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<p><strong>Clinical Laboratory Scientist</strong></p><p></p><p>Are you ready to make a difference in the fight against cancer? We’re looking for a passionate Clinical Laboratory Scientist to join one of the nation’s only outpatient clinics dedicated to multiple myeloma treatment and research!</p><p>Led by a world-renowned oncologist and researcher, our client’s center is a pioneer in creating cutting-edge therapies for patients with myeloma and associated blood cancers. The center is located near Beverly Hills in the Sunset Medical Tower in West Hollywood, California.</p><p><strong>To thrive as a Clinical Laboratory Scientist, you should have:</strong></p><ul><li>Bachelor’s degree in a life science or related ﬁeld</li><li>Hold an active (CLS) Clinical Laboratory Scientist certiﬁcation and license with the state of California.</li><li>ASCP or HEW certiﬁcation.</li><li>3+ years of experience in a laboratory environment with similar functions</li><li>Experience with state and federal regulations.</li><li>Physical requirements: prolonged sitting at a desk and working on a computer. Must be able to lift to 15 pounds at a time.</li><li>Knowledge of basic computer skills, including Microsoft Office applications</li></ul><p><strong>Your responsibilities as the Clinical Laboratory Scientist will include:</strong></p><ul><li>Collect, process, and analyze specimens like blood, urine, and tissues, performing tests of varying complexity (e.g., CBCs, metabolic panels, electrophoresis).</li><li>Ensure high accuracy through routine equipment calibration, troubleshooting, and maintenance.</li><li>Report test results, collaborate with the clinic team, and follow all safety and regulatory standards (CLIA, COLA, state licenses).</li><li>Manage lab supplies, oversee procurement, and recommend new equipment.</li><li>Maintain and complete documentation (temperature logs, records for accreditation) and assist with clinic projects and staff supervision if required.</li></ul><p></p><p><strong>Best-in-Class Benefits: &nbsp;</strong></p><p>Our client values their employees’ time and efforts. Their commitment to your success is enhanced by a competitive compensation of $40 - $45 per hour, depending on experience, and an extensive benefits package including:</p><ul><li>Health benefits, including medical, dental, and vision insurance.</li><li>401(k) / retirement plan with employer matching</li><li>Life and disability insurance.</li><li>Flexible spending account.</li><li>Health savings account.</li><li>Paid time off and holidays.</li><li>Flexible schedule.</li><li>Employee assistance program.</li><li>Professional development assistance.</li></ul><p>Plus, they work to maintain the best environment for their employees, where people can learn and grow with the company. They strive to provide a collaborative, creative environment where everyone feels encouraged to contribute to their processes, decisions, planning, and culture.</p><p><em>We are an equal-opportunity employer that welcomes and encourages diversity in the workplace. We do not discriminate based on race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.</em></p><p></p><p><em>Qualified applicants with arrest or conviction records will be considered for employment with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.&nbsp;</em></p>

Insperity

Clinical Laboratory Scientist

<p>Join the Clean Energy Revolution</p><p>Become&nbsp;a&nbsp;System Operations, Senior Accountant&nbsp;at Southern California Edison (SCE) and build a better tomorrow. In this job, you’ll work with senior leaders in providing hands-on technical support and maintenance for the end-to-end integration and management of the financial accounting SAP/PowerPlant system and interfacing sub-systems, tools, and applications to ensure the data integrity and reliability meets accounting, reporting, and regulatory compliance objectives. </p><p>Also, responsible for resolving technical and complex problems that involve engagement with end users throughout Finance and IT partners, providing technical and functional leadership and guidance in the day-to-day operations of our processes and systems.</p><p>As a Systems Operations, Senior Accountant, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future?</p><h4>Responsibilities</h4><ul><li>Initiates and prepares the general ledger and month end close entries</li><li>Coordinates with internal staff and external accounting firm to facilitate the annual financial statement audit</li><li>Executes the preparation, compilation and review of monthly and annual financial statements and other reports  in accordance with generally accepted accounting principles.</li><li>Conducts a monthly variance analysis and identifies variance causes and trends</li><li>Gathers data for a monthly cash report for management, detailing the current cash position for each bank account and reconciling all temporarily restricted fund balances</li><li>Carries out the year-end audit; compile and prepare supporting schedules, work papers, and financial reports as requested by auditors</li><li>Facilitates the creation of various reports for financial, tax, and regulatory purposes</li><li>Undertakes financial analysis and support for quarterly forecasts and annual budgets</li><li>A material job duty of all positions within the Company is ensuring the protection of all its physical, financial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, confidential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity.</li></ul><h4>Minimum Qualifications</h4><ul><li>Five or more years of experience in accounting.</li><li>Experience with interpreting and applying Generally Accepted Accounting Principles (GAAP)</li></ul><p>Preferred Qualifications</p><ul><li>Bachelor’s degree or higher in Accounting, Finance, Business Administration, Computer Information Systems, or other related fields.</li><li>Project Management Certification.&nbsp;</li><li>Knowledge of SAP/ERP applications/modules with deep understanding of related business processes and operating models spanning one or more business process domains, such as FERC Accounting/Module, G/L Accounting, SAP Finance (FI, CO or S4 Hana Finance), and/or SCE cost flows and allocations.</li><li>Experience identifying and implementing process improvements or technology solutions.</li><li>Experience and technical knowledge of Alteryx, Business Objects, Snowflake, Power BI, SAS, or Python</li></ul><p>You should know</p><ul><li>This position’s work mode is&nbsp;hybrid.&nbsp;The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days.  Unless otherwise noted, employees are required to work and&nbsp;reside in the state of California.  Further details of this work mode will be discussed at the interview stage.&nbsp;The work mode can be changed based on business needs.</li><li>Visit our&nbsp;Candidate Resource&nbsp;page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!</li><li>Relocation does not apply to this position.</li><li>Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.</li></ul><p>About Southern California Edison</p><p>The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world.</p><p>At SCE, we celebrate our differences. We are a proud Equal Opportunity Employer and will not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected status.</p><p>We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodations at (833) 343-0727.</p>

