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<p>Salary Range:&nbsp;&nbsp;$50,216.00&nbsp;(Min.) -&nbsp;$62,770.00&nbsp;(Mid.) -&nbsp;$75,324.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Transitional Care Services (TCS) Care Coordinator II is responsible for outreach to providers, facilities, and others to promote members’ optimal health and well-being by helping them navigate and access health services when transitioning between care settings. </p><p>This position coordinates the flow of information between the TCS Community Health Worker (CHW), member, other health plan staff, provider, and medical group and discharge facility. The position supports the coordination of member care as instructed by the Transitional Care Services (TCS) program requirements including the reinforcement of follow up provider appointments, coordination of transportation and Durable Medical Equipment (DME); linking member to Community Supports, Managed Long Term Supports and Services, Doula, health education information and other community resources to address the Social Determinants of Health (SDoH). The position is responsible to ensure the contractual and regulatory requirements and timelines are met by maintaining accurate documentation and following up with the member and provider as needed.</p><p>In addition, this position is assigned projects to support the department in meeting its regulatory and contractual requirements, such as running reports, data validation, quality checks and other projects. The position assists with the communication and coordination between programs and maintains confidentiality when communicating member information. </p><h4>Duties</h4><p>Responsible for the time sensitive processes for initiating cases, managing referrals to the department, appropriate documentation, routing of information, performing computer data input, faxing, emailing, filing of confidential member information, and maintaining activity logs etc. (50%) </p><p>Conducts telephonic outreach calls to discharge facilities, providers, and medical groups. Consults and collaborates with the TCS CHW to set up provider/specialist appointments and follow up. (10%)</p><p>Collaborates with team members and health plan staff to coordinate services for members. (10%)</p><p>Provides administrative assistance to ensure compliance with the TCS case tracking and closing out within the 30 day time frame. (10%)</p><p>Initiates follow up calls to Community-Based Organizations and other internal departments to confirm linkages to appropriate resources. (10%)</p><p>Performs other duties as assigned. (10%)</p><h4>Duties Continued</h4><h4>Education Required</h4>High School Diploma/or High School Equivalency Certificate<h4>Education Preferred</h4>Associate's Degree<h4>Experience</h4><p>Required:</p><p>At least 6 months of experience in an administrative and/or customer service role in a health care/health services setting. </p><p>Preferred:</p><p>2 years of experience as a Medical Assistant or similar role.</p><p>1 year of experience processing authorizations at a managed care/health plan setting.</p><h4>Skills</h4><p>Required:</p><p>Knowledge of medical terminology.</p><p>Strong verbal and written communication skills.</p><p>Proficiency in Microsoft Office with a high level of accuracy.</p><p>Ability to work in multiple systems/databases.</p><p>Excellent organizational, and time management skills.</p><p>Detail-oriented and a team player.</p><p>Excellent customer service skills with compassion and empathy.</p><p>Ability to demonstrate sensitivity and respect for the opinions, perspectives, customs, and individual differences of others. </p><p>Ability to value diversity of people and ideas, as well as interact with people from a wide range of backgrounds. </p><p>Ability to be flexible, open-minded, listen to and consider others’ viewpoints. </p><p>Ability to work well and develop effective relationships with diverse personalities.</p><p>Preferred:</p><p>&nbsp;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&nbsp;&nbsp; </p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified Management Accountant (CMA)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Preferred:</p><p>Motivation Interviewing</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul>

