L.A. Care Health Plan

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

Provider Dispute Resolution Claims Examiner II

Backend Engineer

• Design, development & support of .NET applications.
• Maintain effective security aligned with HIPAA and state and federal requirements.
• Utilize established development tools, guidelines and conventions.
• Create technical specifications and test plans.
• Ensure performance, quality, and responsiveness of applications.
• Identify bottlenecks and devise solutions.
• Administer the Intranet and maintain existing web applications with 99.99% availability.
• Develop and maintain databases for .NET applications with 99.99% availability.
• Enhance existing systems by analyzing business objectives and identifying areas for modification and improvement.
• Perform other duties as assigned.

.Net Developer II

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
• Provide general database design, implementation and administration
• Manage the Data Synchronization of multiple databases between data centers
• 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

Database Administrator III, SQL Server

Solutions Engineer

• Develop integration and architecture to meet the business needs of the company by working closely with key stakeholders and partners.
• Integrate I.T. Solutions into a common framework.
• Enforce standards around systems technology stacks and mechanisms for governing cloud-based infrastructure.
• Support in-house development teams to implement solutions.
• Responsible for providing technical and management guidance to all departments and works closely with development teams to ensure compliance.
• Supports the creation of roadmap documents, architectural documents, process documents, standards documents and governance documents.
• Collaborates with program-level architects across the organization on the details of the systems architecture for their particular domain.
• Work closely with I.T. functional areas to identify and resolve integration and workflow considerations and issues.
• Responsible for assisting with the overall system design and architecture.
• Responsible for providing EA support to the Development department and Enterprise Architecture team.
• Work with other architects around business, data, systems, and security needs and how applications best participate in the overall enterprise architecture.
• Performs other duties as assigned.

Enterprise Architect, Integration Engineer II

Risk

• Provide day-to-day leadership for analytic teams responsible for development and maintenance of analytic assets within the assigned domain.
• Translate analytic strategies and organizational priorities into structured work plans, deliverables, and performance measures.
• Direct the design, development, and automation of reports, dashboards, and analytic models using SQL and Python in a server-based analytics environment.
• Ensure data accuracy, consistency, and standardization across all analytic products within the domain.
• Partner with other domain analytic leaders to ensure alignment of metrics, definitions, and methodologies.
• Collaborate with cross-functional stakeholders to improve data quality, availability, and usability for analytics.
• Lead analytic intake and prioritization processes to balance recurring operational needs with emerging enterprise priorities.
• Mentor and develop staff, building technical and problem-solving skills within the team.
• Summarize and communicate analytic findings in clear, actionable terms to leaders and cross-functional partners.
• Support the development of dashboards and reporting frameworks for executive, compliance, or regulatory reporting.

Manager, Enterprise Analytics, Risk Adjustment Analytics

Manager

• Develop and execute broker channel strategies for D-SNP and Covered CA lines of business, focused on enrollment growth, retention, and member satisfaction.
• Partner with General Agencies to implement top-down sales training, production incentive programs, and performance tracking.
• Identify and onboard high-performing agencies and brokers aligned with L.A. Care’s mission and compliance standards.
• Collaborate with cross-functional key stakeholders to coordinate outreach, education, and co-branded initiatives in priority communities.
• Serve as the primary point of contact for assigned General Agencies and top-producing brokers.
• Conduct regular agency and broker meetings to review sales performance, compliance expectations, and market opportunities.
• Support brokers with sales tools, product training, and real-time assistance in collaboration with the Broker Support and Inside Sales teams.
• Lead or participate in joint field activities with brokers, providers, and community organizations to increase visibility and education about plan offerings.
• Deliver ongoing broker and GA training sessions on plan benefits, enrollment processes, and regulatory updates.
• Reinforce compliance with CMS and Covered CA marketing and communication rules, including materials distribution, event standards, and beneficiary interactions.
• Partner with internal compliance and quality teams to ensure accurate and ethical representation of L.A. Care products.
• Collaborate with Provider Relations to align brokers with high-impact provider groups, Federally Qualified Health Centers (FQHCs), and clinics for coordinated outreach and member assistance.
• Work with Community Engagement and Outreach teams to support educational and enrollment events at provider sites, Covered California storefronts, and community-based organizations.
• Represent L.A. Care at industry, community, and outreach events to promote awareness and understanding of L.A. Care’s mission and offerings.
• Track broker and GA performance metrics; provide regular reports and insights to leadership on sales production, retention, and pipeline activity.
• Recommend improvements to broker programs, processes, and communication to enhance channel performance.
• Support the development of sales forecasts, annual plans, and market assessments for D-SNP and Covered CA segments.
• Perform other duties as assigned.