Southern California Edison

System Operations, Senior Accountant

<p>Join the Clean Energy Revolution</p><p>Become&nbsp;a&nbsp;Technical Accounting, Senior Advisor&nbsp;at Southern California Edison (SCE) and build a better tomorrow.&nbsp;In this job, you’ll be part of the Technical Accounting group within the Controller’s Department of Southern California Edison’s (SCE) Finance Organizational Unit. You will be an instrumental member of a group of professionals focused on providing accounting interpretation and implementation guidance associated with accounting standards. </p><p>Specifically, within the technical accounting group, you will be exposed to a wide variety of complex accounting issues and be an instrumental part of the decision-making process. The position requires a detailed knowledge of U.S. Generally Accepted Accounting Principles (US GAAP) in areas such as: leases, revenue recognition, derivatives, and variable interest entities as well as ASC 980 – Utilities.</p><p>As a Technical Accounting Senior Advisor, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future? </p><h4>Responsibilities</h4><p>•&nbsp;&nbsp;&nbsp;&nbsp;Conducts the critical assessment, education, and effective implementation of significant accounting guidance updates on a US GAAP, Statutory and Regulatory basis<br>•&nbsp;&nbsp;&nbsp;&nbsp;Acts as a subject matter expert to assist external financial reporting team in reviewing quarterly and annual reports filed with the SEC<br>•&nbsp;&nbsp;&nbsp;&nbsp;Engages with external auditors on complex topics to align proposed accounting treatment<br>•&nbsp;&nbsp;&nbsp;&nbsp;Provides technical accounting guidance and application related to significant strategic and complex transactions through all phases to ensure accounting considerations are evaluated<br>•&nbsp;&nbsp;&nbsp;&nbsp;Partners with senior level leadership in Finance areas across the various businesses and corporate departments regarding appropriate accounting treatment for significant, complex, and strategically important transactions<br>•&nbsp;&nbsp;&nbsp;&nbsp;Delivers technical accounting advice to other departments with regards to accounting for financial products and structures<br>•&nbsp;&nbsp;&nbsp;&nbsp;Supports the Finance function in compliance with the SCE standard accounting practices and US GAAP<br>•&nbsp;&nbsp;&nbsp;&nbsp;Supports audit/regulatory exam review of accounting conclusions<br>•&nbsp;&nbsp;&nbsp;&nbsp;Interprets the impact of emerging US GAAP and Statutory accounting guidance for all lines of business and leads the cross-functional working group that facilitates the accounting and operational objectives ensuring SCE's readiness upon implementation<br>•&nbsp;&nbsp;&nbsp;&nbsp;Conducts technical accounting training when and if needed<br>•&nbsp;&nbsp;&nbsp;&nbsp;Collaborates with cross-functional teams to ensure accurate and consistent application of our capital vs expense accounting policies<br>•&nbsp;&nbsp;&nbsp;&nbsp;A material job duty of all positions within the Company is ensuring the protection of all its physical, financial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, confidential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity.</p><h4>Minimum Qualifications</h4><ul><li>Seven or more years of experience in accounting.</li><li>Experience with interpreting and applying US GAAP</li><li>CPA (or equivalent)</li></ul><p>Preferred Qualifications</p><ul><li>Master’s degree degree or higher in accounting, Business, Finance, or related discipline.</li><li>Experience in a public accounting firm (preferably with a Big 4 firm) with large SEC clients or experience at FASB or SEC.</li><li>Strong quantitative and analytical skills combined with proven business and financial acumen.</li><li>Strong technical and general accounting knowledge and ability to research FASB, SEC, and other accounting literature.</li><li>Experience in contract reviews.</li><li>Experience in energy/utility industry.</li></ul><p>You should know</p><ul><li>This position’s work mode is&nbsp;hybrid.&nbsp;The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days.  Unless otherwise noted, employees are required to work and&nbsp;reside in the state of California.  Further details of this work mode will be discussed at the interview stage.&nbsp;The work mode can be changed based on business needs.</li><li>Visit our&nbsp;Candidate Resource&nbsp;page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!</li><li>Relocation does not apply to this position.</li><li>Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.</li></ul><p>About Southern California Edison</p><p>The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world.</p><p>At SCE, we celebrate our differences. We are a proud Equal Opportunity Employer and will not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected status.</p><p>We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodations at (833) 343-0727.</p>

