L.A. Care Health Plan Jobs

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Compliance Advisor III ensures that the Plan's processes and operations are compliant with all state and federal regulatory requirements, including but not limited to, the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health Care (DMHC) requirements. The Advisor III is responsible for developing and leading key initiatives related to regulatory deliverable submissions, regulatory reporting, regulatory analysis and implementation, regulatory audits, corrective action plans, regulator communications, and department processes/workflows. The Advisor III leads cross-functional teams and workgroups and communicates updates, challenges, and risks to leadership through verbal and written reporting. The Advisor III serves as a Subject Matter Expert for the organization and assists business units in operational decision-making in accordance with regulatory requirements. Duties Serve as a lead Advisor within the department and 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, as needed. Serve as a Subject Matter Expert for the rest of the organization and provide guidance on a wide array of compliance matters; assist business units in making decisions to ensure compliance with regulations. Prepare and conduct compliance-related trainings for internal business units and/or external entities. Lead initiatives by developing and ensuring timely, thorough completion of cross-functional work plans and by leading workgroups. Develop processes and specialized tools to monitor compliance performance and support regulatory deliverables. Perform quality assurance checks on regulatory reports and written submissions by developing review tools. Identify enterprise-wide issues and risks, recommend remediation plans, and oversight through to completion. Escalate risks to Compliance management and the Chief Compliance Officer. Prepare the organization for regulatory audits by developing work plans, implementing audit readiness activities, identifying risks, and liaising with regulators. Proactively drive continuous improvement by recommending compliance process improvement opportunities and implementing key Compliance Program activities. Support all Compliance units in implementing the Plan's compliance program. Create workflows and drive efficiency within the Compliance department. Provide written and verbal status reports to Compliance Leadership and Committees. Duties Continued As a Subject Matter Expert, develop and conduct training on unit processes, for lower-tiered positions. 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. Perform other duties as assigned. Education Required Bachelor's Degree in Business Administration or Related Field In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree in Business Administration or Healthcare Related Field Juris Doctor Degree or Doctor of Law Degree (J.D.) Experience Required: At least 5 years of healthcare related experience, with a minimum of 3 years in a managed care setting. Experience to have working knowledge of Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services(CMS) and National Committee for Quality Assurance (NCQA) requirements. Demonstrated experience developing and delivering training programs and making presentations. Preferred: Supervisory experience and/or project management experience. At least 2 years of regulatory change, policy, or risk management experience for a health plan or healthcare system. Skills Required: Knowledge in health care compliance. Must possess a strong understanding of Medi-Cal and Medicare laws and regulations and other state programs. Highly developed analytical and critical thinking skills. Excellent written and verbal communication skills are essential. Ability to manage multiple priorities and projects and meet deadlines. Ability to develop training programs and make presentations to unit and organization staff, including Leadership. Persuasion Skills. Working knowledge of DHCS, DMHC and CMS regulatory requirements. Preferred: Advanced skills in Excel, Visio, PowerPoint and SharePoint. Licenses/Certifications Required Licenses/Certifications Preferred Certified HealthCare Compliance (CHC) Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Medicare, Medicaid, Risk Management, Healthcare, Finance

Family Practice physician employment in California : FM-1115 Primary Care Provider wanted for a LosAngeles- Santa Clarita Valley - Locatedin the Santa Clarita Valley, Home of Six Flags Magic Mountain, Live the LosAngeles lifestyle near the beaches, mountains, famous for entertainment,world-class theme parks, dining, and shopping - Enjoy this suburban Los Angelescommunity, only few miles to the Los Angeles Hot-spots and activities. Generous Compensation package includes: Salary is $280K -$350K, DOE Malpractice Flex Spending Accounts Health, Dental, Vision w/Family plans Life & Disability insurances 401K, Paid time off, Annual stipend for CME Exceptional additional pension plan Federal Public Service Loan Forgiveness programs Professional Allowances 5 Weeks PTO Shareholder potential after three years Medical Group manages all Business and administrative aspects Outpatient Adult P rimary Care wanted to join one of Los Angeles' oldest Multi-Specialty groups , Physician owned multi-specialty group in Los Angeles, with a 90+ year history of clinical excellence. With over 200 physicians. Group offers a broad scope of multi-specialty services with Ancillary and support services in house. Group prides itself on its delivery of quality comprehensive care services, 18-20 patients a day, Mon Fri 4 Work week , In-clinic only, no hospital rounding, designated call schedule which is split up among the PCPs in the region, Group does recognize the need to balance work and family life. Board Certified or Board Eligible Medical Doctor with or w/o US residency with current US work visa.

