Provider Data Services Program Manager II
L.A. Care Health Plan
full-time
Posted on:
Location Type: Office
Location: Los Angeles • California • United States
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Salary
💰 $88,854 - $142,166 per year
About the role
- Lead organizes and coordinates support for Cactus data remediation in various projects
- Represent Provider Data Services Department and leads streamlining auditing areas of compliance
- Support the Director of Credentialing and Data Management through oversight of all data remediation in Cactus
- Collaborate with the Appeals and Grievances Department and leading the re-development of a compliant process that monitors provider complaints
- Manage Cactus Imports and Exports modules, manage implementation of upgrades to Cactus modules
- Act as the Business Lead for Credentialing data reporting
- Resolve complex problems, and work with moderate guidance and direction from the Senior Director
- Initiate and develop strong interpersonal relationships with both internal and external business partners
- Facilitate constructive dialogue among internal and external stakeholders to ensure problems are properly assessed, analyzed and resolved
- Manage internal and external meetings, including the development of agendas and objectives
Requirements
- Bachelor's Degree
- At least 5 years of credentialing auditing experience in a managed care or hospital setting
- Proven experience conducting root-cause analyses, policy requirements, and managing highly visible organizational programs
- Experience building relationships with organizations and business partners
- Strong knowledge of NCQA Credentialing Standards, CMS and DHCS regulatory requirements
- Strong knowledge of Symplr Cactus database systems
- Knowledge of metric management methodology
- Demonstrated critical thinking, problem solving, and program planning and implementation skills
- Demonstrated strong writing and communication skills
- Demonstrated ability to synthesize and analyze qualitative and/or quantitative data
- Proven knowledge of data entry and reporting management within Symplr Cactus database.
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
credentialing auditingroot-cause analysispolicy requirementsmetric management methodologydata entryreporting managementprogram planningprogram implementationdata remediationCactus database management
Soft Skills
interpersonal relationshipsproblem solvingcritical thinkingcommunication skillscollaborationconstructive dialoguestakeholder managementagenda developmentobjective settinganalytical skills
Certifications
Bachelor's Degree