L.A. Care Health Plan · 6 days ago
Enterprise Risk Adjustment and Encounters Program Manager II
Los Angeles, CA
Full-time
Onsite
Mid, Senior Level
$89K/yr - $142K/yr
4+ years expL.A. Care Health Plan is the nation’s largest publicly operated health plan, dedicated to providing health coverage to low-income residents of Los Angeles County. The Enterprise Risk Adjustment and Encounters Program Manager II oversees multiple programs related to risk adjustment and encounter data, ensuring effective execution and alignment with organizational goals while managing cross-functional teams and program budgets.
FitnessGovernmentHealth Care
Responsibilities
Oversee cross-program activities and ensure the programs achieve their goals
Formulate, organize and monitor inter-connected programs
Develop and control deadlines and activities
Monitor and evaluate Key Performance Indicator (KPI) and return on investment (ROI)
Support cost accounting activities and collaboration with other stakeholders as necessary
Provide guidance to staff
Partner with stakeholders to drive program initiatives improving operating performance such as yield improvements and labor efficiency, balance sheet optimization, and total cost reductions
Direct all phases of programs from inception through completion
Set priorities and milestones for individual projects and team initiatives within the program
Support the implementation and maintenance of internal procedures, policies, and practices to ensure proper safeguarding of L.A. Care’s assets
Develop and implement annual work plans; ensure timely and high-quality reviews and submissions of deliverables; prepare scopes of work and monitor service delivery
Participate and recommend in setting program goals and objectives
Ensure team members have the resources needed to meet their goals
Review, edit, and contribute to technical deliverables and manage field assignments as required
Provide recommendations on financial management of assigned programs including developing, tracking, and updating budgets; monitoring monthly projections and actuals; obligated funds notifications; anticipate budget modifications and other financial matters
Plan, develop, and implement strategies for generating funding and/or resource opportunities for program activities
Provide program management and partnership with technical project team
Communicate and document concise program timelines, risks, escalation path, roles/responsibilities, and accountabilities
Facilitate technical meetings for risk adjustment for all product lines, capturing notes and action plans
Synchronize the work of cross-functional project teams and provides direct or indirect oversight scope of work
Evaluate 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 coordinating with internal teams
Ensure program objectives and deliverables are in alignment with department and L.A. Care goals
Develop program initiative timelines, goals and ensures everything is on schedule and within stated budgets
Serve as a liaison between all I.T. teams to ensure alignment with program goal(s)
Develop and manage detailed program plans, timelines, and deliverables across multiple program activities and risk adjustment initiatives
Provide program coordination with internal risk adjustment functional teams to ensure alignment and progress/completion of program/initiative deliverables
Utilize a client relationship management (CRM) or another system to organize information and facilitate outreach communications, perform forecasting, and measure the performance of programs
Collaborate with key stakeholders on program implementation and facilitate communications with cross-functional departments on the status of ongoing activities, manage compliance to scope and reporting requirements
Obtain approvals from management
Partner with key stakeholders to develop communication, test, training, risk management/mitigation plans, 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 programs in encounter and supplemental data collections, system processes, develop and maintain Standards of Operations (SOPs), retrieval and coding vendor platforms workflows, and update regulatory data submissions for risk adjustment data management and methodologies for all three product lines
Create and manage the Participating Provider Groups (PPGs) related to provider educational webinar presentation decks
Manage PPGs Risk Adjustment meeting agendas, minutes, and deliverables for various risk adjustment programs and initiatives
Track and identify trends across various risk adjustment programs and initiatives for continuous process improvement opportunities and to set up best practices to coordinate with PPGs to close care gaps
Identify issues determined to affect risk adjustment and collaborate with the affected teams to resolve those issues that comply with internal and external governing rules and regulations
Develop and distribute reports for senior leaders as it relates to risk adjustment metrics and performance
Assess program performance and aim to maximize ROI, utilize change management strategies to implement enhancements and process improvements as necessary
Navigate and create reports that monitor KPIs
Ensure the accuracy and timeliness of report and data given to key stakeholders
Monitor program operations for quality, efficiency, and effectiveness
May work with vendors, consultants and government agencies that may include vendor management responsibilities
Perform other duties assigned
Qualification
Required
Bachelor's Degree in Data Analytics or Related Field
At least 4 years of experience in handling encounter data and/or risk adjustment programs or projects
At least 4 years of work experience performing problem solving, policy, and/or program implementation
Experience with Process Improvement Methodology including defining and documenting workflow
Experience with Workflow Tools - JIRA, Data Lake, Project Server etc
Technical program 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
Experience in program management tools and knowledge of both Agile and Waterfall methodologies and ability to apply them when best suited
Strong strategic mindset
Excellent verbal, written communication and presentation skills
Excellent problem-solving skills with the ability to identify research and make decisions
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 skills in identifying process gaps, measuring progress, efficiency and balancing with process overhead and 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 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 program management Systems Development Life Cycle (SDLC) lifecycles
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 all product lines
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
Critical thinking, program planning and implementation skills
Ability to synthesize and analyze qualitative and/or quantitative data
Knowledge of health care operations or health care systems
Preferred
Master's Degree in Data Analytics or Related Field
At least 5 years of experience in Health Care and Managed Care
Experience in finance management
Certificate in Program Management
Program Management Professional (PgMP)
Certification in Project Management Professional
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
2026-01-17
MarketScreener
2025-08-27
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