Pediatrics physician employment in California : UN-1115 Pediatricianfor a Los Angeles bedroom Community located in the High Desert , The VictorValley offers a vastarray of lifestyles, to include local Water-sports and Winter recreation, Malls,shopping, Horse and ranch property, ample golf and other outdoor actives plus,most affordable housing in Southern CA, Close proximity to all of the LosAngeles metro areas various cultural, amusement and entertainment attractions. Generous Compensation package includes: Salaryis $220K -- $240K BOE $20KSign on Bonus Qualifiesfor the NHSC Loan Repayment Program MalpracticeInsurance Medical,Dental insurance with dependents options Lifeinsurance, 403b with 1% Matching Paid Vacation, $2KCME allowance Sickdays and Holidays $10KRelocation allowance Alloverhead, marketing, equipment, and office staff Pediatrician for So Cal Community Health Center, practice is 100% Outpatient, group provides Primary/ Ambulatory Care to theunderserved communities Hesperia and Apple Valley, Clinics also offer age appropriate,dental, and mental health services. Candidates must be competent with EMR, AllOutpatient; Mon Fri - 40-hour week (could include an occasional Sat. ) Board Certified or Board Eligible Medical Doctor with or w/o US residency with current US work visa.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. ***NOTE: For this role we are seeking candidates who live in California*** **Position Purpose:** The Strategic Client Support Manager manages strategic initiatives for assigned large complex customers. This position manages the business relationship with large employer groups and a variety of customer initiatives across the organization. + Performs key liaison to functions between Health Net and large employer groups on strategic initiatives. + Establishes and maintains positive relationships with internal and external parties to assist them in matters relating to the broad scope of Health Net activities + Establishes, organizes and directs work teams to accomplish implementation project work including, but not limited to, identification and confirmation of participants, establishment of a project plan, consistent work team engagement and productivity, meeting facilitation, consensus building, communication and tracking of project timelines, milestones, costs and deliverables, and recommendation documentation and implementation oversight + Provides support for cross-functional and departmental activities lead by others in support of the customer business initiatives. Represents the customer on enterprise-wide cross-functional projects and implementations + Leads impact assessment and business requirements gathering to identify and document impact of an implementation on, for example, existing sales, administrative and operational work streams and systems + Identifies, investigates, and validates improvement opportunities + Conducts work group and steering committee meetings. Prepares and presents project updates for management and work group + Prepares communications and presentations to all levels in the organization and internal and external customers + Prepares and analyzes data to support the customer's programs. Manages ongoing activities such as tracking, monitoring and maintenance of custom contractual obligations for customer, vendor and third-party agreements + Handles and resolves customer problems + Performs other duties as assigned + Statewide travel as required - 10% **Education/Experience:** Bachelor's degree in business or related field or equivalent experience. Minimum five years account or project management experience, which includes leading large complex cross-functional projects. Health care or other relevant industry experience preferred. Experience working with large employers preferred. License/Certification: Possession of a California Department of Insurance: Accident & Health or Sickness and Life licenses or the ability to acquire one within a reasonable period of time preferred. Pay Range: $86,000.00 - $154,700.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Program Manager III oversees multiple complex programs in the department. This position designs and manages the implementation, operations, and the evaluation of strategic programs or functions of the assigned program of responsibility. The position strategizes implements and maintains program initiatives that adhere to the department's goals. Acts as a Subject Matter Expert, (SME) serves as a resource and mentor for other staff. Duties Aligns program goals with the organizational strategy. Defines and maintains standards for program management within the department. Develop program goals and objectives. Ensure team members have the resources needed to meet their objectives. . Responsible for defining the metrics, quality standards, and documentation required for consistent project management and execution across the business Serves as SME for all programmatic processes and procedures. Provide strategic direction to program start-up and closeout activities including development, and refinement of program management tools, resources, and processes. Directly responsible for the financial management of assigned programs including the development, tracking, and updating of budgets; monitoring monthly projections and actuals; obligated funds notifications; budget modifications and other financial matters. Designs and orchestrates the delivery of applicable communication to staff and management to establish goals and strategies related to the program. Oversee the development and implementation of annual work plans, ensuring timely and high-quality reviews and submissions. Collaborates with key stakeholders on program implementation and facilitate communications with cross-functional departments on the status of ongoing activities, manage compliance to scope and reporting requirements. Ensure approval from management are in place. Provides recommendations and guidelines on strategic business development, including the identification and pursuit of new business opportunities, and technical assistance to support full cycle program development Duties Continued Manage and troubleshoot issues, including but not limited to cross-functional team relations, financial, and regulatory compliance, reporting and documentation. Applies subject matter 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 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. Perform other duties as assigned. Education Required Bachelor's Degree in Related Field Education Preferred Master's Degree in Related Field Experience At least 5 years of strong program management experience with large and complex programs. Experience performing problem solving, policy, and/or program implementation. Experience in overseeing program/project teams Skills Required: Strong ability to build strong relationship management with a diverse set of partners Ability to convey complex information, listen actively, and negotiate effectively. Strong skills in strategic thinking. Ability to Identify and analyze issues, and devise effective solutions. Demonstrated ability to Stay open to change and continuously learn. Understand the wider objectives of the program, such as business and strategic goals. Strong knowledge of budgeting and resource allocation procedures. Licenses/Certifications Required Licenses/Certifications Preferred Program Management Professional (PgMP) Lean Six Sigma Managing Successful Programmes (MSP) Required Training Physical Requirements Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Relationship Manager, Customer Service