L.A. Care Health Plan

Transitional Care Services Care Coordinator II

<p><strong>Are you passionate about delivering trusted advice that improves lives?</strong></p><p><strong>Are you passionate about delivering results that delight and inspire your clients?</strong></p><p><strong>This opportunity may be for you!</strong></p><p>Our Senior Project Manager manages projects involving large and/or complex, interdisciplinary assignments that may include coordinating resources from within and outside of the practice.&nbsp; The incumbent may have significant, influential client contact and supports initiatives to grow revenue and profitability through project work and contributing to practice development and quality improvements. The Senior Project Manager is a critical thinker who contributes creative, if not innovative, thought to problem-solving and, leads or participates in initiatives to grow revenue, profitability, and intellectual capital. The Senior Project Manager also contributes to a work culture that is diverse, equitable, and inclusive.</p><p><strong>Key Responsibilities:</strong></p><ul><li>Create strong, ongoing relationships with multiple clients, becoming their trusted resource for on time, on budget, on point deliverables.</li><li>Partner with consultants to offer strategic ideas to influence client outcomes and the employee experience.</li><li>Demonstrate understanding of client’s Brand; Businesses/Business Partners and locations (for distribution); Internal communication channels; Project goals and priorities; Vendor partners; Communication style/preferences; and Benefits offerings.</li><li>Actively contribute to client strategy sessions and utilize expertise to participate in pitching the client on new campaign pieces or formats. Participate in extending and expanding opportunities with current clients and business development activities with prospective clients.</li><li>In partnership with consultants, manage financial processes, develop proposals/estimates and track budgets. Generate client budget reconciliations and budget reports.</li><li>Ensure overall profitability of client engagements by managing scope and expectations as outlined in the statement of work. Surface and partner with consultants on out-of-scope discussions both internally and with clients with a solution mindset.</li></ul><p>&nbsp;<strong>Qualifications</strong></p><ul><li>Minimum of 9+ years of professional experience, ideally industry experience with an undergraduate degree.</li><li>Proficiency in project budgeting and maintenance and financial acumen.</li><li>Design training/background or experience a plus.</li><li>Proficiency with Mac OS, Microsoft Office, Teamwork, Project/Time management software, Outlook, Google Apps.</li><li>Excellent written and verbal skills and ability to create and develop relationships.</li><li>Proficiency with print design, including excellent understanding of offset printing process.</li><li>Strong understanding of web design/build/UX and developing web trends.</li></ul><p>&nbsp;<strong>Why Join Us?</strong></p><ul><li><strong>We’re Trusted.</strong>&nbsp; Simply put, Segal is the only independent, private and employee-owned employee benefits/HR consulting firm left in our industry. Our clients trust us because we still provide unbiased advice without hidden agendas or product pushing.</li><li><strong>We’re Proven</strong>. We’ve been around for over 80 years, providing industry leading consulting to clients of all sizes and industries.</li><li><strong>We’re the right size</strong>. Big enough to compete and succeed….and small enough to feel like you are part of something special.</li><li><strong>We’re winning</strong>. Our results speak for themselves. Our client retention is strong and we are welcoming new logos into the Segal family every week.&nbsp;</li><li><strong>We’re a great place to work</strong>. Want to work with great colleagues, terrific clients, and receive competitive pay and benefits that practices what we preach to clients?&nbsp; Look no further. (Did we mention our Defined Benefit Pension Plan, sabbaticals, and wellbeing benefit?).</li></ul><p><strong>Diversity, Equity &amp; Inclusion at Segal:</strong></p><p>We recognize that individuals bring a broad range of experience and abilities that go beyond the technical requirements of a job. If your experience and qualifications are close to what you see described here,&nbsp;<strong>we encourage you to apply.&nbsp;</strong>Diversity of employment, skills and life experience, combined with passion, are key to innovation and excellence. We&nbsp;<strong>encourage individuals,&nbsp;</strong>including but not limited to women, minorities, the disabled, and protected veterans and those&nbsp;<strong>from all other</strong>&nbsp;<strong>backgrounds to apply&nbsp;</strong>to our positions. Please let us know if you require accommodation during the interview process and…thank you for considering Segal.</p><p><strong>About Segal and its Total Rewards Program:</strong></p><p>Segal is a&nbsp;<strong>privately owned</strong>, leading North American employee benefit, human resources, and investment management consulting firm with&nbsp;<strong>over 80 years of history</strong>&nbsp;providing trusted advice that improves lives. Clients include public and private corporations, multiemployer trust funds, public sector entities, higher education institutions, institutional advisors, among many others.</p><p>Segal’s total rewards are part of what makes Segal a special place to work. The current salary range for this position is $124,500-$165,000&nbsp;plus opportunity for a discretionary performance bonus based on company profitability and employee performance. In addition, Segal offers a comprehensive suite of benefits to include a non-contributory defined benefit pension plan, matching and discretionary contributions to a 401(k) profit sharing plan, medical and prescription benefits including contributions to a health savings account for eligible employees, dental benefits, life insurance, disability insurance, an Employee Assistance Program, wellness benefit reimbursements and rewards, and professional credential and tuition reimbursement. Segal also provides comprehensive paid time off including holidays, vacation days, sick leave, paid family leave and sabbaticals.</p><p><strong>Please Apply:</strong></p><p>Segal is the right size, the right organization and…the right move for you!&nbsp;&nbsp;Please apply now.</p><p><i>#LI-Remote</i></p>

Segal

Senior Project Manager

<p>Salary Range:&nbsp;&nbsp;$105,267.00&nbsp;(Min.) -&nbsp;$139,478.00&nbsp;(Mid.) -&nbsp;$173,689.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Enterprise Portfolio Management Office Solutions Analyst III is accountable for intake, execution, and managing the oversight of strategic programs and projects approved and budgeted by L.A. Care Leadership and the Board of Governors. These programs and projects span multiple functions and departments, and are enterprise investments in infrastructure and process excellence. The portfolio, program, and project management resources within the ePMO are uniquely positioned to support business units in the planning and delivery of large-scale programs and projects.</p><p>The Shared Services team within the ePMO operates as a center of excellence for portfolio management, and provides leadership and support in ensuring the ePMO leverages project management best practices when initiating projects, and while monitoring and reporting the status of those projects to project and business leadership. </p><p>Under the general direction of the Manager, and following best practices based on BABOK and other authoritative bodies, the Solutions Analyst is a critical thinker who is responsible for eliciting, analyzing, communicating, testing and verifying functional and non-functional business requirements for strategic initiatives, assisting with the definition of Acceptance Test Criteria, and ensuring requirements are specific, testable, and in alignment with business goals and architecture. The Solutions Analyst works with business and technology resources to temper and align preferences to develop collective and valuable solutions to business needs. This position performs these duties on large, complex projects and programs that require collaboration across many business units. The requirements, solutions and testing for these larger projects require a complete understanding of all impacted processes and work teams. This position is skilled in negotiating between business units to find the best overall solutions and outcomes. </p><p>This position not only works on the complex and difficult projects, but also mentors other analysts both within the ePMO and within the business units, to strengthen L.A. Care's business analysis capability. This very experienced individual also helps to define and implement best practices for solutions and business analysis for the organization, based on industry-standard authorities. The individual is accountable for intake, execution, and managing the oversight of strategic programs and projects approved and budgeted by L.A. Care Leadership and the Board of Governors. These programs and projects span multiple functions and departments, and are enterprise investments in infrastructure and process excellence. The portfolio, program, and project management resources within the ePMO are uniquely positioned to support business units in the planning and delivery of large-scale programs and projects.&nbsp; Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.</p><h4>Duties</h4><p>Leads analysis and requirements gathering sessions on large, complex programs and projects using methodologies such as JAD, JAR, SCRUM, etc., to define, analyze, and document business needs and requirements in support of strategic initiatives. Collaborates across multiple business units ensuring that all parties get the best possible outcomes for L.A. Care and its members and providers. Documents functional and non-functional business needs and requirements, ensuring requirements are usable, specific and testable, and in alignment to business goals and overall business architecture. Assists in defining Acceptance Test Criteria, tracing back to documented business requirements.</p><p>Creates and updates complex as-is and future state business workflows to enable the documentation of business process needs and production of requirements for all related business, and operational systems critical to the project or program. Makes recommendations for solutions or improvements that can be accomplished through new process or technology, or alternative uses of existing processes or technology. Researches and analyzes data in support of business functions, process knowledge, and systems requirements.</p><p>Tracks maintenance of business need and requirements to ensure they are not attenuated or discarded during the execution and delivery phases. Supports the Project Manager by providing more detailed project objectives; clear structured, and useable requirements; tradeoff analysis; requirement feasibility; and risk analysis to improve the execution of the project plan.</p><p>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable &nbsp;meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed. &nbsp;Mentors other Solutions Analysts and Business Analysts to strengthen L.A. Care's solution and business analysis capability.</p><p>Defines and follows best practices for the organization based on BABOK or other authoritative bodies of knowledge.</p><p>Conducts analysis in support of the entire ePMO.</p><p>Performs other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's Degree in Related FieldIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4>Master's Degree in Related Field<h4>Experience</h4><p>Required:<br>Minimum 5 years of experience eliciting and documenting business and systems requirements using techniques such as JAR/JAD, SCRUM, etc. OR minimum of 5 years of experience developing, implementing, and evaluating workflow processes, policies, and procedures.&nbsp;</p><p>Minimum of 7 years of experience in managed healthcare environment with strong domain expertise in at least one of the following disciplines: Claims/EDI, Membership, Provider, Care Management, or Finance.&nbsp;</p><p>Preferred:<br>Experience with Tableau and Requirements Management software.</p><h4>Skills</h4><p>Required:<br>Proven ability to work with a diverse group of people, including leadership, support staff, coworkers and department management.</p><p>Proven ability to lead cross-functional discussions to reach collaborative outcomes.</p><p>Proven ability to be produce outstanding analysis deliverables on complex, multi-disciplinary projects and programs.</p><p>Demonstrated ability to research complex issues and bring about resolution.</p><p>Demonstrated mentoring and coaching skills to develop other team members.</p><p>Excellent critical thinking and problem solving skills.</p><p>Strong elicitation and process documentation skills.</p><p>Strong organizational and communication skills to build and foster effective relationships.</p><p>Excellent computer skills; MS Office Suite (Word, Excel, Visio, PowerPoint) skills required.</p><p>Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines.</p><p>Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel.&nbsp;</p><p>Ability to maintain a professional and mature demeanor at all times.</p><p>Ability to work in a fast-paced department independently or in a team, and handle multiple tasks with competing priorities; work with interruptions and deal effectively with confidential information.</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4>Certified ScrumMaster (CSM)<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul>

