Provider Data Services Program Manager II

Overview

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Job Category:
Provider Relations

Department:
Provider Data Management

Location:

Los Angeles, CA, US, 90017

Position Type:
Full Time

Requisition

Salary Range: $88,854.00 (Min.) - $ (Mid.) - $ (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, 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.

The Provider Data Services Program Manager II leads, organizes and coordinates support for Cactus data remediation in various projects, including data remediation efforts through the Symphony Utility, Data Standardized Provider Format (SPF) submissions, Data Governance Clean-Up, and Customer Relationship Management (CRM) special projects. The Program Manager II represents the Provider Data Services Department and leads streamlining auditing areas of compliance. This position supports the Director of Credentialing and Data Management through oversight of all data remediation in Cactus.

This position s primary duties include collaboration with the Appeals and Grievances Department and leading the re-development of a compliant process that monitors provider complaints in L.A. Care s network. This position is the business lead for provider data reports required for Credentialing compliance with regulatory audits.

The Provider Data Services Program Manager II also leads Cactus provider data remediation efforts through Symphony, Data Governance, and Standardized Provider Format (SPF) submissions. Additionally, this role manages Cactus Imports and Exports modules, manages implementation of upgrades to Cactus modules, and manages inputs or outputs in the Cactus environment that supports Information Technology (I.T.) and Product. This position acts as the Business Lead for Credentialing data reporting, resolves complex problems, and works with moderate guidance and direction from the Senior Director.

This individual also initiates and develops strong interpersonal relationships with both internal L.A. Care staff and external business partners in order to facilitate joint decision-making and successful program implementation to support delivery of timely and accurate data remediation through Cactus.

• Formulate and propose recommended solutions/ options to address moderately complex operational and programmatic challenges with Cactus provider data remediation, with moderate guidance from Senior Director.
• Assume ownership of data remediation initiatives for Cactus, under direction of Senior Director, for successful development, planning, and execution of programs, data reporting, analysis and improvements to infrastructure, from initial concept to implementation stage, with moderate guidance and supervision from Senior Director.
• Represent Cactus database interests and initiate engagement of existing internal and external business partners, colleagues, to jointly problem-solve complex member and provider issues. Facilitate constructive dialogue among internal and external stakeholders to ensure problems are properly assessed, analyzed and resolved, with moderate guidance and supervision from Senior Director.
• Draft work plans, policies and procedures that define business needs for Cactus data remediation, including scope, key milestones and tasks necessary to guide the implementation of new program initiatives, such as Target State, Data Governance, and development of an Appeals & Grievances process for the Direct Network. Maintain work plan updates to capture changes throughout each initiative, ensuring Cactus alignment with downstream business processes across the organization.
• Manage progress and performance as it relates to Cactus tasks; track and report on program status. Identify…