- LA Care Health Plan (Los Angeles, CA)
- …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 ... Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances Department to ensure clinical grievances, complaints, appeals and complex… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Customer Solution Center Service Representative I is responsible for a successful completion of the Member Services training program and continues to gain strong knowledge of Medi-Cal and Personal Assistance Services Council (PASC) managed care product lines.… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the quality review of complex and/or escalated… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Manager, Financial Compliance Audit (Finance) has a $10,000 SIGN-ON BONUS. This role is responsible for the timely and quality delivery of a variety of complex areas across all lines of business, including Medi-Cal, Covered California, D-SNP, and PASC-SEIU.… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Delphix Engineer III responsible for designing, building, and maintaining secure, compliant, and efficient non-production data environments using advanced automation, data masking, and virtualized data provisioning with Delphix Masking & Virtualization… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. This position will provide resolution of complaints in compliance with… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Manager, Cyber Defense Operations Center (CDOC) is responsible for leading a team of CDOC Analysts and managing LAC's relationship with its Managed Security Service Provider (MSSP) and the CrowdStrike Falcon Complete Analysts. This position manages all aspects… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Internal Auditor III prepares audit programs and conducts audit reviews of assigned areas, including performing various audit procedures and documents in findings in work papers in accordance with department standards. Identifies internal control weaknesses,… more
- LA Care Health Plan (Los Angeles, CA)
- …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 ... Payment Integrity Nurse Coder RN III is responsible for investigating, reviewing, and providing clinical and/or coding expertise/judgement in the application of medical and reimbursement policies within the claim adjudication process through medical record… more
- LA Care Health Plan (Los Angeles, CA)
- …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 audits of claims processed by Delegated Participating Physician Groups (PPGs), hospitals and health plans contracted with LA Care and various tasks within the Financial Compliance Unit. This position… more