Enterprise Portfolio Management Office Solutions Analyst III

<p><strong>Clinical Project Manager</strong></p><p><strong>Onsite in West Hollywood, CA</strong></p><p><strong>ONCOtherapeutics</strong>&nbsp;is a full-service Contract Research Organization (CRO) with a unique focus in the therapeutic area of oncology. We are a strategic CRO running multiple clinical trials in community oncology sites throughout the United States (US). We provide the necessary support to major biopharmaceutical companies throughout the US to successfully run, enroll, and complete clinical trials. Uniquely focused on community-based Hematology &amp; Oncology research sites, we provide real-world experience, data, and outcomes that lead to improved clinical utility of cancer therapies, improving the lives of cancer patients.</p><p>We hire exceptional people. We want individuals who thrive on being challenged and are passionate about building a great company and growing with us. If you want your next step to be the right one, and you've worked hard to get where you are today, then we have the perfect opportunity for you.</p><p>As the Clinical Project Manager, you will ensure project timelines and goals are met on time and within budget while following Good Clinical Practices (GCP), ICH, FDA, and best practices. This includes utilizing expert working knowledge to anticipate project roadblocks and solve problems efficiently and effectively. You will be the primary liaison between Oncotherapeutics and its clients (Sponsors and Sites), ensuring questions are answered and issues resolved. You must demonstrate the ability to manage multiple projects with different sponsors and timeline demands.</p><p></p><p><strong>To succeed, you should have:</strong></p><ul><li>Bachelor’s degree in a scientific discipline</li><li>2+ years' experience in clinical trial project management&nbsp;</li><li>Therapeutic experience in oncology.</li><li>Ability to work independently and establish and maintain effective working relationships with co-workers, supervisors, and other staff. Excellent interpersonal abilities are required.</li><li>Thorough knowledge of clinical research concepts, practices, and FDA regulations and ICF Guidelines regarding drug development phases, clinical research, and data management methods.</li><li>Ability to solve problems. Must have effective time management and organizational skills.</li><li>Read, write, and speak in fluent English. Excellent verbal and written communication skills.</li><li>Willing to wear many hats in a growing company.&nbsp;</li><li>Ability to work onsite in the West Hollywood, CA office.</li></ul><p></p><p><strong>Your responsibilities as the Clinical Project Manager will include:</strong></p><ul><li>Manage several multi-site clinical trials throughout the project's lifetime. Lead the study start-up process, including, but not limited to, the Trial Kick-off meeting, the set-up of the trial master file (TMF), the set-up of the electronic data capturing (EDC) system, site selection, and the finalization of site Clinical Trial Agreements and budgets.</li><li>Develop project plans such as data management plans (DMPs), case report forms, data management plans, source document worksheets, central laboratory specifications, etc.</li><li>Maintain the TMF to date, set up, and maintain the investigator site file (ISF) for all participating sites.</li><li>Manage clinical research associates (CRAs), review and approve site trip reports; Oversee tracking, follow-up, and resolution of site issues. Assist in source data verification (SDV) as needed.</li><li>Conduct site-initiating visits (SIV) and guide protocol and proper data collection.</li><li>Organize and prioritize work according to study timelines and proactively address potential problems; Create tracking tools for weekly internal meetings and monthly reports to clients.</li><li>Create effective and professional relationships with sites, vendors, and clients to ensure project goals are met. Act as liaison between Oncotherapeutics, sites, and sponsors.</li><li>Ensure adherence to GCP, ICH, and FDA regulations and guidelines and international regulations.</li><li>Prepare study regulatory documents, FDA, and IRB submissions such as yearly reports/renewals, SAEs, etc.; Manage submissions and distribution of documents to sites of protocols amendments, informed consent forms, investigator documentation, safety reports, and recruitment materials.</li><li>Assist the Medical Writer with creating trial protocols, schedule of procedures, and informed consent, as needed.</li><li>Provide efficient updates on the trial progress to the Director of Clinical Operation and CEO. Ensure potential risks are escalated to the appropriate team.</li></ul><p><strong>Best-in-Class Benefits and Perks:</strong></p><p>We value their employees’ time and efforts. Their competitive compensation of $80K-$100K annually, depending on experience and extensive benefits package, enhances their commitment to your success. Our client’s benefits package includes:&nbsp;</p><ul><li>Comprehensive health coverage: Medical, dental, and vision insurance</li><li>Retirement planning: 401(k) plan with employer matching</li><li>Financial security: Life and disability insurance</li><li>Flexible financial options: Flexible spending and health savings accounts</li><li>Work-life balance: Generous paid time off and holidays</li><li>Supportive resources: Employee assistance program</li></ul><p></p><p>Plus, we maintain the best environment for their employees, where people can learn and grow with the company. They strive to provide a collaborative environment where everyone feels encouraged to contribute to their processes, decisions, planning, and culture.</p><p></p><p><em>We are an equal opportunity employer that welcomes and encourages diversity in the workplace. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law. We will consider qualified applicants with criminal histories for employment.</em></p>