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Financial Compliance Auditor III Claims is responsible for various tasks within the Financial Compliance Unit, including audit of claims processed by medical groups and health plans contracted with L.A. Care. This role works closely with the Supervisor and/or Lead Auditor on identification and resolution of issues in a timely and efficient manner. For Claims Emphasis: This position is responsible for all aspects of assigned claim audits, including audit testing and completion of the audit report. This position is responsible for a variety of complex areas of the Medi-Cal, Medicare, Covered California, and PASC-SEIU benefit and process. This position audits focuses on contractual and regulatory compliance with timeliness and appropriateness standards. This position is responsible for other ongoing tasks as assigned by the Manager of Financial Compliance. These assignments may include claims data reporting in the Online Monitor Tool (OMT), compiling Monthly Timeliness Report (MTR), completion of the financial statement analysis, and Plan Partner oversight of their Independent Practice Association (IPA) network on a quarterly & annual basis. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Perform auditing procedures under minimal supervision during the audits of medical groups and health plans. Provide timely and accurate reports that detail whether medical groups and health plans are meeting certain regulatory and contractual requirements. Communicate issues and findings that would affect the audit results. Perform claims audits for all medical groups and health plans contracted with L.A. Care. Timely audit reports presented to supervisor with one week of the audit date. Communicate issues and findings that would affect the audit results. Perform analysis of medical groups and plan partners. Set up financial audit work papers. Perform certain administrative functions for the audit team. Set up completely and timely work papers needed prior to going on site for the claims audits. Perform other duties as assigned. Duties Continued Education Required Bachelor's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree Experience Required: A minimum of 5 years of experience performing claims audits or claims processing related to Medi-Cal, Cal MediConnect, and/or other managed care product lines similar to L.A. Care's, L.A. Care Covered, and PASC-SEIU programs. Skills Required: Must be self-motivated. Detail-oriented. Able to prioritize assignments, and able to work as part of a team. Excellent verbal and written communication skills. Ability to interface professionally with both internal and external customers at all levels of the organization. Must also have flexible mode of transportation for considerable amount of travel to work off-site. Knowledge and understanding of legislation and regulatory bodies affecting healthcare practices. Knowledge of medical records systems applications. Knowledge of the insurance industry's trends, directions, major issues, regulatory considerations and trendsetters. Knowledge of health insurance products, market segments and marketplaces. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Delegates: This position also conducts sub-delegation claims oversight audit of the PPGs, capitated hospitals and the Plan Partners. This includes all claims processing sub-contracting functions of the delegates. Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Claims, Medicare, Audit, Financial, Insurance, Healthcare, Finance

Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Healthcare Effectiveness Data and Information Set (HEDIS) Abstractor II reviews medical records to ensure completeness, compliance with National Committee for Quality Assurance (NCQA), California Department of Health Care Services (DHCS) and other regulatory agencies. Abstracts medical record information and enters data on appropriate HEDIS forms (tool). Makes determinations regarding compliance on records and refers records to supervisor for clarification when needed. Overreads record review performed by Medical Record vendor for accuracy and researches possible additional records to close HEDIS gaps. Conducts audits and provides HEDIS education at provider offices and provides feedback to office staff and providers on documentation, medical record coding, preventative services, member satisfaction. Duties Reviews medical records to ensure completeness, compliance with NCQA, DHCS and other regulatory requirements. Ensure records are complete and compliant to meet all regulatory requirements with 100% accuracy. Abstracts medical record information and enters data on HEDIS forms (tool) and over reads medical record review performed by vendors. All received medical record information is abstracted and entered accurately on HEDIS forms. Abstracts an average of 100 records or more per day for multiple measures. Works with other staff members to complete the HEDIS project within the time frame for submission to the auditor, NCQA, and regulatory agencies. Identifies compliance issues on records and refers records to supervisor for clarification and approval. Responsible for accurate and prompt medical record decisions. May support schedulers by contacting plan partners or providers for additional information if necessary. Works with schedulers to help them better understand the medical record requests. Speaks with the office staff/manager/provider to clarify the medical record request as necessary. Supports the Lead Medical Record by conducting over reads. Overreads medical record abstractions accurately and documents results in the tools provided in the time frame necessary for reporting HEDIS results. Assists with the preparation of de-identifying records for the audit process. Conducts HEDIS audits at provider sites. Abstracts and calculates findings of 100 or more records from the provider office; meets with the office staff, provider to discuss findings; makes appropriate recommendations to improve documentation and data submission pertinent to HEDIS. Performs other duties as assigned. Duties Continued Education Required Bachelor's Degree in Health Science or Related Field In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Experience Required: A minimum of 3 years of experience in HEDIS abstraction and/or other Quality Improvement, Quality Management experience in a managed healthcare setting. Preferred: Experience in outpatient clinic or hospital setting with three years of HEDIS abstraction training in HEDIS measures pertinent to Medicare and Medi-Cal. Skills Required: Strong background in medical terminology, anatomy and physiology. Proficient in Microsoft Office (Excel, Word and Outlook). Strong communications skills: written, verbal, and interpersonal. Understanding of Health Insurance Portability and Accountability Act (HIPAA); Ability to abide by strict confidentiality regulations as defined by HIPAA and company policy. Working knowledge of the health record, computer system, and data integrity/processing techniques. Must be able to work with providers on documentation and coding. Licenses/Certifications Required Licenses/Certifications Preferred Medical Coding Certification Accredited Health Information Technician (AHIA) Required Training Physical Requirements Light Additional Information Financial Impact: Additional position required due to the impact that the Medicare Star program and Medi-Cal auto-assignment program has on the organization. Required: Travel to offsite locations for work. Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Medical Coding, Physiology, Medicare, Healthcare

Salary Range: $46,800.00 (Min.) - $52,597.00 (Mid.) - $62,270.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Quality and Population Health Coordinator I (QPHC) is responsible for outreaching to members to close care gaps. The QPHC also outreaches to providers for medical record pursuit and retrieval. This position supports the L.A. Care medical groups by assisting with scheduling member appointments. While this role is a combination of remote and in office work, this role is intended to support L.A. Care medical groups by being embedded in the provider offices and providing direct outreach to L.A. Care members. The QPHC is an important member of L.A. Care's quality improvement team, helping to drive improvement in health outcomes, population health, and health equity, as well as member and provider experience. Duties Make outbound calls to members to assist with scheduling and coordinating services (e.g. appointments, lab tests, health screenings, other diagnostic studies, transportation, etc.). (25%) Educate members on missing gaps in care. Encourage them to close care gaps and pursue preventative health and health promotion activities such as health fairs. (25%) Outreach to providers to request medical reports by fax, electronic medical records, or on-site visits if needed. (15%) Review medical records, claims, and encounter data to identify key information to help close gaps in care. (15%) Provide support as needed for care gap closure campaigns and other quality improvement programs. (15%) Perform other duties as assigned. (5%) Duties Continued Education Required High School Diploma/or High School Equivalency Certificate Education Preferred Associate's Degree Experience Required: At least 3 months of experience following basic workflows, procedures, and