff, subcontractors, network providers, and entities included, but not limited to local community-based organizations, local health department, behavioral health and social services, child welfare systems and members in health equity efforts and initiatives.
• Participates in federal, state, and as well as foundation-funded projects focused on the improvement of population-wide behavioral health and social determinants of health.

Senior Medical Director II, Community Health – Health Equity

Account Manager

• Responsible for all aspects of the L.A. Care (LAC) provider contracting and relationship management process
• Drafting, reviewing, negotiating and implementing phases of contracts
• Building, nurturing, and maintaining positive working relationships between LAC and its network of providers
• Representing LAC in their partnership with contracted and non-contracted providers
• Maintaining an in-depth understanding of LAC governing regulations, policies and procedures, operating standards, provider contracts, and provider performance and needs
• Identifying, developing, and conducting relevant and tailored provider orientation sessions
• Monitoring and managing network adequacy by assuring appropriate access to services throughout L.A. County
• Supporting credentialing and re-credentialing process, investigation of member complaints, and assisting in investigating any potential quality issues
• Monitoring timely receipt of contractually required reporting
• Acquiring and maintaining a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases

Provider Network Account Manager III

Auditor

• Works closely with the Claims Quality Auditing Manager.
• Maintains up-to-date knowledge of current trends and issues in healthcare, national and statewide standards and regulations.
• Serves as a liaison between partnering departments (i.e. Payment Integrity and Claims Compliance).
• Conducts audits of high dollar claims, Provider Disputes and Adjustments.
• Develops procedures ensuring the achievement of goals and continuously improves the quality of work performed within the department.
• Researches complex claims problems.

Claims Quality Auditor II

Claims Specialist

• Process all types of claims with focus on L.A. Care direct services
• Meet production and quality standards set by PDR Claims Department Management
• Resolve provider claims payment disputes within the specific time frame as required by regulatory agencies
• Identify and report PDR trends to management for process improvement opportunities
• Work with internal departments to resolve issues preventing claims processing or enhance processing effectiveness
• Perform other duties as assigned