Insperity

Clinical Project Manager

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Utilization Management Clinical Quality Nurse Reviewer RN II, under the purview the Utilization Management (UM) Department Leadership Team, is responsible for conducting and tracking targeted and random internal department documentation audits. This role is ensures that UM practices and supporting documentation are compliant with all regulatory requirements. &nbsp;The Incumbent also serves as a Subject Matter Expert during external audits as well as leads pre- and post-audit preparation/follow-up.&nbsp; This position actively participates in development and review of policies and procedures to certify compliance with regulatory guidelines and mandates. This position will focus on UM cases for all lines of business to identify areas of opportunity for increasing positive audit outcomes and improved service to L.A. Care’s membership. This position is responsible for identifying and monitoring staff (non-clinical, nurse, and physician) performance against key performance indicator trends that warrant recognition or remediation. This position performs data mining and analysis and create reports on audit findings, as well as make recommendations, to submit to the department's Quality Assurance Team and UM Management.</p><h4>Duties</h4><p>Facilitates the development, review, and revision of organizational and departmental process flows to ensure compliance with relevant regulatory, organizational, and departmental guidelines.</p><p>Keenly focuses on practices and documentation of clinical staff, serving as a resource on state and federal industry mandates applicable to UM functions.</p><p>Generates results of findings, enhances, and analyzes various reports related, but not limited to, quality and accuracy of case documentation.&nbsp;</p><p>Works with department leadership to assess for all opportunities related to quality improvements.&nbsp;</p><p>Compiles and presents quality report cards that measure adherence to quality and regulatory compliance.&nbsp;</p><p>Keeps UM Leadership apprised of departmental and industry trends, deficiencies, and any potential risks, and collaborates with the team to develop and execute mitigation efforts.</p><p>Serves as a consultant to the organization's Compliance team on an ad hoc basis.</p><p>Performs other duties as assigned.&nbsp;</p><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's DegreeMaster's Degree in Nursing<h4>Experience</h4><p>Required:&nbsp;<br>At least 5 years of experience in Clinical Nursing. Minimum of 2 years of auditing clinical documentation. &nbsp;Active participation in at least two state regulatory audits and one federal regulatory audits. Previous experience with Medi-Cal and Medicare in a managed care environment and experience with mitigation planning and implementation.</p><p>Preferred: &nbsp;<br>Experience performing clinical documentation for a health plan. Active participation in at least three state regulatory audits, at least one National Committee for Quality Assurance (NCQA) audit and/or Centers for Medicare and Medicaid Services (CMS) audit. &nbsp;Background in teaching and/or clinical education.</p><h4>Skills</h4><p>Required:&nbsp;<br>Superior verbal and written communication skills.&nbsp;</p><p>Advanced computer proficiency in both Microsoft Word and Excel.&nbsp;</p><p>Strong analytical and team building skills.&nbsp;</p><p>Ability to work independently and be self-directed.&nbsp;</p><p>Ability to work effectively with diverse team members.&nbsp;</p><p>Strong problem-solving skills.&nbsp;</p><p>Ability to multitask and streamline day-to-day operations.&nbsp;</p><p>Ability to translate regulatory requirements into auditable tools.&nbsp;</p><p>Preferred:</p><p>Proven ability to lead successful performance improvement projects.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul>

