L.A. Care Health Plan

Compliance

• Assisting in the design and implementation of complex compliance projects and activities
• Performing project management
• Assisting with compliance quality assurance and monitoring efforts
• Supporting compliance management on compliance special projects
• Conducting research on regulatory requirements
• Expanding working knowledge of federal and state requirements

Compliance Advisor I

• Ensure compliance of L.A. Care business units with all contractual, state and federal regulatory, and accreditation requirements.
• Develop regulatory submissions, reports, agendas and communications to the Internal Compliance Committee and Compliance and Quality Committee of the Board of Governors.
• Provide support for external regulatory audits.
• Prepare executive summaries and reports, and conduct training activities for business units.
• Investigate and manage teams in compliance-related activities.
• Work with internal business units to create reports, identify gaps, and develop corrective action plans.

Compliance Advisor II

• Lead tactical execution of enterprise compliance initiatives by coordinating planning, prioritization, and progress tracking across departments.
• Translate enterprise strategy into actionable compliance initiatives and measurable outcomes.
• Drive cross-functional integration to embed compliance practices across the enterprise.
• Support and manage compliance analytics, metrics, and performance dashboards.
• Lead change management initiatives to modernize and mature the compliance function.
• Facilitate cross-functional work groups and integration forums to align business units with compliance objectives and resolve barriers to progress.
• Embed compliance controls and protocols into core enterprise workflows, projects, and systems.
• Track initiative milestones, key performance indicators (KPIs), and implementation metrics, escalating delays or risks to ensure timely resolution.
• Prepare and develop status reports, dashboards, and executive briefings for internal committees and leadership.
• Ensure activities under the Annual Compliance Work Plan are supported, tracked, and delivered in collaboration with compliance partners.
• Create and lead adoption of new compliance processes, ensuring proper communication and training where needed.
• Collaborate with key stakeholders, compliance subject matter experts (SMEs), and senior management to sustain alignment across regulatory priorities.
• Represent the Compliance Department in director-level and above leadership forums, contributing to strategic discussions and enterprise alignment.

Advisor, Compliance and Strategy

Manager

• Lead, coach, and develop a team handling inbound and outbound calls, emails, and case escalations for Medicare and Commercial lines of business.
• Set clear performance goals and monitor key metrics to ensure high-quality, timely service.
• Foster a culture of accountability, empathy, and continuous improvement aligned with L.A. Care’s organizational values.
• Ensure brokers and agencies receive a best-in-class experience that reflects L.A. Care’s commitment to service and integrity.
• Monitor trends in broker feedback to identify process or policy improvement opportunities.
• Serve as a point of escalation for complex or high-priority broker issues.
• Partner with cross functional teams to align broker support with overall growth and retention goals.

Manager, Broker Services

• Ensure that the Plan’s processes and operations are compliant with state and federal regulatory requirements
• Develop and lead key initiatives related to regulatory deliverable submissions, regulatory reporting, regulatory analysis and implementation, regulatory audits, corrective action plans, regulator communications, and department processes/workflows
• Lead cross-functional teams and workgroups
• Communicate updates, challenges, and risks to leadership through verbal and written reporting
• Serve as a Subject Matter Expert for the organization
• Assist business units in operational decision-making in accordance with regulatory requirements
• Conduct applicable departmental trainings
• Manage competing priorities and tight regulatory deadlines
• Research, analyze, and clearly communicate regulatory requirements/deliverables to applicable business units
• Provide recommendations from a compliance perspective
• Prepare and conduct compliance-related trainings for internal business units and/or external entities
• Develop processes and specialized tools to monitor compliance performance and support regulatory deliverables
• Perform quality assurance checks on regulatory reports and written submissions
• Identify enterprise-wide issues and risks and recommend remediation plans
• Prepare the organization for regulatory audits
• Proactively drive continuous improvement by recommending compliance process improvement opportunities

Compliance Advisor III

• Lead L.A. Care’s overall Delegation Oversight strategy.
• Ensure that all delegated entities comply with contractual and regulatory requirements.
• Collaborate with cross-functional departments to align oversight activities, mitigate risk, and ensure accountability.
• Develop strategic plans, drive change, and influence critical business outcomes.
• Oversee operations, ensuring efficiency and effectiveness.
• Direct oversight of compliance monitoring and auditing for delegated entities.
• Chair executive governance forums to ensure cross-functional accountability and transparent reporting.
• Identify opportunities for operational improvements and create new policies.
• Prepare and approve budgets, manage financial investments and resources, and monitor performance data.