Technical Accounting, Senior Advisor

<p>Join the Clean Energy Revolution</p><p>Become&nbsp;a&nbsp;Senior Information and Integration Architect&nbsp;at Southern California Edison (SCE) and build a better tomorrow. In this job, you’ll&nbsp;collaborate with the Senior Manager to develop and implement innovative data solutions that power our Grid Operations, Generation, Transmission and Distribution systems. Your expertise in architecture, data engineering, and integration will drive operational efficiency and inform strategic decisions. If you're passionate about data-driven innovation and want to make a positive impact on the energy industry, join our team.&nbsp;</p><p><br>Data Architecture key focus involves:</p><ul><li>Architectural Design: Develop and maintain data architectures and integration frameworks, patterns for enterprise with emphasis on Asset and Work Management systems. Develop system requirements, logical data models, data mappings, comprehensive data, and integration design for solutions. Ensure alignment with organizational goals and industry standards.</li><li>Data Management: Design and implement data models, data warehouses, and data solutions that support the needs of asset management and work management functions.</li><li>Integration Solutions: Create and manage integration solutions to facilitate seamless data flow between disparate systems, including Enterprise Resource Planning (ERP), Geographic Information Systems (GIS), and Supervisory Control and Data Acquisition (SCADA) systems.</li><li>Data Engineering: Execute data engineering work to support data science and analytics use cases</li><li>Best practices/standards/guidelines: Development for data and integration domain</li><li>Collaboration: Work closely with multi-functional teams, including IT, engineering, operations, and business partners, to understand requirements and deliver integrated solutions.</li><li>Optimization and Performance: Optimize data and integration solutions and design to ensure data quality, reliable and efficient operations.</li><li>Compliance and Security: Ensure data solutions comply with regulatory requirements and data governance policies. Implement robust data security measures.</li><li>Documentation and Reporting: Develop and maintain comprehensive documentation for data architectures, integration solutions, and processes. Provide regular reports on project progress and data engineering use cases.</li></ul><p><br>As a&nbsp;Senior Information and Integration Architect, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future?</p><h4>Responsibilities</h4><ul><li>Creates proof of concepts which identify the right projects to use new technology, assists the project with technology implementation and assists DevOps teams with maintenance of the new implemented technology</li><li>Supports new projects with designing, testing and approving architecture compliance with SCE's architectural principles, standards and blueprints</li><li>Partners with the DevOps team to resolve architectural problems related to any IT domain, including Business, Apps, Data, Security, Server, Networks or Storage</li><li>Analyzes business requirements to develop robust systems requirements to ensure the system characteristic required by the design are achieved</li><li>Analyzes architecture changes and upgrades to existing operational business application and updates supporting design documents.</li><li>Supports IT management with providing technology direction and support</li><li>Writes conceptual, logical and occasional physical architecture specification adhering to SCE adapted TOGAF methodologies and templates</li><li>Assists the Enterprise Architecture team with creating needed artifacts for architecture reviews</li><li>Reviews estimates for software development and delivery to ensure quality and accuracy</li><li>Ensures that platform and project architecture documentation is completed to a high standard</li><li>A material job duty of all positions within the Company is ensuring the protection of all its physical, financial and cybersecurity assets, and properly accessing and managing private customer data, proprietary information, confidential medical records, and other types of highly sensitive information and data with the highest standards of conduct and integrity.</li></ul><h4>Minimum Qualifications</h4><ul><li>Seven or more years of designing and developing IT architecture.</li></ul><p>Preferred Qualifications</p><ul><li>Seven (7) or more years providing architectural direction in information and integration domain to project teams.</li><li>Experience in overall information/data management &amp; governance, data modeling, metadata management, master data management, data quality management, and data integration.</li><li>Experience with systems utilizing high volume and complex data processing, database platform selection and optimization, metadata management suites and OLAP or similar technologies.</li><li>Experience and solid understanding with formal project life cycle methodologies.</li><li>Experience and solid knowledge regarding data stewardship, data quality, ETL and business intelligence tools, and techniques used with big data.</li><li>Bachelor’s degree or higher in Information Management, Information Science &amp; Technology or Data Science preferred.</li><li>Experience with data modeling, data engineering, and data warehousing.</li><li>Experience and proficiency in integration tools and platforms such as Azure APIM, API (Application Programming Interface) management (DataPower), SAP DI, SAP Datasphere, SAP CPI/PO, Microsoft Fabric.</li><li>Experience and knowledge of technologies (e.g., Snowflake, SAP BW/Hana, SQL Server, Oracle, PostgreSQL).</li><li>Experience and familiarity with GIS systems and SCADA architectures.</li><li>Experience with cloud platforms (e.g., Azure, Google Cloud, AWS) and their data services.</li><li>Experience in the utility industry, preferably within an electric utility functional domain in one or more of the areas - Asset Management, Work management, Electric Grid Operations, Outage Management.</li><li>Experience with big data, modeling for structured and unstructured data.</li><li>Experience with Services Oriented Architectures, Microservices, API management</li></ul><p>Additional Information</p><ul><li>This position’s work mode is&nbsp;hybrid.&nbsp;The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days.  Unless otherwise noted, employees are required to work and&nbsp;reside in the state of California.  Further details of this work mode will be discussed at the interview stage.&nbsp;The work mode can be changed based on business needs.</li><li>Visit our&nbsp;Candidate Resource&nbsp;page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!</li><li>Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.</li><li>Relocation does not apply to this position.</li></ul><p>About Southern California Edison</p><p>The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world.</p><p>At SCE, we celebrate our differences. We are a proud Equal Opportunity Employer and will not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected status.</p><p>We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodations at (833) 343-0727.</p>