Broker Channel Manager II

• Responsible for assisting the product leadership team within the Product Strategy, Sales and Marketing (PSSM) service area
• Supports ongoing operations of assigned product lines
• Navigates the regulatory/legislative and market environment to drive desired performance levels
• Evaluates policy and regulatory changes to identify impacts to current processes
• Defines product strategy and positioning
• Drives design, feasibility and definition of new innovations
• Conducts cost/benefit analyses, needs assessment and data analysis
• Leads and documents requirement sessions/JAD sessions
• Reviews data to monitor product performance
• Develops processes and product requirements that support business needs
• Designs methods for integrating function and process including improvement opportunities
• Leads efforts to identify best practices to drive product integrity and efficiency

Product Solutions Manager – Senior

• Collaborate with cross-functional teams to develop and coordinate release schedules
• Oversee the packaging of software releases
• Work closely with testing teams to establish and optimize test pipelines
• Assess and document risks associated with each release
• Monitor software performance and reliability post-release

Information Technology Release Manager II

Community Manager

• Support L.A. Care’s mission to provide access to quality health care for Los Angeles County residents by building meaningful connections with members, community partners, and the public
• Conduct presentations, workshops, and outreach events to educate members and community stakeholders about L.A. Care’s Medi-Cal, DSNP, and Covered California programs
• Serve as an L.A. Care ambassador at outreach venues
• Distribute approved educational and promotional materials to increase awareness of health coverage options and program benefits
• Provide culturally and linguistically appropriate information to meet the needs of diverse communities across Los Angeles County
• Educate members and community partners about key regulatory impacts
• Partner with internal teams to ensure messaging aligns with current regulatory guidance and state/federal policy updates
• Build and maintain relationships with community-based organizations, provider groups, advocacy networks, and local government partners to promote L.A. Care programs and services
• Collect feedback from members and partners to identify barriers to enrollment, redetermination, and retention
• Support members in navigating the healthcare system and connecting with enrollment assistance resources, as appropriate
• Plan, schedule, and execute community events including logistics, setup, and coordination with partner organizations
• Track participation, outreach metrics, and community feedback for reporting and evaluation
• Represent L.A. Care professionally and ensure compliance with all marketing and outreach regulatory requirements
• Maintain accurate records of outreach activities, attendance, and outcomes in accordance with L.A. Care standards
• Prepare reports and summaries for management, highlighting community engagement trends and outreach effectiveness

Community and Field Engagement Representative II

• Serve as a primary community ambassador, orchestrating outreach efforts.
• Lead and coordinate outreach and educational events.
• Represent L.A. Care at high-visibility community events.
• Deliver culturally appropriate education to diverse community groups.
• Support onboarding and skills development for new outreach staff.

Community and Field Engagement Representative III

Actuary

• Manage the Monthly Financial Reporting and Analysis
• Review reports to ensure consistency and appropriateness of methodologies used
• Ensure actuarial assumptions, methodologies, and documentation meet regulatory standards
• Interpret results and recommend solutions to identified issues
• Provide assistance in ad-hoc projects related to rate filings, new business development, financial projections, budgeting, and acquisitions
• Oversee the production, validation, and documentation of actuarial reports along with shared risk settlement estimates and regular analyses of revenue and cost trends across benefits and programs
• Manage risk score data analysis and reporting for all lines of business
• Review rates and other at-risk payments from DHCS, CMS, Covered CA, or other governmental agencies
• Manage staff, including monitoring of day-to-day activities of staff, performance, mentoring, training, and cross-training of staff
• Engage and update key stakeholders, develop timelines, and ensure implementation upon approval

Manager, Actuarial Services – Commercial, Medicare

Communications

• Lead and execute L.A. Care’s digital communications strategy across all digital channels
• Manage front-end and back-end operations including content development, UX design, page creation, SEO strategy, coding, development, and platform security
• Strengthen L.A. Care’s reputation and elevate the member experience
• Support digital communications for Community Resource Centers and ensure localized outreach efforts
• Manage all aspects of running an efficient team, including hiring, supervising, coaching, training, and motivating direct reports
• Collaborate with internal stakeholders to ensure secure, compliant, and scalable digital infrastructure
• Utilize analytics tools to monitor performance across digital channels and conduct usability testing