Utilization Management Clinical Quality Nurse Reviewer RN II

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Business Analyst III facilitates business process improvement via the methodical investigation, analysis, review and documentation of functional business specifications. This position manages the requirements development process through the elicitation, analysis, specification and verification of multiple levels of requirements from an end-to-end perspective and supports the ongoing management of the requirements. This position develops report and analysis for the department. It is responsible in communicating and coordinating with IT on a day-to-day department related efforts. The Business Analyst III manages and coordinates the implementation and/or integration of products or new features for clients including client training and provides subject matter expertise (SME) and support of the department's inbound and outbound functions. This position acts as mentor to Business Analysts I/ II.</p><h4>Duties</h4><p>Develop functional and user acceptance test plans and scenarios. Coordinate functional and user acceptance testing by executing the testing strategy, scheduling resources and tracking test performance. Perform data analysis to support evaluation of system defects or to develop requirements for new functionality; assist in various system trouble shooting and balancing and correction efforts including analysis, verification and validation of issues and fixes. Coordinate activities including on-time delivery, testing and production moves.</p><p>Collaborate with I.T. on all department &nbsp;related efforts, including submission of Service Requests and writing BRD's. Coordinate related data requests from internal departments, and/or assist I.T. with definition of criteria. Delegate data and reporting requests to business analysts. Facilitate collaborative system and data design sessions with the user community, technical architecture resources and development resources. Preparation of status updates to enterprise for distribution and communication.</p><p>Work as a technical support and liaison to designated I.T. personnel to provide testing, support and feedback on enhancement requests and regular updates/releases; adhere to release schedules. Provide analytical support for critical corporate initiatives including business function support for system migrations and consolidations, significant business area process improvement projects and complex product installations.</p><p>Demonstrate a high level of subject matter expertise in functional area to bridge business requirements and I.T. solutions; provide technical direction and ensure compliance with best practice solutions. Practice knowledge transfer and foster change management as the organization changes and new skills are required, focusing on team/individual development to be a valued contributor.</p><p>Participate and contribute on the development/ creation of data models and interface design specifications. Support internal/ external stakeholder's roadmap and audits as needed.</p><p><br>Oversee the business process support across multiple client engagements. Communication with internal/ external stakeholders for department's submission requirements. Review submission of data against established benchmarks and coordinate correction and improvement efforts. Monitor timely and accurate outbound data submission to state and federal recipients.</p><h4>Applies subject expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, providing mentorship, and contributing specialized knowledge. Ensures that the facts and details are correct so that the project’s/program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training, recommends process improvements, and mentors junior level staff, department interns, etc. as needed.</h4><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.<h4>Education Preferred</h4><h4>Experience</h4><p>Required:</p><p>At least 5 years of successful experience in a quantitative role as a Business Analyst, Data Analyst, Programming Analyst, Claims processing, encounter processing.</p><h4>Skills</h4><p><strong>Required:</strong><br>Competent to work at the highest technical level of most phases of systems analysis.</p><p>Excellent verbal and written communication skills.</p><p>Coaching, Mentoring and Teaching skills.</p><p>Teamwork-focused/collaborative work style.</p><p>Demonstrated ability to work successfully on large projects.</p><p>Problem solving skills evidenced by demonstrated results in past positions.</p><p>Ability to work under tight deadlines and handle multiple/detail-oriented tasks.</p><p>Ability to influence at all levels of the organization.</p><p>Proficient in Microsoft Office and Vizio.</p><p><strong>Preferred:</strong><br>Ability to work on other programs such as SharePoint and/ or OneNote</p><h4>Licenses/Certifications Required</h4><h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul>

Business Analyst III

<strong>Job Description</strong><h4>Join the Clean Energy Revolution</h4><p>Become an IT Outsource Management, Advisor at Southern California Edison (SCE) and build a better tomorrow. In this job, you’ll be responsible for providing application services to meet SCE business needs in the Transmission &amp; Distribution, Wildfire (T&amp;D), and Grid Modernization portfolio. Provide oversight and strategic direction to the Manage Service Provider (MSP) to ensure efficient service delivery to T&amp;D business users and to manage the day-to-day responsibilities to support and maintain applications in T&amp;D. Follow up on application services and problem escalations. Ensure customer satisfaction throughout the application service process. Communicate and coordinate with business and other IT teams and leadership to ensure appropriate integration of operational activities. As an IT Outsource Management, Advisor, your work will help power our planet, reduce carbon emissions and create cleaner air for everyone. Are you ready to take on the challenge to help us build the future?</p><p>A day in the life - Get ready to think big, work smart and shine bright!</p><h4>Partner with Manage Service Providers (MSP) to:</h4><ul><li>Ensure application stability, data integrity, and policy adherence</li><li>Monitor, measure, and improve application service delivery to meet business needs</li><li>Ensure that the quality and timeliness of resolution for application issues and operational activities are met within service level agreements and within business expectation</li><li>Report on operational health to business and IT leadership</li><li>Ensure satisfaction in the timely delivery of IT services to business</li><li>Drive service improvements within IT</li><li>Manage software renewals to maintain latest software versions</li><li>Ensure that appropriate services are being delivered in a timely fashion and uphold terms of the contract via governance.</li><li>Manage enhancements, provide operational feedback to projects to ensure quality, and review roadmaps</li></ul><h4>Service Integration</h4><ul><li>Accountable for service management and integration of defined services to ensure efficient, predictable, and reliable services that meet expected customer outcomes</li><li>Utilize defined service management and integration practices to proactively orchestrate, align, and integrate defined IT service processes to achieve desired end-to-end service outcomes and experiences</li><li>Manage vendor relationships to ensure timely response and issue resolution as defined by vendor SLA</li><li>Meet with vendors to review SCE priority issues and plan for delivery of the bug fixes and software updates.</li></ul><h4>Client Engagement</h4><ul><li>Manage business relationships and liaises with the business units to establish stronger communication and drive towards collaboration and innovation.</li><li>Establish meeting cadence and appropriate communication channels with business counterparts. Report on operational health to business and IT leadership.</li><li>Proactively communicate with clients and provide details on planned and unplanned outages including one with business impact.</li><li>Engineering Services -- Partner with Quality Advisors to oversee and review the product design and testing of the products/applications to ensure proper architecture/design to maintain quality levels by minimizing defects and failures of the application.</li></ul><p>The essentials</p><ul><li>Seven or more years of combined technical experience in application development &amp; maintenance, integration systems, databases, and/or job scheduling environment.</li><li>Experience in working in IT Operations in a managed services environment.</li></ul><h4>The preferred</h4><ul><li>Bachelor's degree or higher in Information Technology or related field.</li><li>Experience with applications such as ArcGIS, AutoCAD Map3D, ClickSchedule, SPIDA, SAP PO, their related Interfaces, and databases such as HANA, Oracle, and SQL.</li><li>Experience with the agile workflow process and operating modes such as DevOps, Waterfall, Product Lines, Value Streams, and SOX compliance.</li><li>Knowledge of ITIL practices, processes, and principles.</li><li>ITIL Foundation Certified.</li><li>Transmission Distribution experience and/or knowledge in electric utility industry.</li><li>Experience with having technical conversations or making technical presentations to both technical and non-technical audiences.</li></ul><h4>You should know</h4><ul><li>This position’s work mode is hybrid. The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days. Unless otherwise noted, employees are required to reside in the state of California. Further details of this work mode will be discussed at the interview stage. The work mode can be changed based on business needs.</li><li>Visit our Candidate Resource page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!</li><li>The primary work location for this position is Rosemead, CA.</li><li>Relocation does not apply to this position.</li></ul><h4>About Southern California Edison</h4><p>The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world.</p><p>At SCE, we celebrate our differences. We are a proud Equal Opportunity Employer and will not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected status.</p><p>We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodations at (833) 343-0727.</p>