standards related to patient or provider communication and outreach. Previous experience working in an office setting with basic office equipment such as telephones, fax machines, computers, etc. Preferred: Health Plan, provider practice, or health education experience. Skills Required: Demonstrates deep compassion and sensitivity towards patient needs and community well-being. Driven by strong motivation to positively impact people's lives. Excellent verbal and written communication skills. Excellent interpersonal skills. Proficient with Microsoft Word, Excel, PowerPoint, and Outlook. Skills in utilizing various online platforms and search engines to efficiently gather accurate and relevant information. Highly organized with ability to maintain accurate notes and records. Demonstrates high efficiency in managing tasks and consistently delivering projects to successful and reliable completion. Ability to communicate effectively with patients and health care providers. Preferred: Some knowledge of HEDIS and other quality measures. Some knowledge of quality improvement processes. Bilingual in one of L.A. Care Health Plan's threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese Licenses/Certifications Required Active & Current Driver's License, with a clean record and Auto Insurance Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Required: Travel to offsite locations for work. Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: EMR, Claims, Equity, Medical, Healthcare, Insurance, Finance

Salary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up. This position provides but is not limited to: Supervision for Authorization Technicians Leads, Authorization Technician and clerical staff in the UM department. Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc. Conduct 1.1 monthly sessions with staff to review performance. Consistently track staff performance, and work with individuals to improve performance as needed. Create, review, and administer corrective action forms. Responsible for hiring, training, motivating, evaluating and counseling of assigned Associate Supervisors, Leads, and Representatives. Ensure that Associates, Supervisors, Leads, and Representatives provide efficient and courteous service. Oversee overtime work and will produce accurate accounting of each representative work performance. Conducting evaluations of and implementing enhancements to the day-to-day operations of the unit. Aid with product launches and expansions. Execute tracking, and assessing member satisfaction efforts and identifying potential areas of the unit dissatisfaction and opportunities for improvement. Facilitating the development, review, and revision, as appropriate, of organizational and departmental policies, procedures, and process flows to ensure compliance with relevant regulatory and organizational guidelines. Ensure Associate Supervisors are providing consistent and direct feedback to staff (including Leads) regarding performance, customer service, etc. This position collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports. In addition, this position performs Supervisory roles including payroll, employee Paid Time-Off (PTO) time management, supporting the Leads providing direction and support. The Supervisor authorizes request consistent with auto authorization criteria, maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers. The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports. Duties Supervision of day to day activities of Authorization Technicians, including but not limited to: Providing direction, Monitoring of staff performance and skillsets for consistency and improvement for all lines of business, Handling all questions/issues raised by staff, Developing tools and procedures on training for staff, Recommending process improvement processes, Preparing and analyzing call center statistical reports, Monitoring of skillsets for consistency, Ensuring quantity/quality is met for overtime, Ensure that all comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: Diagnosis (DX) codes, Current Procedural Terminology (CPT) ,Healthcare Common Procedure Coding System (HCPCs) codes. Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements. Computer Input: Accurately and completely processing referrals/authorizations in the MHC system. And distributing a complete file to UM Specialist. Within 2 hours of receipt Identify duplicate requests using the claims and CSIM system to verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system. Appropriately documenting what information was used in making this determination. Within 4 hours of receipt: Appropriate identification and timely notification of time sensitive requests: Appropriately identifying for the staff which you support; request that are priority based on date of receipt and established TAT criteria for compliance. Accurate Filing/Maintenance of confidential member information. Creating secure, complete files. Assist in the preparation of communication for authorization determinations, including, but not limited to preparing template letters for members and providers (authorization approval, denial, deferral, modification and pay/education). Duties Continued Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing). Support UM Committee and Audit activity via Department performance reporting. Assures the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames. Employee training and development within all core systems. New employee orientation to the departments structure and work flow assignments. The Supervisor will support performance standards and develop performance improvement plans. Monitoring policies and procedures including but not limited to time and attendance, monthly incentive and monthly performance audits Perform other duties as assigned. Education Required Associate's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Bachelor's Degree Experience Required: At least 2 years in Medi-Cal managed supervisory experience in a health plan/health insurance authorization processes and/or as a Medical Assistant. At least 1 year of lead (process, program, or staff)/supervisory experience. Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement. Preferred: Experience in working with the disadvantaged population, seniors, or people with chronic conditions or disabilities. Medi-Cal, Healthy Families, Healthy Kids and Medicare background preferred. Skills Required: Strong verbal and written communication skills. Proficient with Microsoft Word, Excel, and Access. Excellent organizational, interpersonal and time management skills. Must be detail-oriented and an enthusiastic team player. Demonstrate proficiency in data entry and processing of referrals/authorizations in the system. Knowledge of medical terminology and ICD-10 and CPT codes. Persuasion Skills: Must be able to interface with members, medical personnel and other internal and external agencies and sometimes convince/persuade others to comply with L.A. Care requirements such as submitting requested information in a timely manner. Also to use the approved Authorization Request form with complete medical information i.e.: DX codes, CPT, HCPC codes. Preferred: Knowledge of MHC and CSIIM computer system. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Call Center Manager, Call Center Supervisor, Payroll, Call Center, Claims, Customer Service, Finance, Insurance