Senior Information and Integration Architect

<p>Salary Range:&nbsp;&nbsp;$55,245.00&nbsp;(Min.) -&nbsp;$69,045.00&nbsp;(Mid.) -&nbsp;$82,867.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Transitional Care Services (TCS) Community Health Worker II (CHW) is responsible for promoting members’ optimal health and well-being through active engagement and helping them navigate and access health services when transitioning between care settings. The TCS CHW supports members and providers through an integrated approach inclusive of community outreach. Through assessment, collaboration, education and support, the TCS CHW helps identify and resolve members’ barriers to safe care transitions from facilities by ensuring coordination with the facility discharge staff and connecting members to their providers as well as appropriate programs and services to support their daily functioning.</p><h4>Duties</h4><p>Cultural Mediation Among Individuals, Communities, and Health and Social Service Systems: Educating individuals and communities about how to use health and social service systems (including understanding how systems operate). Educating systems about community perspectives and cultural norms. Building health literacy and cross-cultural communication. (5%)</p><p>Providing Culturally Appropriate Health Education and Information: Conducting health promotion and disease prevention education in a manner that matches linguistic and cultural needs of members. Providing necessary information to understand and prevent diseases and help members manage health conditions (including chronic disease). (5%)</p><p>Care Coordination, Case Management, and System Navigation: Participating in telephonic and/or in-person care coordination and case management with members, facility staff, and providers. Making post-transition referrals and providing follow-up. Coordinating transportation to services and helping address barriers to services. Documenting and tracking individual and population level data. Informing people and systems about community assets and challenges. (25%)</p><p>Providing Coaching and Social Support: Providing individual support and coaching, including how to manage their health conditions following discharge and identifying critical symptoms. Motivating and encouraging people to obtain care and other services. Supporting self-management of disease prevention and management of health conditions (including chronic disease). Planning and/or leading support and health education groups. (10%)</p><h4>Advocating for Individuals and Communities: Advocating for the needs and perspectives of communities. Connecting to resources and advocating for basic needs (e.g. food and housing). Conducting policy advocacy for their communities. (5%) </h4><h4>Building Individual and Community Capacity: Building individual and community capacity by training with peers and among CHW groups. (5%)</h4><h4>Implementing Individual Assessments: Participating in design, implementation, and interpretation of individual-level assessments (e.g. Health Risk Assessments, medication reviews, home environmental and safety assessment). (10%)</h4><h4>Duties Continued</h4><h4>Conducting Outreach: Telephonic and/or in-person recruitment of individuals and families to participate in Transitional Care Services and other supports. Follow up on health and social service encounters with individuals and families, in coordination with primary care providers and facility staff. Home visiting to provide education, assessment, and social support following a care transition, if appropriate. (25%)</h4><h4>Perform other duties as assigned. (10%)</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>At least 6 months of experience as a health navigator, peer support worker, outreach worker, promotora, or working in a community setting and providing health education for chronic conditions, or equivalent.</p><h4>Skills</h4><p>Required:</p><p>Knowledge of community resources for Medi-Cal members. </p><p>Comfortable working with diverse populations.</p><p>Exceptional ability to connect and engage with people.</p><p>Willingness to work in various environments including 1:1 in member’s homes, hospitals, skilled nursing facilities, other clinical settings, and/ or shelters.</p><p>Excellent verbal and written communication skills.</p><p>Detail oriented, organized and possess time management skills.</p><p>Basic computer skills.</p><p>Preferred:&nbsp;</p><p><br>"Bilingual in one of LA Care Health Plan’s threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese ".</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Mental Health First Aide Certification<h4>Required Training</h4><p>Preferred:<br>Successful completion of a Community Health Worker formal training program from a college or other education institution is preferred.</p><p>Training in health education for chronic diseases, motivational interviewing is desirable.</p><h4>Physical Requirements</h4><h4>Additional Information</h4><p>Required:</p><p>Must have access to reliable transportation to carry out job-related essential functions.</p><p>Able to work flexible job hours.</p><p>Travel to offsite locations for work.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Public Health, Travel Nurse, Medical, Counseling, Healthcare                                                    </p>

