Cultural and Linguistic Services Specialist II

Job Summary

The Cultural and Linguistic Services (C&L) Specialist II is responsible for overseeing and ensuring the delegated subcontractors’ (i.e. Plan partners, Specialty Plans, Ancillary Vendors, Participating Provider Groups (PPGs)) compliance with the regulatory and National Committee for Quality Assurance (NCQA) in the C&L area. This includes but not limited to monitoring of delegates’ C&L activities, addressing gaps through corrective action plans, and providing technical assistance regarding C&L services delegated subcontractors. The C&L Specialist II manages organization-wide translation and alternative format requests and ensures quality and timely delivery of all requests by working closely with translation vendors during the high-volume periods.

The C&L Specialist II investigates and analyzes member grievances related to C&L Services to identify root causes.

The C&L Specialist II completes activities to ensure compliance with regulatory and NCQA C&L requirements and assists with regulatory audits and NCQA survey preparation.

The C&L Specialist II participates in the multi-department/cross-functional work groups, prepares reports, data, agendas/minutes or other materials.

The C&L Specialist II reviews the effectiveness of the monitoring processes and implements projects to address any gaps and improve C&L services.

Duties

Monitor and oversee delegated subcontractors (i.e., Plan Partners, Specialty Plans, Vendors, and PPGs) through review of their annual and quarterly reports along with audit findings from L.A. Care’s Delegation Oversight. Provide technical assistance to delegates to help them understand and comply with the regulatory and contractual C&L requirements. Work closely with delegates to have them remediate gaps through the corrective action plan process.

Manage the C&L grievance and complaint process by working closely with Appeals and Grievances (A&G) and language vendors on case investigation and timely resolution. Analyze grievance data to identify root causes and implement interventions to address any gaps.

Participate in the multi-department/cross-functional work groups. Prepare reports and data for committees and work groups such as Delegation Oversight work group, Appeals and Grievances work group, and Quality Oversight Committee.

Manage various ongoing and ad-hoc compliance initiatives and projects, including implementing activities to ensure regulatory adherence, preparing documentation for regulatory audits and NCQA accreditation surveys, enhancing compliance processes, and implementing new regulations.

Manage end-to-end translation and alternative format projects in accordance with project timeline, budget, and resources.

Provide additional support to Translation Services Specialists and Interpreting Services Specialists as requested.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

A minimum of 4 years of experience working in a compliance related role; developing interventions; successfully implementing projects; data management/analysis; preparing reports in a managed care setting or in a relevant field.

Skills

Required:

Knowledge of Department of Health Care Services (DHCS), California Department of Managed Health Care (DHMC), CMS Language Assistance requirements, Office of Minority Culturally and Linguistically Appropriate Services (CLAS) Standards, and NCQA Health Equity standards.

Ability to critically think, work independently and assume responsibility for successful completion while soliciting help from internal or external sources as needed.    

Demonstrated ability to multi-task, problem-solve and troubleshoot all assignments/project issues in a timely manner.

Excellent interpersonal skills to work alongside delegates and other stakeholders to address all client specifications and requirements while maintaining alignment with the overall goals of the C&L Unit and organization.   

High level of professionalism.

Excellent verbal and written communication and presentation skills.

Must be proficient in Microsoft Office (Word, Excel, and PowerPoint) and other computer applications.

Attention to detail with an ability to work within tight deadlines in a fast-paced environment. 

Preferred:

Advance Microsoft Access skills (ability to write queries).

Knowledge of health equity.

Knowledge of translation and/or interpreting project cycle.

Knowledge of machine translation, translation memory, glossary management and best practices.

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

Licenses/Certifications Preferred

Required Training

Preferred: 

Project management

Physical Requirements

Additional Information