Southern California Edison

IT Outsource Management, Advisor [HYBRID]

<p>Job Description:</p><p>POSITION SUMMARY:</p><p>The School of Human Development &amp; Education (SHDE) Administrative Faculty Fieldwork Coordinator is a full-time administrative faculty member serving to coordinate the fieldwork portion of the intern, student teaching and residency programs. The Administrative Faculty Fieldwork Coordinator is responsible for the development, coordination and monitoring of student fieldwork and clinical practice experiences in collaboration with the Credential Analyst and SHDE Faculty, fieldwork supervisors, and in compliance with the standards of CCTC accreditation. The Fieldwork Coordinator will have a reduced teaching course load per academic year.</p><p>The Administrative Faculty Fieldwork Coordinator will work directly within SHDE, working collaboratively with the Credential Analyst and reporting to the Dean of SHDE.</p><p>SUPERVISION RECEIVED (The degree of supervision exercised over this position):</p><p>The incumbent establishes methods and procedures for attaining specific goals and objectives and receives guidance in terms of broad goals. Only the final results of work are typically reviewed.</p><p>SUPERVISION EXERCISED:</p><p>Minimal or no supervisory responsibilities.</p><p>ESSENTIAL FUNCTIONS:</p><p>Recruitment and Training</p><ul><li>Recruit, train, and assign fieldwork supervisors in collaboration with the Credential Analyst.</li><li>Coordinate and facilitate mentor teacher and student teaching orientations.</li></ul><p>Partnership Development and Support</p><ul><li>Strengthen and support partnerships with key school districts and other school locations (e.g., NPS sites) in California where teacher education candidates serve during their practicum, student teaching, intern, or residency experiences.</li><li>Build deep partnerships with key school districts to discuss their human capital and instructional needs by meeting with key school personnel regularly.</li><li>Identify and assess existing programs and services for SHDE, including school-based opportunities and partnerships across the college and with community agencies.</li><li>Research partnership development opportunities for SHDE and advise the Dean’s Office on strategic priorities for candidate enrollment and placement.</li><li>Create, coordinate, and implement partner recognition activities.</li></ul><p>Representation and Collaboration</p><ul><li>Serve as an ambassador for SHDE credential programs at recruitment events, New Student Orientation, and Open House events.</li><li>Represent the SHDE in various settings, including internal collaboration with college offices and external partners such as districts, community-based agencies, and state and professional associations.</li></ul><p>Program Management and Coordination</p><ul><li>Manage the creation and submission of Professional Studies and Continuing Education Units.</li><li>Coordinate the Intern program at SHDE.</li><li>Collaborate with core and administrative faculty to strengthen the preparation of student teachers, interns, and residents.</li></ul><p>Teaching</p><ul><li>Directed Teaching courses.</li></ul><p>Communication Strategy</p><ul><li>Work with the Dean and identified departments to develop a multi-faceted integrative communication strategy incorporating web-based technology and social media to provide alumni, current candidates, and K-12 partners with ongoing updates about college and community-based professional development, job search, and collaborative opportunities.</li></ul><p>Additional Responsibilities</p><ul><li>Perform other duties as assigned.</li></ul><p>Is regular attendance an essential function?&nbsp; ☒ Yes&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ No</p><p>ESSENTIAL KNOWLEDGE, SKILLS and ABILITIES:</p><p>Knowledge:</p><ul><li>Comprehensive understanding of California Credential Requirements, Teacher Performance Expectations, and State-adopted Academic Content Standards is required.</li><li>Knowledge of the teaching profession is required</li></ul><p>Transportation:</p><ul><li>Must have reliable transportation for travel to school sites and events in Southern California, including Los Angeles County and other areas as needed.</li></ul><p>Technical Skills:</p><ul><li>Proficiency in computer applications, including word processing, spreadsheets, and database management is required; MS Office Suite is preferred</li></ul><p>Soft Skills:</p><ul><li>Strong organizational and problem-solving abilities.</li><li>Excellent interpersonal, teamwork, and customer service skills.</li><li>Effective written and oral communication skills.</li></ul><p>POSITION QUALIFICATIONS:</p><p>Education: </p><ul><li>Master’s degree in related education field required; Doctoral degree preferred</li><li>Valid Multiple Subject and/or Education Specialist Instruction Credential California teaching credential is preferred.</li></ul><p>Experience:</p><ul><li>Experience mentoring student teachers and intern teachers is required</li><li>A minimum of three years of teaching experience in a K-12 school in California.</li><li>Experience teaching in the field for at least three years in a K-12 school in California is required</li><li>Teaching experience within California public or private schools is preferred</li></ul><p>TYPICAL WORKING CONDITIONS</p><ul><li>Office environment; typically, 70 degrees</li><li>Noise level is usually quiet to moderately noisy while in the office</li></ul><p>EQUIPMENT USED</p><ul><li>Computer/Laptop</li><li>Calculator/10-key</li><li>Telephone</li><li>Copier, scanner and fax machines</li></ul><p>ESSENTIAL PHYSICAL &amp; MENTAL TASKS: (Check all that apply):</p><p>Physical Demands: </p><p>☒ Standing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Lifting:&nbsp; 10 Lbs.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Pushing/Pulling&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Driving</p><p>☒ Walking&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Carrying&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Hearing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Speaking</p><p>☒ Reaching&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Writing &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Squatting/Kneeling&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Seeing</p><p>☐ Climbing&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Pushing&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Other:&nbsp; Typing</p><p>Physical Environment - Exposed to:&nbsp; </p><p>☒ Noise&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Heat/Cold&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Fumes/Gases&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Human Tissue/Fluids</p><p>☐ Chemicals&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Carcinogens&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Dirt&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Animal Tissue/Fluids</p><p>☐ Toxic Chemicals&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐ Radiation&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐Other:&nbsp;</p><p>☐ Biohazardous Material</p><p>Mental Demands:&nbsp; </p><p>☒ Reading&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Frequent Interruptions&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Periods of Concentrated Attention&nbsp;&nbsp;&nbsp;</p><p>☒ Detailed Work&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Irregular Work Schedule&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☒ Frequent Contact with People</p><p>☒ Frequent Deadlines&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ☐Other:&nbsp;</p><p>☒ Multiple Concurrent Tasks</p><p>TRAVEL: (% of total time): Up to 25% of total time</p><p>ENVIRONMENTAL CONDITIONS:</p><p>The noise level in the work environment is usually quite to moderately noisy while in the office.&nbsp; The office temperature is about 70 degrees.</p><p>DECISION MAKING:</p><p>The position is governed by the policies of Pacific Oaks, along with established procedures for the department.</p><p>CONTACT RESPONSIBILITIES:</p><p>Routine exchange or presentation of information.</p><p>Responsible for demonstrating professionalism and leadership in resolving conflicts with students and employees.&nbsp; Recommends alternative approaches to solve problems and conflicts.&nbsp;</p><p>FINANCIAL RESPONSIBILITY:</p><p>This position does require the management of budgets, but it is required to follow Pacific Oaks policies for purchasing and budget approvals.</p><p>Compensation &amp; Benefits</p>This opportunity is budgeted at $66,560.00-73,170.00 base compensation. Additional compensation factors may impact total compensation. To learn more about our competitive benefits and additional rewards, including generous paid time-off, medical and dental insurance coverage, life and disability insurance, retirement plan with employer contribution, multiple flexible spending accounts, tuition reimbursement, click the link below.<p><a href="https://www.pacificoaks.edu/about/careers-pacific-oaks/" target="_blank">https://www.pacificoaks.edu/about/careers-pacific-oaks/</a></p><p>Pacific Oaks is an Equal Opportunity Employer.</p><p>Pacific Oaks participates in E-Verify and verifies identity and employment eligibility of all persons hired.<br></p><p><i>The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Pacific Oaks offers equal employment opportunities to all persons without regard to race, color, ethnicity, religion, sex, sexual orientation, national origin, age, marital status, physical or mental disability, parental status, housing status, source of income or military status, in accordance with applicable federal, state and local EEO laws.</i></p>

