L.A. Care Health Plan · 19 hours ago
Provider Network Account Manager II
Los Angeles, CA
Full-time
Onsite
Mid Level
$77K/yr - $124K/yr
3+ 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 Provider Network Account Manager II is responsible for managing provider contracting and relationships, ensuring compliance with regulations, and facilitating effective communication between L.A. Care and its network of providers.
FitnessGovernmentHealth Care
Responsibilities
Responsible for identifying, and contacting, providers and/or provider organizations that are interested in participating with LAC; assuring the financial integrity of LAC is maintained through rate negotiation; and, ensuring contract requirements are adhered to, including language, terms, and reimbursement requirements
Responsible for the project management of all contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards, while ensuring a smooth transition of services for members
Draft contract clauses/addenda, review, and negotiate new contracts/amendments and other contracting related documents based on LAC contracting guidelines, parameters, and standards, including leadership strategy discussions; implement contracts/amendments across LAC; and provide in-service orientation meetings with providers
Responsible for monitoring managed care contracts for renewals and expirations
Act as the liaison between PNM and other internal Plan departments, as necessary, to resolve complex issues, and to effectively deliver accurate, timely, and appropriate information to their assigned accounts
Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting LAC in investigating any potential quality issues
Monitor timely receipt of contractually-required reporting
Acquire and maintain a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases, and routinely relay information about additions, deletions, or changes to the LAC Provider Network Management (PNM) Provider Data Management department
Research and resolve contractual interpretation, operational and/or payment issues; Research and resolve incoming escalated provider inquiries within specified guidelines; Educate providers on new protocols, policies, and procedures
Ensure provider database and documentation is up-to-date, accurate, and complete
Maintain an understanding of LACs reports and metrics to evaluate the performance of assigned providers and/or provider organizations, and use the data to develop and implement methods to improve relationship with all providers
Responsible to assist in all corrective actions required, up to and including termination, following LAC policies and procedures, and applicable contractual and regulatory requirements
Serve as a communication link between provider accounts and LAC
Complete regularly scheduled meetings (site visits, or conference calls) with all accounts
Translate information exchange, ideas, requests and other inquiries into actionable items for improved contracting/relationship management and enhanced operational service delivery
Supporting all of the LAC PNM departments (Oversight and Monitoring; Engagement and Strategy; Data Management; and, Operations)
Assist in the development and distribution of provider engagement material (trainings, notices, newsletters); assist in oversight and monitoring efforts; implement LAC provider strategies; and assist in improving the quality of provider data
Perform other duties as assigned
Qualification
Required
Bachelor's Degree
At least 3 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry
At least 3 years of healthcare experience in Managed Care; or, with a physician group, clinical-based organization, and/or in a hospital/facility setting
Good organizational skills and demonstrate excellent attention to detail and follow up skills
Knowledgeable financial and financial risk analysis
Competent computer skills; MS Office skills required
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
Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel, and LAC provider network physicians
Possess a professional and mature demeanor at all times
Ability to work in a fast-paced department independently and handle multiple tasks; work with interruptions and deal effectively with confidential information
Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management
Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others
Experience in provider data regulatory reporting and provider directory management
Preferred
Master's Degree
Knowledge of ICD-9, ICD-10, and CPT codes desired
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
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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