L.A. Care Health Plan · 4 hours ago
Risk Adjustment Strategies and Initiatives Analytics Program Manager II
Los Angeles, CA
Full-time
Onsite
Mid, Senior Level
$89K/yr - $142K/yr
5+ years expL.A. Care Health Plan is the nation’s largest publicly operated health plan, providing health coverage to low-income Los Angeles County residents. The Risk Adjustment Strategies and Initiatives Analytics Program Manager II is responsible for executing risk adjustment system implementations, improving data processes, and coordinating cross-functional teams for effective program management.
FitnessGovernmentHealth Care
Responsibilities
Develop, propose and implement program strategies and objectives
Responsible for monitoring program budget and expenditures
Plans, develops, and implements strategies for generating funding and/or resource opportunities for program activities
Provide program management and partnership with technical project team, and communicate and document concise project timelines, risks, escalation path, roles/responsibilities, and accountabilities
Facilitate technical meetings related to encounters and claims data for risk adjustment for all product lines (Commercial, Medicare, and Medi-Cal), capture notes and action plans
Synchronize the work of cross-functional project teams and provide direct or indirect oversight scope of work
Evaluates and oversee the development and implementation of Centers for Medicare and Medicaid Services (CMS) and Department of Health Care Services (DHCS) risk adjustment program changes; incorporate changes and requirements into strategy
Develop and manage risk adjustment data Infrastructure programs and manage deliveries from beginning to end, including project scope, timeline, software or hardware requirements, resource allocation, and project execution coordinating with inter/intra Technical and Business Functional teams
Ensure program objectives and deliverables are in alignment with department and LA Care goals
Develop program initiative timelines, goals and ensure everything is on schedule and within stated budgets
Serve as a liaison between all I.T. teams to ensure alignment with project goal(s)
Coordinate cross-project activities
Partners with Business Owner(s) to develop communications plan, test plan, training plan, risk management/mitigation plan, and plan of record
Monitor inter-connected programs/project work product, outcome and interplay to be able to make necessary enhancements or modifications as appropriate to ensure alignment with department objectives
Coordinate cross-program/project activities as necessary
Formulate, organize and coordinate inter-connected projects in encounter and supplemental data collections, system processes, and regulatory data submissions for risk adjustment data management and methodologies for all three product lines (Commercial, Medicare, and Medi-Cal)
Develops and distributes reports for senior leaders as it relates to risk adjustment metrics and performance
Assess program performance and aim to maximize return on investment (ROI), utilize change management strategies to implement enhancements and process improvements as necessary
Navigate and create reports that monitors key performance indicators
Ensures the accuracy and timeliness of report and data given to senior leaders and stakeholders
Identify issues determined to impact risk adjustment, and work with the affected teams to resolve those issues in a manner that complies with all applicable internal and external governing rules and regulations
Perform other duties assigned
Qualification
Required
Bachelor's Degree
At least 5 years of experience in handling encounter data and/or risk adjustment projects or programs
Experience with Process Improvement Methodology including defining and documenting workflow
Experience with Workflow Tools - JIRA, Data Lake, Project Server etc
Technical project experience in large distributed systems, complex competing environments, Micro services Architecture, Cloud computing etc
Experience resolving effective program critical metrics and using them to measure program success and identify issues
Experienced in project management tools
Familiar with both Agile and Waterfall methodologies and able to apply them when best suited
Proven ability to work closely and skillfully with all stakeholders across the organization
Strong organizational, analytical and truth-seeking mentality skills to juggle many tasks without losing sight of the highest priority or roadmap projects
Excellent in identifying process gaps, measuring progress, efficiency and balancing with process overhead and be exceptional at facilitating discussions
Proven technical capability and an understanding of technical designs, challenges, and risks
Ability to influence, motivate, and align people across a broad variety of job functions through your project/program management skills
Basic understanding of IT driven technologies and Architectures
Working knowledge of SQL Server, Visual Studio, Oracle, MS Office, Visio, Project Server & Jira Management
Ability to articulate and communicate effectively and follow the project management and Systems Development Life Cycle (SDLC) lifecycles
Strong problem solving skills with the demonstrated ability to identify research and make decisions
Demonstrated ability to be an effective, collaborative partner with internal and external stakeholders
Understanding of encounter and supplemental data collections, system processes, and regulatory data submissions for risk adjustment data management and methodologies for Commercial, Medicare, and Medi-Cal product lines
Have an understanding of end-to-end encounters/claims, supplemental, and risk adjustment data software systems
Ability to lead cross functional internal teams to execute on complex tasks
Preferred
At least 5 years experience in Health Care, Managed Care
Project Management Certificate
Benefits
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
Company
L.A. Care Health Plan
L.A. Care’s mission is to provide access to quality health care for L.A.
1001-5000 employees
H1B Sponsorship
L.A. Care Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (1)
2023 (1)
2021 (3)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Melanie Rainer
Chief Strategy and Transformation Officer
Recent News
MarketScreener
2025-08-27
2025-08-04
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