Pacific Oaks Children’s School

Administrative Faculty - Fieldwork Coordinator

<strong>Job Description</strong><p><strong>Join the Clean Energy Revolution &nbsp;</strong></p><p>Become a <strong>Product Management Advisor – Marketing Automation</strong> at Southern California Edison (SCE) and build a better tomorrow. In this job, you’ll be a part of the team that is redefining the way SCE markets its programs and services to all business and residential customer segments to drive more efficient marketing outcomes and improve the overall service experience for SCE customers. You’ll accomplish this by leading cross-functional teams comprised of members from across SCE, as well as external partners, vendors, and stakeholders. Working in collaboration with Product / Program owners, marketing /digital leads to execute the end-to-end project management of marketing automation campaigns, reporting directly to the Senior Manager. You’ll work at both strategic and tactical levels, placing a strong focus on innovation, technology enablement, operations, and performance. This role will require a heavy bias towards the application of digital marketing technology (Martech), showing strength in data literacy.</p><p><strong>A day in the life - Get ready to think big, work smart and shine bright! &nbsp;</strong></p><ul><li>Lead the process of gathering requirements for personalization and automation use cases. </li><li>Collaborate with the following: program leads, marketing project managers, digital SCE.com team, IT web development team, customer experience data specialists, third-party marketing vendors, and program implementers to define and streamline data transformation processes required to meet marketing and program goals.&nbsp;</li><li>Lead the end-to-end project coordination including development, QA, delivery and optimization of automated marketing campaigns as part of the broader program marketing and education plans. &nbsp;</li><li>Support the building of marketing performance reports and dashboards via data automation to measure effectiveness. &nbsp;</li></ul><p><strong>The Essentials &nbsp;</strong></p><ul><li>Seven to Ten years of experience in email marketing, technical project coordination, solution architecture, or product management. &nbsp;</li><li>Two (2) or more years of Salesforce Marketing Cloud experience or equivalent enterprise-grade multi-channel marketing hub. </li><li>Experience building outstanding marketing automation practices/marketing campaigns which increases engagement with customers. </li><li>Experience designing and testing customer journeys and workflows in support of marketing campaigns/journeys.</li></ul><p><strong>The Preferred &nbsp;</strong></p><ul><li>Bachelor’s Degree or higher in Marketing, Business or Technical field.</li><li>Completing high priority initiatives as aligned to marketing automation/MarTech roadmaps.&nbsp;&nbsp;</li></ul><p><strong>You should know&nbsp;</strong></p><ul><li>This position’s work mode is <strong>hybrid</strong>. The employee will report to an SCE facility for a set number of days with the option to work remotely on the remaining days. Unless otherwise noted, employees are required to reside in the state of California. Further details of this work mode will be discussed at the interview stage. &nbsp;The work mode can be changed based on business needs.</li><li>Visit our Candidate Resource page to get meaningful information related to benefits, perks, resources, testing information, hiring process, and more!</li><li>The primary work location for this position is Irwindale, CA. However, the successful candidate may also be asked to work for an extended amount of time at (alternate work location). &nbsp;</li><li>Position will require up to 10% traveling and being out in the field throughout the SCE service territory. &nbsp;</li><li>Relocation does not apply to this position. &nbsp;</li></ul><p>About Southern California Edison</p><p>The people at SCE don't just keep the lights on. Our mission is so much bigger. We’re fueling the kind of innovation that’s changing an entire industry, and quite possibly the planet. Join us and create a future with cleaner energy, while providing our customers with the safety and reliability they demand. At SCE, you’ll have a chance to grow personally and professionally, making a real impact in Southern California and around the world. &nbsp;</p><p>At SCE, we celebrate our differences. We are a proud Equal Opportunity Employer and will not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected status. &nbsp;</p><p>We are committed to ensuring that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation at (833) 343-0727. &nbsp;</p>