Senior Director, Compliance Delegation Oversight

Communications

• Responsible for the production and distribution of L.A. Care’s daily employee e-newsletter
• Support and maintain intranet content
• Monitor performance metrics for internal channels
• Write, edit, and format messaging for internal audiences
• Maintain editorial calendars
• Lead assigned internal communications projects and campaigns
• Serve as liaison to Human Resources for organizational messaging needs
• Build relationships with internal departments and senior leaders
• Manage complex projects and engage key stakeholders

Lead Internal Communications

• Lead and implement L.A. Care’s strategic communication initiatives
• Oversee communications and public relations campaigns, media relations, and internal communications
• Support executive leadership with messaging and talking points
• Develop and implement strategic communications plans to support organizational goals
• Manage media relations strategy and serve as point of contact for journalists
• Collaborate with stakeholders to support organizational change, culture, and employee experience
• Monitor performance metrics across communication channels
• Manage staff, including monitoring performance, mentoring, and training

Manager, Strategic Communications

• The DCCO is responsible for advancing the strategic direction of the Compliance department.
• Ensures effective execution of L.A. Care Health Plan’s enterprise-wide compliance program.
• Acts as the department’s operational leader overseeing the day-to-day management of compliance functions.
• Provides direct leadership to Regulatory Compliance, Delegation Oversight, Corporate Compliance Monitoring, and related program areas.
• Serves as the centralized executive leader for Delegation Oversight and accountable for overseeing all delegated functions across the enterprise.
• Leads the transition to a standardized, compliance-led delegation oversight model that strengthens monitoring, auditing, reporting, and corrective action processes across all delegates.

Deputy Chief Compliance Officer

• Manage and strengthen the Compliance Department's communication and engagement with delegated entities
• Ensure L.A. Care maintains an initiative-taking and transparent oversight posture
• Oversee activities related to compliance correspondence, regulatory guidance, and formal Notices of Non-Compliance (NONCs)
• Manage a team serving as L.A. Care's Compliance point of contact for assigned delegates
• Collaborate with cross-functional departments to promote alignment and documentation of oversight activities
• Develop and maintain standardized tools and workflows for issuing and tracking communications

Senior Manager, Compliance Delegation Oversight

Community Manager

• Oversee a team responsible for building and maintaining strong relationships with local communities, members, and partner organizations across Los Angeles County.
• Lead strategic community outreach, executes grassroots outreach, health education, and engagement initiatives.
• Ensure field strategies align with organizational goals and regulatory requirements.
• Set the standard on how the organization shows up in neighborhoods, supports targeted outreach, and gathers market insights.
• Manage all aspects of running an efficient team, including hiring, supervising, coaching, training, and motivating direct reports.

Manager, Community and Field Engagement

Program Manager

• Responsible for investment projects to address key leadership priorities
• Works on projects from concept to implementation stages
• Develops, designs and implements investments in alignment with specific strategic initiatives to support local workforce needs
• Responsible for monitoring program budget and expenditures
• Plans, develops, and implements strategies for generating funding and/or resource opportunities for program activities
• Supports internal planning to identify key investment opportunities
• Identifies key contributors, strategy partners, and overall resources required for investment execution and evaluation
• Recognizes risks and recommends solutions to mitigate impact on operations and maximize benefit to investment recipients
• Conducts needs assessment of investment requirements, scope, budget and timeline for cross-functional department participation and execution
• Identifies opportunities for efficiency in scope and ensure program objectives and deliverables are in alignment with department and L.A. Care goals
• Drafts agreements, work plans and budgets based on approved funding decisions and desired outcomes
• Contributes to annual strategic investment planning in partnership with internal and external stakeholders, including senior leadership
• Develops materials to summarize investment plans, general updates, areas of concerns and proposed solutions to advance priority outcomes
• Monitors inter-connected programs/project work product, outcome and interplay to be able to make necessary enhancements or modifications as appropriate to ensure alignment with department objectives
• Coordinates cross-program/project activities as necessary
• Maintains up to date knowledge of compliance requirements and supports with regulatory body reporting, as requested
• Assesses program performance and aims to maximize return on investment (ROI)

Strategic Investments Program Manager II

Inside Sales

• Provide strategic and operational leadership for inside sales operations and broker telephonic support
• Oversee the inside sales team responsible for Medicare Advantage and Covered CA enrollment support
• Collaborate with internal and external partners to streamline broker engagement
• Develop training programs to ensure staff proficiency in plan benefits and compliance
• Monitor sales performance metrics and implement continuous improvement strategies
• Communicate with senior leadership on performance and objective progress

Director, Inside Sales, Broker Services

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
• Responsible for representing LAC in their partnership with contracted and non-contracted providers
• Responsible for maintaining an understanding of LAC governing regulations, policies and procedures
• Monitoring and managing network adequacy by assuring appropriate access to services throughout L.A. County
• Responsible for the initial on-board training of new managed care contract provider partners
• Responsible for identifying, and contacting, providers and/or provider organizations that are interested in participating with LAC
• Draft contract clauses/addenda, review, and negotiate new contracts/amendments and other contracting related documents
• Act as the liaison between PNM and other internal Plan departments
• Responsible for supporting the credentialing and re-credentialing process

Provider Network Account Manager II

• 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