Well-Being Navigator - Bilingual - Anaheim CA The Well-Being Navigator will build trust and rapport with employees and leaders at their dedicated worksite to help facilitate culture change in all areas of well-being. This client-facing role will be onsite full-time with the ability to travel to any of the client's locations at their request. Responsibilities: * Serve as a wellness benefit concierge, providing referrals and education that support both emotional and physical well-being. * Address the employee's barriers to care including social determinants of health by helping the employees navigate and schedule all healthcare appointments or connect to community resources to meet their needs. * Provide culturally sensitive care to a diverse group of employees. * In partnership with the wellness team, implement and execute effective wellness solutions to close gaps in care and reduce total plan spend. Qualifications * Minimum of a (BSW) Bachelors Degree in Social Work, but strongly prefer a Master's degree in Social Work (MSW) * Bilingual Spanish or Haitian Creole to support client population. * At least 2 or more years in benefits and/or healthcare * Understanding and sensitivity to multi-cultural communities * Excellent communication and interpersonal skills * Strong organizational and time management skills * Ability to document patient interactions in multiple electronic systems. * Work independently with critical thinking skills. * Strong team player and proactive problem solver capable of accomplishing program goals * Ability to maintain member confidentiality. * High degree of patience and commitment to team culture * Ability to work the following hours: Hours: 8:30 am - 7 pm Monday - Thursday with occasional weekends (Weekly schedule will not exceed 40 hours). This role is based in the office in Anaheim CA. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 65,500 - 109,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Salary Range: $91,536.00 (Min.) - $121,286.00 (Mid.) - $151,034.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Unified Communications Engineer III leads support of all administrative, planning, monitoring and integration aspects of Call Center, Converge IVR/CVP, In House WebEx, Right fax, Cisco Universal Call Manager and UCCE / PCCE with an emphasis on CVP Scripting. Assist in implementing ICM, CTI/CTIOS and Call Center Reporting. Help secure operation, as well as participate in disaster recovery preparation to ensure communications are in place. Contribute with disaster recovery exercises to demonstrate the capability of establishing Telecommunications in the event of an outage. Perform research, evaluation, installation, and upgrades of Telecom hardware and applications. Assist Helpdesk in areas concerning telecommunications and work with network administration to resolve connectivity issues. Be proactive with training and ensure that documentation is created so that junior staffs can grow and handle such issues with ease in the future. Troubleshoot, rebuild, recover and tune telecom equipment. Adhere to standard operating procedures (SOP's) to guarantee a stable environment. Work closely with business units/end-users, and vendors resulting in solutions for L.A. Care's growth and success. Lead large telecomm projects and ensure staff are effectively performing their tasks to meet deadlines and provide fully functional outcomes. Help with monthly telecommunication system risk analysis and assessment reports. Provide the above mentioned support in a 7x24 operation. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Lead the troubleshooting and design efforts, including IVR/CVP, WebEx, Cisco phone technologies. Installs, configures, and maintains complex Telecommunication components such as gateways, telecomm software. Oversees and coordinates the day-to-day planning, design, operation and maintenance of the voice networks, including call center systems and software. Monitor Cisco IP phones and extensions. Lead all telecom projects and act as an escalation point for senior and junior telecom staffs. Oversees and mature collaboration tools such as WebEx and all videoconferencing systems. Facilitates implementation of Cisco IVR/CVP design and NICE Recording along with configuring UCCE, ICM and CVP scripts. Assists with the preparation of cost estimates for current and proposed telecommunications work. Evaluates new products, performs complex telephony problem resolution and develops documentation of technical standards and interface applications. Document translations and gateway configurations. Work closely with business units/end-users, and vendors resulting in solutions for L.A. Care's growth and success. Provides strategic direction, guidance and integration of products and services. Develops, implements, and maintains policies, procedures, and associated training plans for the telecommunications engineering group. Oversees and coordinates the work of the voice telecommunications engineering staff members to achieve availability goals. Keeps current on latest technologies and best practices. Lead project teams through implementation of large, complex projects from project conceptualization through implementation and project acceptance. Leads complex research and development efforts associated with the network. Responsible for researching hardware and telecom software that will fit the needs of all L.A. Care business units. Duties Continued Outlines and reviews departmental records, which include total network assessment and voice system appraisals. Performs liaison duties, including providing daily support and essential telecommunications activities to customers. Provides mentoring to less experienced members of the team. Works on client requests for support in terms of helping out with telephony, sudden changes, maintenance, and repair issues. Actively participates in reporting and supervising telephony systems, network nodes, and other associated voice related functions. Performs the monthly telecommunication service reports submitted to senior management. Assesses, diagnoses, and resolves complex network problems utilizing advanced capabilities of network analysis tools such as the Network Associates Sniffer; trains other Network Engineers on the resolution of complex problems. Collaborates with the IT operation team to get telecom technologies up and running. Leads the enhancement, execution, and design of a client focused solution based on specified prerequisites, defined within a contract. Responsible for all aspects of administration and monitoring of Call Center systems and software, IVR/CVP, AT&T Connect Conferencing, Right fax, Cisco Universal, Call Manager, WebEx, IM and UCCX. 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. Performs other duties as assigned. Education Required Bachelor's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Experience Required: At least 5 years of system testing and integration experience and/or I.T. Telecommunications with the demonstrated experience on the following list of stated knowledge/experience/skills. Skills Required: Customer orientation- establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations. Timing and prioritization of production jobs to meet deadlines and regulatory compliance. Critical thinking skills and a team player. Strong communication (written and verbal), project management, and organization skills. Display effort on personal growth while contributing to the advancement of the department and company as a whole. Demonstrate working knowledge of telecommunications equipment and software (Cisco UCCE / PCCE, VRU, UCM, CVP,VXML,SIP Trunking, Workforce management (WFM) Convergys IVR/CVP, WebEx, Jabber, and AVST). Configure PG Explorer, CUCM Server. Knowledgeable in intelligence collection systems, identifying and gathering requirements, and supporting operational planning. Strong experience in TCP/IP, Microsoft Outlook email and PDA's. Demonstrate working knowledge in voice recording technologies such as NICE. Licenses/Certifications Required Cisco Certification in Voice over Internet Protocol (VOIP) Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Call Center, Customer Service

Internal Medicine physician employment in California : CC-1108 Internist wanted for opportunity located on the 'Blue Pacific' shore, in beautiful Ventura, live the California lifestyle of beaches, mountains, malls and theme parks, live minutes from the Beach. Just a short commute to Los Angeles, area offers numerous Golf Courses, Universities, Shopping Malls, Nationally recognized public schools, and easy access to airports. Suburban Coastal Southern California at its finest Generous Compensation package includes: Medical Group manages all administrative aspects and office costs Competitive Salary Malpractice insurance with tail coverage Full medical, dental, vision, life, and disability insurance Pension program; 401(a) & 403(b) Flex Spending account 6 weeks PTO $2. 5K for CME Student loan repayment options Relocation fees Internal Medicine wanted for a Federally Qualified Health Care Clinics . An exciting primary care opportunity to join our team of professionals. Provide medical care to patients and refers patients for ancillary or specialty services, supervises medical staff, which may include ACP. Establishes medical policies and procedures and works closely with administration in ensuring the delivery of effective primary health care. Candidates with J1 and H1-B waiver are encouraged to apply. Board Certified or Board Eligible Medical Doctor with or w/o US residency with current US work visa.

