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Frankly, if you need a job, the best time to apply for one is right now. But, regardless of timing, the competition is fierce and job seekers should do everything they can to score an advantage. Understanding when companies hire, the typical hiring season trends, and the right time of year to apply for jobs will give you the best chance at success.&nbsp;

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This position supports business owners in preparing the project executive summary of needs, solutions, costs, benefits, and implementation schedules.. Integral to the success of this position is positive interaction with business owners and unit staff, management, third party contractors/vendors, cross-functional project team members and other department resources to ensure effective management and momentum of Enterprise Shared Services projects as well as organizational strategic initiatives.. Experience and knowledge working with FHIR standards on Patient Access API, Provider Directory API, Payer to Payer API, Pre Authorization API. Experience working on: Claims - Intake, adjudication, premium billing, capitation and FFS check runs, batch jobs, accumulators, Coordination of Benefits (including MOoP and TrOOP), EOBs, NDC/RxNorm Codes, DOFR, Pre-Authorizations, Reversal and Adjustments, Share of Cost, MOU; Membership - Enrollment, Medicare, Medi-Cal, Covered California, Dual eligibility, retro-active membership; Varied applications - QNXT, CCA, Syntranet, Mulesoft, SQL, EPIC, PCT, Salesforce.. Job Segment: Healthcare Administration, Claims, EMR, Medicare, Risk Management, Healthcare, Insurance, Finance

Services Program Manager

Salary Range: $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (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 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 Enterprise Shared Services Program Manager II is responsible for leading and managing a portfolio of strategic and transformational enterprise wide programs and projects that are generally complex and large in scope. In this capacity, the Program Manager will work collaboratively with leadership, management and other stakeholders including Business Owner(s), Investment Review Board, intake and program/project teams and participate in program governance and administration meetings as appropriate. This position will synchronize the work of cross-functional project teams and provide direct or indirect oversight of Senior Project Managers and Project Managers across the organization. A key function of this position is to serve as the primary point of contact between executive leadership and the program team, engage all stakeholders and communicate the program's progress. This position is accountable for working with and facilitating processes to accomplish complex program objectives, managing change and resolving issues that span project teams and departments by planning, organizing, directing and supervising program activities in a cost effective and productive manner to achieve strategic value and the organizational vision.

This position closely collaborates with business owners, vendors and other organizational staff to understand the business need for each project and makes decisions based on what is best for the organization. This position supports business owners in preparing the project executive summary of needs, solutions, costs, benefits, and implementation schedules. In addition, this position ensures executive summaries are submitted to the Investment Review Board/Leadership Team for review and approval in a timely manner. Upon Leadership approval, this position will manage the creation of definitive project execution plans (Plan of Record) and business cases. In addition, this position will have the ability to turn around any-size troubled project when necessary.

Integral to the success of this position is positive interaction with business owners and unit staff, management, third party contractors/vendors, cross-functional project team members and other department resources to ensure effective management and momentum of Enterprise Shared Services projects as well as organizational strategic initiatives. This position identifies PM-related training needs and conducts trainings. This individual will be a role model for integrity and will establish and maintain effective professional work relationships, working collaboratively with all levels of management and business owners to help guide the discipline of planning, organizing, securing, managing, leading, and controlling resources to achieve specific goals.

Duties

Creates, develops, and maintains the program plan and supports development of program related project plans.

Manages quadruple constraints of scope, schedule, cost and quality and ensures that integrated master plans including: business, technical, reporting, training, testing, and implementation plans and schedules are followed.

Meets with Business Owner(s) and Project Managers/teams on a regular basis, weekly or more often, as needed.

Partners with Business Owner(s) to develop communications plan, test plan, training plan, risk management/mitigation plan, and plan of record.

Directs others to successfully complete projects on time, within scope and on budget by ensuring that all Project Managers supporting the program create, manage, and maintain their project schedules, resources, and project artifacts, support centralized document repository, identify risks, assumptions, issues, and dependencies, provide timely status reports and proactively escalate issues for resolution.