L.A. Care Health Plan

Transitional Care Services Community Health Worker II

<p>Salary Range:&nbsp;&nbsp;$105,267.00&nbsp;(Min.) -&nbsp;$139,478.00&nbsp;(Mid.) -&nbsp;$173,689.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Enterprise Architect Integration Engineer II is responsible for developing standards, tools and governance for capturing, storing and delivering enterprise data. This position is responsible to design and build L.A. Care's Data API work and/or SOA architecture. Working closely with the business, application and Information Technology (I.T.) infrastructure teams, the Enterprise Architect Integration Engineer II will analyze business and technical problems and develop the appropriate the framework to incorporate Master Data, event driven and batch processing entities to the Enterprise Data Management Cloud (EDMC) and/or master service bus.</p><h4>Duties</h4><p>Develop integration and architecture to meet the business needs of the company by working closely with key stakeholders and partners.</p><p>Integrate I.T. Solutions into a common framework. Enforce standards around systems technology stacks and mechanisms for governing cloud-based infrastructure.</p><p>Support in-house development teams to implement solutions. Responsible for providing technical and management guidance to all departments and works closely with development teams to ensure compliance. Supports the creation of roadmap documents, architectural documents, process documents, standards documents and governance documents. Collaborates with program-level architects across the organization on the details of the systems architecture for their particular domain.</p><p>Work closely with I.T. functional areas to identify and resolve integration and workflow considerations and issues. Responsible for assisting with the overall system design and architecture. Responsible for providing EA support to the Development department and Enterprise Architecture team. Work with other architects around business, data, systems, and security needs and how applications best participate in the overall enterprise architecture.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Computer Science or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 5 years of experience in design and implementation of data applications and integrations, using modern development tools, i.e. Java JSP applications or ORACLE/PL/SQL, or SQL Server Batch processes or similar technologies. </p><p>At least 5 years of experience designing and building solutions with SOAP, Rest API, Micro service development suites, i.e.&nbsp; Informatica IDMC/IICS, Mulesoft, or ORACLE SOA suite (ESB/BPEL/SOA/BAM).</p><p>Strong experience of managing advanced technical resources.</p><p>Demonstrated experience designing and building enterprise level canonical models.</p><p>Experience in multiple database platforms, including NoSQL, SQL Server and/or Oracle, Snowflake, Red Shift, Data Bricks, etc.</p><p>Experience working with end users to gather requirements and build technical solutions from concept to implementation.</p><p>Preferred:</p><p>Previous healthcare experience.</p><h4>Skills</h4><p>Required:</p><p>Strong understanding of process and queueing design patterns.</p><p>Strong problem-solving and analytical skills.</p><p>Excellent verbal and written communication skills with the ability to discuss and understand HealthCare business partners across all operations.&nbsp; </p><p>Must be well organized, flexible, motivated and enjoy the challenges of supporting a complex, changing environment, with attention to detail, at times under pressure, remaining flexible, proactive, resourceful and efficient. </p><p>Ability to build relationships throughout business units, our customers, and their teams to ensure that the services provided are of exceptional quality.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Department Specifics:</p><p><em>IT Enterprise Architecture:</em></p><p>Additional Duties and Responsibilities:</p><p>Develop Data Integration, API Integration and Application Integration architecture to meet the business needs of the company by working closely with key stakeholders and partners.</p><p>Integrate I.T. Solutions into the Enterprise Data Management Cloud framework.</p><p><em>IT Solutions Delivery:</em></p><p>Additional Duties and Responsibilities:</p><p>Develop SOA integration and Business Workflow architecture to meet the business needs of the company by working closely with key stakeholders and partners.</p><p>Integrate common SOA, BPEL, BAM, OSB, B2B, SQL, Core JAVA and Service Gateway Standards.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