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Clinical Data Analyst III supports Healthcare metrics, quality and process improvement activities by producing healthcare outcome measurements that are used for internal and external reporting, the tasks including data quality assurance, process programming, specification documentation and report developing. The Clinical Data Analyst III designs, develops, and generates production and similar reports that may evolve into complex data analysis/data integration projects that this individual may be responsible for maintaining. The complex data analysis/integration projects are those, which may require periodic maintenance on a weekly, monthly, quarterly, biannual, or annual basis. This position works with Information Systems analysts when ongoing reports can be accurately transferred for production. The Clinical Data Analyst III interprets and documents both written and verbal specifications. This position takes basic instructions or specifications and interviews with the client for complete details sufficient for writing data queries based for ad hoc and ongoing health care measures. This position must comprehend the relationships between the field elements in encounters and claims, membership, and provider databases. This position supports the functions related to quality improvement activities inclusive of quarterly reports that demonstrate health care outcomes in comparison to targets or national averages/percentiles published by recognized organizations such as National Committee for Quality Assurance (NCQA) and Center for Disease Control (CDC). Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Design, develop and maintain complex ongoing data projects. Design, develop, and generate ad hoc/production reports. Produce automatic, robust, timely and accurate results based on client specifications and as allowed by available resources. Produce complete documentation, QC reports and periodic results as scheduled. Identify and create work-around to generate valid results that meet the intent of the client's specifications. Investigate and document organizational data flow and sources. Provide thorough documentation regarding current 1) data sources 2) data flow 3) current process and procedures to code, group, QC, link and seed the data. Develop automatic, robust and sharable Statistical Analysis System (SAS) or Structured Query Language (SQL) procedures and programs towards building a comprehensive clinical data repository. Develop analytical programs, databases, routine procedures using SAS or SQL programming language. Create work tools that facilitate tasks by reducing paperwork and errors. Document assumptions, specification in a clear and sharable fashion. 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. Educate/Tutor clients/junior staff on maintenance/usage of database/solutions designed. Educate/Tutor junior staff on data/business knowledge and technical skills. Communicate with stakeholders/clients/collaborators regarding project details and plans. Perform other duties as assigned. Duties Continued Education Required Bachelor's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree in Public Health or Related Field Experience Required: At least 4 years of experience in designing, developing, generating and analyzing ad hoc/production reports in Healthcare/Managed Care setting. Preferred: Experience as a Clinical Data Analyst. Skills Required: Must be able to apply and/or develop technical specifications for health care measures such as those used by National Committee for Quality Assurance (NCQA), HEDIS, Centers for Medicare and Medicaid Services (CMS), and State. Must demonstrate advanced SQL and/or SAS skills in developing programs and procedures for analytics and quality assurance. Must be able to present data in a format that is appropriate for analysis. This includes the ability to determine select the correct information for calculating basic rates, table configuration, and graphical presentations. Must demonstrate an aptitude in learning and expanding abilities to use new applications with basic training. Must be a self-starter and can multi-task and can take charge of assigned projects. Must be able to make recommendations to the clients that demonstrate strengths and limitations of the organization's ability to meet the request. Preferred: Working knowledge of SAS Proc SQL, SAS Macro and database related SAS skills are highly preferred. Licenses/Certifications Required Licenses/Certifications Preferred Statistical Analysis System (SAS) Certification Certified Healthcare Data Analyst (CHDA) Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Public Health, Clinic, Medical Research, Claims, Clinical Research, Healthcare, Insurance

Evernorth Behavioral Health Job Description Case Management Lead Analyst (Licensed Telephonic Counselor) ****Remote but must be licensed in California**** **Licensed in multiple states OR experience with adoption, special needs trusts, estate planning or disability entitlements highly preferred** JOB TITLE: Case Management Lead Analyst (Licensed Telephonic Counselor) JOB BAND: 3 DEPARTMENT: Clinical Operations-Clinical UNIT/SECTION: Military OneSource, Non-medical Counseling REPORTS TO: Non-medical Counseling Manager (Supervisor) ROLE SUMMARY: A great opportunity to help military members and their families! This position is responsible for providing confidential behavioral health consultations and 1-12 fifty minute sessions of non-medical counseling (EAP) to members of the military and their family. Non-medical counseling is focused on a specific issue or concern and includes developing strategies and solutions, building on the participant's strengths, accessing support systems, and utilizing community resources. Sessions are provided telephonically, via video or secure chat and are intended to be solution focused and short-term. Non-medical Counseling topics are varied but often include the following issues: Stress Transition/Relocation Grief and loss Employment issues Marital/couple conflict or communication Parent-Child Relational Problems Academic or Educational problems Problems related to Primary Support The successful candidate will have demonstrated excellence with solution focused therapy with a passion to deliver a service experience that exceeds the participant's expectation. The team works in a fast-paced environment, on a queue, taking non-medical counseling calls in the moment, as well as through scheduled appointments. This role offers a great salary with an excellent benefits package that starts your first day of employment including a continuing education program with funding and extra leave time. Duties and Responsibilities: Provide participants with confidential, non-medical counseling services Assess the participant's immediate risk and biopsychosocial needs Provide appropriate referrals for resources and treatment Use clinical expertise, professional judgment and best practices Execute duty to warn/mandated reporting processes Partner with peers and leaders promoting and embracing a culture of change; supporting all parties through the change process Demonstrate the ability to be agile and flexible in work process. Deliver excellent clinical judgment and interpersonal communication skills Understand confidentiality and privacy regulations Demonstrate excellent verbal and written communication Display knowledge and understanding of the military lifestyle and culture while maintaining the highest degree of sensitivity, compassion and respect for Service Members and their families. Qualifications: Must be a U.S. Citizen Master's degree or PhD from an accredited graduate program in a mental health related field such as social work, psychology, marriage/family therapy, or counseling Current, valid, unrestricted counseling license/certification from the state of California that grants the authority to provide counseling services as an independent