L.A. Care Health Plan

Bilingual

• Assessment of the medical, social, and behavioral needs of an assigned population
• Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
• Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
• Conducts telephonic, and face-to-face/virtual visits as required.
• Performs ongoing monitoring of the care plan to evaluate effectiveness of interventions for goal achievement, suggest changes as needed and document updates accordingly.
• Maintains ongoing member caseload for regular outreach and management.
• Promotes integration of services for members including behavioral health care and longterm services and supports/home and community to enhance the continuity of care for Clever Care members.
• Uses motivational interviewing and Clever Care clinical guidelines to educate, support and motivate change during member contacts.
• Assesses barriers to care, provides care coordination, and assistance to members to address concerns.
• Additional duties, as assigned.

Case Manager, Bilingual Mandarin, Korean, Spanish

• Assist case managers with member outreach, including scheduling appointments, conducting assessments, referrals, and providing educational materials
• Organize meeting schedules, training sessions, and project timelines
• Extract, analyze, and report on data from various sources, ensuring accuracy and consistency
• Ensure all necessary regulatory reports and documentation are prepared on time

Care Management Coordinator, Bilingual Mandarin, Cantonese, Korean, Spanish

Database Administrator

• Oversee all aspects of SQL Server database system design, implementation, troubleshooting, and administration.
• Develop, install, maintain and monitor company databases in a high performance/high availability environment while supporting enterprise projects.
• Provide general database design, implementation and administration to assure highest reliability and availability of I.T. services.
• Manage the Data Synchronization of multiple databases between data centers using transaction replication.
• Maintain database backup/recovery procedures and disaster recovery database environment.
• Implement and support database software upgrade and patch management procedures.
• Identify performance issues, deadlocks/contentions and resolve them.
• Generate traces, execution plans and SQL Profiling.
• Create and manage database constraints and indexes.
• Support Development Team and Business users with database operations including the development of complex SQL, tuning of DML and the creation of stored procedures.
• Perform proactive housekeeping/archiving and shrinking of databases and logs.
• Develop and support procedures for database security.
• Develop processes, procedures and guidelines for troubleshooting database events and performing tasks.
• Provide tier 2 and 3 support for all corporate SQL Server database systems and services to meet or exceed service level agreements.

SQL Server Database Administrator III

Compliance

• Lead L.A. Care’s Special Investigations Unit (SIU) in overseeing the internal and external investigations into fraud, waste, abuse, and compliance violations
• Drive the design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program
• Ensure effective case intake, triage, investigation, tracking, and resolution processes
• Develop and support enterprise policies, procedures, and training programs for FWA prevention
• Direct and oversee investigations into allegations of non-compliance, ethical violations, or fraudulent behavior
• Ensure timely and accurate reporting of SIU/FWA activity to external agencies
• Develop dashboards, analytics, and reporting tools for visibility into investigative outcomes and risk trends
• Serve as a trusted advisor and subject matter expert to senior leadership

Director, Compliance – Special Investigations Unit, Fraud, Waste and Abuse

Software Engineer

• Responsible for the requirement analysis, design, development, architecture, implementation and support of enterprise-wide databases
• Presents ETL documentation and designs to team members
• Leads the work of assigned staff and provides guidance, training and feedback
• Oversees daily office workflow
• Optimizes data warehouse performance and addresses data conflicts
• Collaborates with Quality Assurance resources to debug ETL development

Lead ETL Data Integration Developer

• Operational support of Informatica environment
• Automation, job scheduling, monitoring, and maintenance of ETL processes
• Development of complex ETL processes for Data Warehouse projects
• Analysis and evaluation of data sources and targets for ETL mapping
• Acts as Subject Matter Expert and mentor for staff
• Training and recommending process improvements for junior staff

ETL Data Integration Developer – III

Analyst

• Support the procure-to-pay business processes
• Collaborate with various stakeholders to analyze, troubleshoot, and resolve production issues impacting the Ariba system
• Provide support for enhancements and projects related to the Ariba application and procure-to-pay processes
• Support and optimize existing business processes
• Contribute to the design, build, and testing of new solutions
• Provide comprehensive support for the FI/CO applications
• Act as a Subject Matter Expert, serve as a resource and mentor for other staff
• Analyze business processes and coordinate with the project team to provide solutions to optimize productivity and ensure data accuracy
• Manage projects to roll out applications/business processes to ensure goals and objectives are accomplished on time and within budget

Ariba Functional Analyst III

• Responsible for the more complex technical and analytical work related to the maintenance, update, etc. of the configuration of the L.A. Care Health Plan Core Systems applications, and databases.
• Serves as a subject matter expert who has the ability to proactively identify and independently rectify issues and opportunities for configuration improvements.
• Performs peer review and applies advanced skillset to ensure quality of the work product.
• Collaborates closely with peers and management within the department as well as throughout and outside of the organization to troubleshoot and facilitate the maintenance and update of the most complex configuration of the various modules of our core systems, applications, and databases as well as facilitate end-to-end interdepartmental and enterprise projects.
• Provides well thought-out recommendations for vendor enhancement of the core products.

Core Systems Configuration Analyst III

Security Operations

• Responsible for leading a team of CDOC Analysts and managing LAC's relationship with its Managed Security Service Provider (MSSP) and the CrowdStrike Falcon Complete Analysts.
• Directs the daily functions, processes, and operations of the CDOC, ensuring policies and procedures are followed and performance expectations are met.
• Oversees security alerts and leads the team in identifying and responding to security threats.
• Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.
• Creates, reviews, and approves new procedural documentation.
• Develops and maintains procedures and workflows for CDOC management, including escalation and notification procedures.
• Collaborates with other Information Security (InfoSec) and Information Technology (I.T.) teams to ensure that relevant organization-wide data is processed by the CDOC.

Manager, Cyber Defense Operations Center

Auditor

• Prepares audit programs and conducts audit reviews of assigned areas, including performing various audit procedures and documents in findings in work papers in accordance with department standards.
• Identifies internal control weaknesses, develops audit recommendations and drafts written reports.
• Provides independent evaluations of operational and financial controls, policies, and procedures.
• Prepares audit report detailing findings and recommendations.
• Performs and coordinates follow-up audits to determine if management has taken action to mitigate risks identified.
• Participates in special reviews as necessary.
• Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.
• Develops audit programs and testing procedures relevant to risk and test objectives.
• Obtains and reviews evidence ensuring audit conclusions are well-documented.
• Identifies and communicates issues raised, offering recommended solutions relevant to business and risk.
• Ensures audit conclusions are based on a complete understanding of the process, circumstances, and risk.
• 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.