Enterprise Architect Integration Engineer II

<p>Salary Range:&nbsp;&nbsp;$47,840.00&nbsp;(Min.) -&nbsp;$57,062.00&nbsp;(Mid.) -&nbsp;$68,474.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Community Resource Center (CRC) Specialist II supports in building relationships with members of the community, L.A. Care departments, and Blue Shield of California Promise Health Plan staff (under a collaborative partnership agreement), community based agencies, government agencies, and CRC vendors and instructors. The role supports community and provider communication and engagement initiatives to increase member traffic at a CRC and provides information to members of the community to physical and health education programs, classes and resources. Acts as a key partner to support the CRC marketing and promotional initiatives to meet operational needs. Follows workflows to refer members to receive services across L.A. Care departments that support a member's health care journey to promote positive health care outcomes. Helps connect members and community participants in understanding health care access issues, identifies resource needs based on social drivers resulting from member inquiries and health assessments, and refers to the appropriate source for subject matter assistance. Provides ongoing member assistance and follow-up in select cases. Works in partnership with L.A. Care health plan departments to provide customer service, social services support, care management, health education resources, behavioral health, member engagement marketing and communication, relies on line of business product knowledge and business insight. The CRCs serve anyone in the community in which they are located; and therefore, this role will provide support on referral processes to connect non-member cases to the appropriate external resources and collaborate with key stakeholders across L.A. Care in support of positive outcomes for members.</p><p>Supports the planning and development, implementation, and analysis of CRC services, programming, and vendor management. This role may support special projects following directions and instructions from a work plan, technical procedures, and relationship management ensuring successful implementation of CRC initiatives. </p><h4>Duties</h4><p>Day-to-Day Representation: (25%)<br>Supports the coordination of member-centric customer service to respond and resolve inquiries and questions and bridges members to appropriate resources. &nbsp;Provides guidance and support to inform, guide, and educate members, community residents, and other stakeholders regarding health education programs, benefit information, resources and support available at L.A. Care and partner health plan benefits, CRC resources to meet the member/visitor needs. Collaborates with team members to create resource guides and reference materials. &nbsp;Implements the appropriate approach to identify member or visitor resource needs in complex situations and takes action to link the member/visitor to the appropriate services, programs, or resources. Actively identifies gaps in CRC services, resources, and programs, delivers recommendations for new programs and proposes solutions for the implementation of new services. &nbsp;Participates in day-to-day work operations including opening and closing of the CRC, ordering and maintaining of office supplies, and inventory. Supports CRC vendors which deliver facility maintenance. Coordinates, maintains, and schedules CRC calendar and conference rooms, including management of appointments. Prepares conference/training rooms and assists with support services, as needed. Answers incoming calls in a timely and professional manner. &nbsp;</p><p>High-Touch Customer Focus: (25%)&nbsp;<br>Performs high quality in-person service and contributes to the extended-hour schedule of the CRC to support members and visitors that may need services outside of regular operating hours and days based on business needs. Implements child development activities and programs to support children development while parents and guardians attend a class or service appointment at the CRC. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p><p>Cross-Collaboration: (20%)<br>Supports community initiatives maintaining good relationships within L.A. Care and Blue Shield Promise Health Plan, and with community stakeholders to promote access to health care programs, classes, and preventative services offered at the CRC. &nbsp;Provides information to other L.A. Care departments on services and activities that resonate with and engage members of the CRC community based on hands-on experience at the Center.</p><p>Outreach and Engagement: (15%)</p><p>Supports and nurtures relationships with key internal and external stakeholders; and, is an ambassador to promote CRC partnership brand recognition. &nbsp;Establishes relationships with key community stakeholders, informs management on community needs, and enters data to inform an integrated approach to outreach activities and targeted member engagement. &nbsp;Supports planning, development, implementation, and analysis, of member and community engagement activities to increase member traffic at the supports outreach and engagement activities to attract new L.A. Care and partner health plan members into the CRC to participate in services and programs. Provides feedback to bridge members of the community to physical and health education programs and classes which will enhance health outcomes and member experience. &nbsp;Supports communications and marketing efforts through multiple platforms to increase member traffic at assigned CRC.</p><h4>Duties Continued</h4><p>Implementing Strategic Initiatives: (15%)<br>Supports the implementation of special projects which include identifying the scope of work responsibilities, accountabilities, deliverables, key milestones, timelines, and specific tasks that &nbsp;must be completed in order to ensure project, initiatives, and events are successfully implemented within the required timeframe.<br>Supports in monitoring risks and provides recommendations for management to implement mitigation plans to keep initiatives on-track. &nbsp;Collaborates in the maintenance of consistent documentation of project deliverables, tracks and reports project status. &nbsp;&nbsp;</p><p>Performs other duties as assigned. (10%)</p><h4>Education Required</h4>Associate's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p>Required:<br>At least 6 months of community work focused on health care, public health, or health education, OR at least 6 months of operations work experience, community events, leading projects, and supporting relationships with multiple stakeholders.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<br>Experience with data entry and reporting processes.&nbsp;</p><p>Preferred:<br>Previous experience in child development activities. &nbsp;</p><h4>Skills</h4><p>Required:<br>Ability to communicate verbally and in writing.</p><p>Organizational skills.</p><p>Detail-oriented, collaborative and enthusiastic team player.&nbsp;</p><p>Ability to assist with inquiries and identify creative solutions to assist members and community stakeholders.</p><p>Ability to troubleshoot problem areas and support effective alternative solutions and provide optimal customer service for internal and external customers.</p><p>Action oriented attitude to take on new opportunities and rewarding challenges with a sense of urgency, high energy, and enthusiasm.</p><p>Ability to multi-task and meet competing deadlines while maintaining attention to detail and accuracy.</p><p>Ability to work independently or as part of a diverse team while applying business-insight as well as empathy towards members.</p><p>Initiative to act on anticipated business needs in the operational and customer service areas.<br><br>Ability to adapt quickly to a fast-changing environment.</p><p>Knowledge of MS Office including Outlook, Word, Excel, and PowerPoint</p><p>Excellent customer service skills.</p><p>Interpersonal skills, ability to read non-verbal cues and apply situational adaptability skills.</p><p>Ability to make sound decisions with incomplete information.</p><p>Preferred:<br>Experience with the Salesforce Customer Relationship Management (CRM) platform</p><p>Knowledge and understanding of the unique needs of the Medi-Cal beneficiary populations within a social service, healthcare, not-for-profit, or government setting.&nbsp;</p><p>Knowledge of public agencies, organizations, and other resources that support Community Resource Center visitors.</p><p>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.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p>Required:&nbsp;<br>Cardiopulmonary&nbsp;resuscitation &nbsp;(CPR) and California Mandated Reporter within 90 days-of-hire</p><p>Preferred:&nbsp;<br>Management of Aggressive Behavior (MOAB), de-escalation techniques training, safe lifting practices training.</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Required:</p><p>Travel to offsite locations for work.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Long Beach                                            <br><strong>Nearest Secondary Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Relationship Manager, Behavioral Health, Data Entry, Public Health, Social Services, Customer Service, Healthcare, Administrative, Service                                                    </p>