Product Management Advisor – Marketing Automation [HYBRID]

<p>Salary Range:&nbsp;&nbsp;$67,186.00&nbsp;(Min.) -&nbsp;$87,342.00&nbsp;(Mid.) -&nbsp;$107,498.00&nbsp;(Max.)</p><p>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.<br><br>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.<br></p><h4>Job Summary</h4><p>The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically necessary referrals that meet established criteria. Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status. Generates approval, modification and denial communications to include member and provider notification of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review, and collaborates with onsite staff, physicians, providers, member/ family interaction to develop and implement a successful discharge plan. </p><p>Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and retrospective claims medical review. Monitors and oversees the collection and transfer of data (medical records) and referral requests by Providers. Acts as a department resource for medical service requests /referral management and processes. Receives incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner.</p><h4>Duties</h4><p>Promote and support team engagements, programs and activities to create and ensure a positive and productive workplace environment.</p><p>Perform prospective, concurrent, post-service and retrospective claim medical review processes. Utilizing considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge and application of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times specific to the case type. Identifies cases needing Physician Advisor (PA) review or input and presents for physician review if indicated.</p><p>Perform telephonic and/or on site admission and concurrent review, and collaborates with onsite staff, physicians, providers, the member and significant others to develop and implement a successful discharge plan. Process, finalize and facilitate Inbound requests received from providers. </p><p>Generate appropriate member and provider communication for all determinations within the required timelines as defined by the most current department policy.</p><p>Facilitate/review requests for Higher level of care or skilled nursing/discharge planning needs.&nbsp; Research for appropriate facilities, specialty providers and ancillary providers to utilize for all lines of business. Identification of potential areas of improvement within the provider network.</p><p>Identify and initiates referrals for appropriate members to the various L.A. Care programs/processes and external community based programs or Linked and Carve Out Services (e.g. DDS/CCS/MH). Ensure potential quality of care/potential fraud issues are identified and documented per L.A. Care policy. Ensure high risk/high cost cases and reports are maintained and referred to the Physician Advisor/UM Director. </p><p>Documents in platform/system of record. Utilizes designated software system to document reviews and or notes.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </p><h4>Duties Continued</h4><h4>Participate in the department’s continuous quality improvement activities. Communicates to UM Manager and supervising RN, barriers to completing assignments or daily work in an efficient and effective manner.</h4><h4>Receive incoming calls from providers, professionally handles complex calls, researches to identify timely and accurate resolution steps. Follows up with caller to provide response or resolution steps. Answers all inquiries in a professional and courteous manner.</h4><p>Perform other duties as assigned.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p><h4>Education Required</h4>Associate's Degree<h4>Education Preferred</h4>Bachelor's Degree<h4>Experience</h4><p>Required:</p><p>At least 4 years of experience in a patient care setting and/or combination in utilization management, appeals and grievances, delegation oversight, and/or CNA experience. </p><p>At least 2 years of Utilization Management/Case Management experience in a hospital or HMO setting.</p><p>Preferred:&nbsp; </p><p>Managed Care experience performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare, and commercial lines of business.</p><h4>Skills</h4><p>Required:</p><p>Technical skills: Must be computer literate, with expertise in Outlook, Word, Excel, and PowerPoint.&nbsp; Effectively utilize computer and appropriate software and interacts as needed with L.A. Care Information System. </p><p>Customer Service Skills: Provision of excellent customer service required due to frequent communication with providers and other members of the interdisciplinary team.</p><p>Excellent time management and priority-setting skills.</p><p>Maintains strict member confidentiality and complies with all HIPAA requirements.</p><p>Strong verbal and written communication skills.</p><p>Preferred:</p><p>Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. </p><p>Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and Medicaid Services(CMS) requirements for health plan compliance with UM or CM.</p><h4>Licenses/Certifications Required</h4>Licensed Vocational Nurse (LVN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4>Case Management Certificate<h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>May work on occasional weekends and some holidays depending on business needs.</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul>

44 Project Management / Professional Services Jobs in Irwindale, CA, USA