practitioner in their respective fields Ability to meet the expectation to sit / apply for cross-licensure in additional state(s). Licensure costs will be fully covered by the company upon hire Minimum 4 years post masters clinical experience as a mental health and/or substance use clinician with demonstrated understanding of multiple therapeutic modalities, including brief therapy. Knowledge and experience with Employee Assistance Programs (CEAP certification optional) Knowledge and experience in crisis management Solid understanding of Z-codes Proficient with multiple software and system applications. Demonstrated ability to set priorities including, but not limited to time management and organizational skills Ability to manage own caseload and coordinate all assigned cases Passion for helping the military community Understanding of military life and culture REQUIRED WORK HOURS: Full time job with a minimum of forty hours per week five days a week. Cigna Background check and Government suitability (including fingerprinting) required. For more information please visit: **************************************************************************************** If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 65,600 - 109,400 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group . About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Performs a broad range of sales operations functions for the new business sales process and will serve as a liaison between assigned New Business Managers and internal partners. This role will have external facing responsibilities and is accountable to be a trusted resource for the end-to-end Sales process from prospective clients (Request for Proposals - RFP) to sold business. Key functions include working closely with presale, underwriting and brokers to ensure documents, information and tasks are moving through the sales process timely with the highest degree of accuracy. This role requires a demonstrated ability to work independently, under tight time constraints while prioritizing workload, demonstrating sound judgment and build relationships internally and externally. Job Duties: Key resource aligned to designated new business managers and their block of brokers, clients and internal matrix partners for the sales operations functions from Request for Proposal (RFP) to post sale implementation and client effective date. Responsible to coordinate and process end- to -end new business sold transactions and document package across all product lines, programs and compliance legislations and mandates as assigned to include “In Good Order” status for successful implementation Demonstrate professional interaction with internal and external partners, proactively obtain missing/incomplete information and ensures the key transactions are moving through the process timely and accurately with attention to detail and follow ups Partner with presale, Underwriting, Product, Health Engagement, Compliance, Service Operations (1st 30 days of new install) and Commission team as needed Communicate information regarding the renewal experience to include downstream risks and notifications for confirmed and pending renewing clients. Maintain tracking and reporting of status and deliverables associated with assigned book of business Supports creation of Finalist Presentation materials with New Business Manager Perform work within standard operating procedures related to the new business process ensuring compliance and timeliness in alignment with quality and service delivery expectations Utilize multiple web-based knowledge resources to review benefits for Federal Regulation and State Mandate compliance, as well as Cigna product standards SFDC audits/updates based on opportunity received Participate in projects related to new business services and other product/process related initiatives. Qualifications: Bachelor/Associate's degree in a related field preferred or at least one year of related experience. Previous sales operations, presale or benefit service experience preferred Prior experience working with matrix partners and external customers is preferred Strong attention to detail and demonstrated experience in delivering high quality work Excellent communication, organization and presentation skills Knowledge of systems such as Excel, Word, Outlook, SFDC applications. Strong attention to detail, analytical and problem solving skills Demonstrated ability to work in a fast paced environment General knowledge of insurance products, procedures and systems for the sales operations/sales support functional area is desired If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of 25 - 38 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Director of Development and Communications (Santa Barbara) Director of Development and Communications - Santa Barbara June 17, 2013 Family Service Agency (FSA) seeks an expert and engaging Director of Development and Communications. The position reports to the Executive Director and also works closely with the Development/Marketing Committee to develop, implement and evaluate a comprehensive fundraising program that includes major gift solicitations, public, foundation and corporate support, special events, planned giving, and public relations/communications. Must possess integrity, astute interpersonal skills, and the ability to leverage key relationships and contacts to ensure meeting revenue goals. At least five years demonstrated success in nonprofit fundraising and effective collaborative relationships with staff, board, and donors required. Personnel management experience and strong analytical, organizational, written and verbal communication skills are imperative. Must be familiar with and passionate about FSA's mission and long tradition of service and commitment to the most vulnerable in our community. F/T position. Salary commensurate with experience. Excellent benefits. Please send cover letter of interest and resumes to: Attention: HR Family Service Agency 123 W. Gutierrez St. Santa Barbara, CA 93101 Fax: ************ *************** EOE

Salary Range: $105,267.00 (Min.) - $139,478.00 (Mid.) - $173,689.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Oracle Database Administrator III is responsible for providing oversight in all aspects of Oracle database systems design, implementation, troubleshooting, and administration. Oversee all aspects of Oracle database system design, implementation, troubleshooting, and administration. Provide tier 2 and 3 support for all corporate Oracle database systems and services to meet or exceed service level agreements. 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 IT services. Maintain database backup/recovery procedures and disaster recovery database environment. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff. Duties Develop and support procedures for database security. Implement and support database software upgrade and patch management procedures. Develop processes, procedures and guidelines for troubleshooting database events and performing tasks. Evaluate and seek solutions to production issues as well as new projects. Work closely with application developers and project managers in solving production issues. Work on Oracle help desk tickets using foot print and resolve the issues and request in timely fashion as defined in SLA. Work with system admins, storage admins and network admins for getting necessary resources for building databases. Deploy codes from version control when approved by the IT release management. Monitor and fix any issues with the daily jobs, and report to production support team as required. Provide on call support to support databases during maintenance and other necessary periods as defined by L.A. Care policy. Install and configure Oracle Goldengate and maintain the existing setups. Manage and monitor more than 100 Oracle databases in various environments such as Dev, QA, and UAT, pre-prod and prod environments. 