Community Resource Center Specialist II

<p>Salary Range:&nbsp;&nbsp;$45,760.00&nbsp;(Min.) -&nbsp;$47,823.00&nbsp;(Mid.) -&nbsp;$55,818.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p><br>The Claims Data Entry Clerk II is responsible for the accurate and timely data entry of claims and other documents, which includes: Keying claims for all lines of business, including complex claims. Data Entry of Claims in Core adjudication system. Checking the eligibility of members of services in order to sort claims by product. Scanning and sorting medical records. Reviewing claims for required information, returning claims to the provider when necessary. Preparing reports and ensuring that reports are accurate and generated within specified timeframes.</p><h4>Duties</h4><p>Creates and sends Rejection letters to the providers for the rejected Claims with 98.5% accuracy. Follows L.A. Care (LAC) policies and procedures. Keeps current with incoming daily receipts. Meets production standards. (50%)</p><p>Accurately sorts based on department procedures. Keeps current with incoming daily receipts. (25%)</p><p>Performs special projects and ad-hoc reporting as necessary. Projects are complete and reports are generated within the specific time frame agreed upon at the time of assignment. (15%)</p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>At least 6&nbsp;months&nbsp;of accurate, high-volume claims data entry or claims processing experience.</p><p>Preferred: <br>Managed care or Medi-Cal claims experience.</p><h4>Skills</h4><p><br>Proficient in Microsoft Office</p><p>Strong verbal and written communication skills</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><p><strong>Preferred:</strong><br>Claims Examiner Training</p><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Data Entry, Claims, Clerical, Administrative, Insurance                                                    </p>