Accountable for scheduling, cost tracking/budget, resource management allocation and utilization, program component integration and supporting program performance.

Supervises multiple projects within a program to achieve continuous alignment with the organization's strategic plans and objectives.

Supports Business Owner(s) with proposal development, vendor contract negotiation, program dashboard/weekly status reports, quality assurance, business process improvement, and other program documentation.

Functions as the lead expert in Enterprise Shared Service, leading a team or multiple teams and performs liaison activities with leadership, management, and other stakeholders.

Optimizes program governance by working with the over-arching infrastructure, processes, and procedures to accomplish objectives including establishing metrics of success and deliverables.

Supports PACE methodology and ensures projects are executed using the appropriate Project Management tools and techniques to successfully implement projects.

Promotes cultural and organizational change to achieve strategic outcomes and a corporate vision.

Performs 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

Experience

Required:

At least 6-8 years of relevant Project Management, Program Management, Health Care Administration, Research or Clinical field work experience in an organizational setting.

Experience facilitating complex decision making among multiple executive stakeholders with different interests and priorities.

Experienced in vendor/contract management and negotiations.

Skills

Required:

Demonstrated success managing multiple, large scale, diverse and complex projects simultaneously.

Ability to work well independently or leading a project team/efforts with limited supervision; strong team collaboration.

Ability to manage priorities across multiple teams/projects, platforms.

Ability to coach and mentor colleagues. Strong facilitation and mentoring skill.

Ability to understand business or clinical strategies and plans, and their relationship to organizational strategies.

Excellent written and oral communication skills, speaks clearly and persuasively in positive or negative situations; strong interpersonal and leadership skills.

Excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated.

Strong interpersonal and leadership skills with ability to interact with cross functional project teams; reacts professionally under pressure.

Ability to work independently in a fast-paced and changing environment.

Proficiency in Microsoft Office Suite (Word, Excel, Access, PowerPoint, Project, Outlook, Visio, Publisher); HTML.

Licenses/Certifications Required

Licenses/Certifications Preferred

Project Management Professional (PMP)

Required Training

Additional Information

Electronic Data Interchange (EDI) Specifics:

Summary:

This position will synchronize the work of cross-functional project teams, specifically those that are technical in nature, and provide direct or indirect oversight of Senior Project Managers and Project Managers across the organization, as well as technical resources assigned to projects and programs being managed by this position. This position also identifies technical gaps in existing systems and potential new implementations.

Duties and Responsibilities:

Leads all system upgrades, enhancements, and new deployments for Enterprise Shares Services and is a subject matter expert in EDI and Claims transactions.

Works collaboratively with Information Technology leadership (Architecture, Solutions Delivery, Technical Delivery, etc.) to prioritize, evaluate, and deploy solutions which contribute to the accurate receipt, loading, and exchange of claims data managed by the Claims Data & Support Services teams.

Functions as the Lead Technical expert in Enterprise Shared Service, leading a team or multiple teams and performs liaison activities with leadership, management, and other stakeholders.

Experience:

Required:

Extensive knowledge and experience working on EDI transactions - 827, 835, RA, 277CA, 834, and 278

Experience and knowledge working with FHIR standards on Patient Access API, Provider Directory API, Payer to Payer API, Pre Authorization API

Experience working on: Claims - Intake, adjudication, premium billing, capitation and FFS check runs, batch jobs, accumulators, Coordination of Benefits (including MOoP and TrOOP), EOBs, NDC/RxNorm Codes, DOFR, Pre-Authorizations, Reversal and Adjustments, Share of Cost, MOU; Membership - Enrollment, Medicare, Medi-Cal, Covered California, Dual eligibility, retro-active membership; Varied applications - QNXT, CCA, Syntranet, Mulesoft, SQL, EPIC, PCT, Salesforce.

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: Healthcare Administration, Claims, EMR, Medicare, Risk Management, Healthcare, Insurance, Finance