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. Perform other duties as assigned. Duties Continued Education Required Bachelor's Degree in Computer Science or Information Technology In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Experience Required: At least 10 years of experience in the design, administration and support of Oracle databases in one or more client server environments (e.g. LINUX, UNIX). At least 5 years of technical hands on experience. Experience in Oracle 10g/11g/12c. Experience in Installation and configuration of Oracle database 12c in RHEL. Experience in applying CPU and PSU patches. Experience with Oracle ASM and ASM (Automatic Storage Management) disk group management. Extensive experience with Oracle Database architecture, including RAC, Data Guard, ASM, and Oracle Grid Infrastructure. Experience with scripting languages such as Shell, Python, or Perl for automation of database tasks. Experience in managing large-scale databases and mission-critical systems. Preferred: Experience working with Oracle RAC solutions (Real Application Clusters). Knowledge and experience in RMAN backup and recovery and Oracle EXPDP and IMPDP. Skills Required: Proficiency in working with Unix/Linux and Windows operating systems for database management and scripting. Knowledge of data modeling techniques, database schema design, and normalization. Proficiency in database installation, configuration, upgrading, and patching. Advanced knowledge of SQL and PL/SQL programming for database querying, scripting, and stored procedure development. Ability in tuning and optimizing database performance using tools like Oracle Enterprise Manager (OEM), AWR, ADDM, and SQL Trace. Excellent written and verbal communication skills to interact with team members, stakeholders, and users. Ability in creating and maintaining comprehensive documentation for database configurations, processes, and procedures. High level of accuracy and attention to detail in managing database configurations and performance tuning. Ability in implementing and managing high availability solutions like Oracle RAC and Data Guard, and disaster recovery planning. Ability to manage and execute database projects, including upgrades, migrations, and new implementations. Ability in working in cross-functional teams and collaborating with developers, system administrators, and other IT professionals. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles

Home Infusion Nurse (RN):Candidates for this position should reside in/near Morgan City, Thibodaux, or Houma. Take your nursing expertise and passion to the next level by helping to improve the lives of those we serve. Accredo is the specialty pharma Infusion, Nurse, Registered Nurse, Per Diem, Insurance, Healthcare, Patient, Health Learn More

Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Compliance Advisor II ensures L.A. Care business units are compliant with all Product Lines' contractual, state and federal regulatory, and accreditation requirements. The Compliance Advisor develops regulatory submissions, reports, agendas and communications to the Internal Compliance Committee and the Compliance and Quality Committee of the Board of Governors and provides support for the management of external state and federal regulatory audits. The Compliance Advisor prepares executive summaries and reports, develops and conducts training activities for subordinates, peers and L.A. Care business units and participates in interdisciplinary/cross-functional teams. The Compliance Advisor may investigate, assist with coordination and management of teams and workgroups, project documentation and workflows, draft and complete presentations, auditing and monitoring of performance standards, and other duties as assigned. Although the Compliance Advisor's primary responsibility is providing support and for the Regulatory Compliance unit, the Advisor also advises and supports the Manager, Director, and Chief Compliance Officer on other duties as assigned to support the mission and responsibilities of the Compliance Department and to support the business operations of L.A. Care Health Plan. Duties Analyze and interpret contractual, state and federal regulatory, and accreditation requirements. Participate in and conduct compliance functions, including, but not limited to, developing compliance tools and validating implementation of new requirements and corrective action plans. Work with internal business units to prepare reports for distribution to internal Committees and external entities. Facilitate cross-functional teams including internal business units and/or external entities to correct performance deficiencies. Prepare and conduct trainings for internal business units and/or external entities. Review, approve and suggest revisions on policies and procedures, member/provider materials, compliance work plans, etc., as well as submit to regulatory entities for approval. Work with internal business units to identify gaps, develop and implement corrective action plans and facilitate monitoring activities to ensure compliance with regulatory requirements. Review internal and external inquiries and collaborate with all levels of organizational management, business units and our Delegates to ensure timely, accurate, and complete submissions. This includes self-disclosures of non-compliance issues to the regulators. Develop, maintain, and monitor Internal Compliance Committee (ICC) Charter, Compliance Program and key performance indicators. Responsible for the development of Board/committee write-ups to be presented at the Compliance & Quality (C&Q) and Internal Compliance Committee (ICC) meetings. Perform other duties as assigned. Duties Continued Education Required Bachelor's Degree in Public Health or Related Field In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Master's Degree in Public Health or Related Field Experience Required: At least 3 years of experience in a managed care setting. Experience in health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management (UM) and so forth) and developing audit tools. Demonstrated experience developing and delivering training programs and making presentations. Preferred: 2 years of Medi-Cal, Medicare or commercial product compliance. Regulatory change management and risk management experience and/or business continuity experience in a health plan or hospital setting preferred. Skills Required: Excellent written and verbal communication skills. Knowledge in health care compliance. Ability to manage multiple priorities and projects and meet deadlines. Knowledge of Medi-Cal Managed Care principles and/or government programs. Persuasion Skills: 1. Ensuring organizational compliance with all state and federal Medi-Cal Program requirements reduces L.A. Care's risk to state/federal sanctions and fines- communicate required action to senior management/Board of Governor (BoG), Plan Partner staff. 2. Internal audit program and internal reviews are indicators of the quality of health care services provided to L.A. Care Medi-Cal members. This serves to help maintain a quality and solvent provider network and avert provider network disruptions due to poor quality of care and/or insolvent providers. All areas of risk/noncompliance are to be identified, reported and monitored. Working knowledge of California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and Knox-Keene requirements, as well as highly developed analytical and critical thinking skills, to serve as a resource to internal business units and external entities. Preferred: Advanced skills in Visio, PowerPoint and/or SharePoint preferred. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including * Paid Time Off (PTO) * Tuition Reimbursement * Retirement Plans * Medical, Dental and Vision * Wellness Program * Volunteer Time Off (VTO) Nearest Major Market: Los Angeles Job Segment: Public Health, Internal Audit, Medicare, Risk Management, Medicaid, Healthcare, Finance