Claims Data Entry Clerk II

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Business Insights Data Analyst III is a key contributor responsible for supporting short and long-term operational and/or strategic business initiatives in the healthcare sector.&nbsp; This position navigates the complexities of healthcare data. This position encourages a dynamic and innovative mindset, emphasizing the importance of thinking outside the box.&nbsp; Independently navigates and analyzes data sources to derive meaningful insights. As part of the essential duties, this role involves extensive experience in data visualization, utilizing tools to translate complex datasets into visually compelling and easily understandable presentations. This position provides weaving narratives that communicate actionable insights to diverse stakeholders. </p><p>Furthermore, the Business Insights Data Analyst III collaborates in a highly matrixed environment with senior leaders, management, and line staff is essential. This position serves as a mentor to team members, leveraging analytics proficiency to drive successful outcomes. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Technical Excellence and Systematic Analysis: Completes work in a technical and systematic manner, applying standard formulas and methods prevalent in the healthcare industry.</p><p>Collects, manipulates, and analyzes data with precision, ensuring adherence to industry standards and relevance to current data trends.</p><p>Statistical Analysis and Modeling: Utilizes correlation analysis techniques to expose potential drivers in outcomes. Deploys statistical process controls to identify observations (e.g., providers, time-periods) which require additional special cause investigation. Determines and implements case-appropriate multivariate modeling techniques, such as basic regression and clustering.</p><p>Report Preparation and Visualization: Prepares detailed reports, utilizing a variety of visualizations such as graphs, charts, and dashboards effectively communicating significant results derived from data analysis. Collaborates with cross-functional teams to ensure reports align with business objectives and provide actionable insights.</p><p>Influential Communication and Project Leadership:&nbsp; Influences senior leadership, management, and line staff through compelling recommendations generated from data analysis. Drives initiatives to completion within a highly matrixed environment.</p><p>Adaptive Responsibilities: Conducts root cause analysis to identify underlying issues and drive effective solutions, leveraging data insights to address systemic problems. Adapts to evolving healthcare business and processes, demonstrating the ability to pivot and quickly learn new industry concepts and practices.</p><p>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.</p><p>Performs other duties as assigned.</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Healthcare Analytics or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:<br>Minimum 4 years of collecting, manipulating, and analyzing data in business and/or healthcare</p><p>Minimum of 4 years of SQL experience, leveraging big data for complex analyses.</p><p>Extensive experience with data visualization using Tableau.</p><p>Proven experience in independently managing multiple priorities, including researching conflicting and/or inaccurate data to ensure data integrity and reliability.</p><p>Preferred<br>Experience in the healthcare industry.</p><h4>Skills</h4><p><br>Required<br>Proven hands-on experience with relational databases, including Oracle or SQL Server, and expertise in comprehensive data management and analytics platforms such as Cloudera.</p><p>Ability to articulate sophisticated analyses, trends, and strategic opportunities to clients and stakeholders through powerful data storytelling.</p><p>Strong interpersonal skills for effective engagement with management at various levels of the organization, including demonstrated ability to manage projects and initiatives.</p><p><br>Preferred<br>Strong proficiency in Python or R programming, showcasing the ability to harness advanced analytics and automation in data-driven initiatives.<br></p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                </p>

Business Insights Data Analyst III

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>PLEASE NOTE:&nbsp; This position will work&nbsp;Wednesday - Sunday, 7 a.m. to 4 p.m. PST, with rotating holidays.</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p><br>The Customer Solution Center Appeals and Grievances (A&amp;G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care products, Fee for services (FFS )Medi-Cal/Medicare, or commercial insurance.&nbsp;</p><h4>Duties</h4><p>Conducts intake/triage and appropriate classification of Clinical A&amp;G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department.</p><p>Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements.&nbsp; Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA). Identification of Expedited Cases and resolution within 72 hours.</p><p>Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation.</p><p>Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE).&nbsp; Process the case thru to effectuation and final case documentation in the A&amp;G system of record.</p><p>Investigation and preparation of State Fair Hearing cases as assigned. Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE).</p><p>Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews. Prepares authorizations, after approval by the Medical Director.</p><p>When necessary, outreaches to providers, vendors, hospitals, and members to request necessary information or to provide case status and/or next steps.&nbsp; In instances where necessary, sends written notifications to appropriate parties. All interactions including verbal outreach and written communication will be documented in the A&amp;G system of record. </p><p>Participates inter-rater reliability training and assessments.</p><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p>Required:</p><p>At least 5 years of experience in Clinical Nursing and 2 years in Medicare/ Medicaid in a managed care/ health plan environment. </p><h4>Skills</h4><p><br>Required:</p><p>Excellent interpersonal and communication skills. </p><p>Computer literacy and adaptability to computer learning. </p><p>Time management and priority setting skills.</p><p>Must be organized and a team player </p><p>Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.</p><p>Good working knowledge of regulatory requirements/standards.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nursing, Registered Nurse, Medicare, Medicaid, Pharmacy, Healthcare                                                    </p>

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