Loading...
 
Apply now »

Director, Medi-Cal Plan Partner Administration

Job Category:  Management/Executive
Department:  Medi-Cal Product Management
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  7124

 

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 in five health plans, 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.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary


The Director of Medi-Cal Plan Partner Administration provides leadership support and drives to strengthen the high performing relationship with subcontracted health plans (Plan Partners) for the Medi-Cal product line.  The Director supports the development and leads the execution of the Medi-Cal Plan Partner strategic and tactical plan, ensuring deliverables are on time and in alignment with L.A. Care’s strategic vision while utilizing a clear understanding of the factors that impact membership growth, cost containment, operational excellence, and compliance/risk.

 

The Director reports to the Executive Director of Medi-Cal to align the goals of the Plan Partner and L.A. Care product domains and ensure consistency in achievement of product objectives (ensure product integrity, maintain financial sustainability, deliver service excellence). The Director directs all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties


Oversees daily Plan Partner communications, proactively identifying and driving solutions for process and operational issues, monitoring service level performance, aligning and driving strategic initiatives that enhance service excellence and membership growth, and monitoring and understanding membership trends.  Regularly works with key leaders, both internally and with the Plan Partners, and external organizations to ensure clear communication and a collaborative and community-based approach is taken to identify and meet member needs. 

 

Partners with subcontracted health plans and cross functional internal stakeholders across the organization to ensure the resolution of  day to day operational issues through timely communications, appropriate escalation/de-escalation, and clear understanding of impact to product performance.  Identifies accountability and ownership of business process enhancements and monitoring functions within the organization to ensure service excellence, an optimal member experience, and compliance.

 

Directs the execution of the tactical and strategic roadmap and cyclical activities in the Plan Partner product life cycle.  Monitors key performance indicators and uses data to identify opportunities for improvement and drive decision making.

 

Directs staff, including but not limited to, monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

 

Perform other duties as assigned.

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:
A minimum of 7 years serving Medi-Cal population.

 

At least 3-5 years direct experience in working in a Medi-Cal managed care environment and with Medi-Cal program requirements. 

 

At least 5-7 years of supervisor/management experience.

 

Preferred: 
At least 7-10 years of direct experience with Medi-Cal population and Medi-Cal program requirements.

 

Demonstrated experience in relationship management with contracted agencies and delegates and navigating large, complex organizations.

Skills

 

Required:

Ability to think strategically with the ability to create and convey messaging to influence desired outcomes.

 

Build and maintain collaborative relationships with contracted partners.

 

Ensure alignment between Plan Partner and L.A. Care strategic goals and objectives including but not limited to growth, retention, quality, member experience, and compliance.

 

Ability to interpret Medi-Cal program requirements for impacts to Medi-Cal product management and overall compliance.

 

Knowledge of operational processes required to effectively administer a compliant Medi-Cal program including network, claims, encounters, member assignment, call center, IT, benefits/services, and model of care.

 

Excellent interpersonal, leadership, motivational, negotiation, influencing, and communication skills; with success in building, developing, and retaining high performing teams.

 

Able to lead, manage, conclude, and recommend using data and experience to drive decisions.  Ability to monitor key performance indicators to drive identification for process improvement opportunities.  Ability to mentor and coach team through ambiguity and able to make decisions to drive towards and accomplish team objectives.

 

Ability to oversee due diligence to support development of requirements needed for operational enhancements and fixes.

 

Ability to manage risk through escalation protocols, if necessary.

 

Ability to understand the competitive landscape, the Medi-Cal managed health care delivery system, and regulatory requirements impacting the Medi-Cal program.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information

 

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)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Medical, Claims, Public Health, Relationship Manager, Call Center, Healthcare, Insurance, Customer Service

Apply now »