About this role
<p><b>Salary Range: </b> $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)</p> <p> </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> <div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Job Summary</H2> </div><div><p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">The Quality Improvement Project Manager II is a healthcare project specialist who is responsible for managing day-to-day operations of a portfolio of projects, and providing support for ongoing special projects within L.A. Care's Quality Improvement Department. In this role, the Project Manager is responsible for ensuring program activities are completed in a high quality and timely manner and ensuring compliance with all regulatory guidelines such as Medicaid (Medi-Cal), Medicare, Health Exchange, and Healthy Kids as well as National Committee for Quality Assurance (NCQA) Accreditation. Successful candidate must have excellent project management, analytic, reporting, and written and oral communication skills. In addition, candidate is detail-oriented and self-motivated.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">This position works on various quality improvement projects including, but not limited to:</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> * Implementation of any new product lines;</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> * Data collection and analysis using internal data and using various analytic tools to develop interventions to improve overall member satisfaction, such as grievances and appeals data, CAHPS surveys, Healthcare Effectiveness Data and Information Set (HEDIS) results and network access and availability.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> * NCQA Accreditation readiness and oversight.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> * Delegation oversight.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> * Vendor contract management and operations.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> * Nurse Advice Line management and oversight.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif"> * Inter-departmental committee participation.</span></span></p> </div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Duties</H2> </div><div><p>Design and management of a portfolio of assigned projects within budget to: Ensure that projects are delivered timely, accurately and in compliance with all regulatory requirements and NCQA Standards and within other established metrics. Present quarterly quantitative and qualitative performance analysis and reports to Quality Oversight Committees as well as other committees. Monitor the performance of current service interventions as well as coordinate new interventions</p> <p>Process analysis, process evaluation and assist in implementing process improvements to: Ensure Business Process Improvement meets requirements and expected business benefits. Develop appropriate project management tools to develop, implement and evaluate current projects. At least annually, assess projects to determine if they are meeting performance goals and provide project plan for continuous quality improvement.</p> <p>Identify, recommend and apply business solutions, derived from findings of research and analysis. Gain departmental efficiencies.</p> <p>Documentation of existing business processes and industry best practices by: Workflows of existing processes and interdependencies. Complete and accurate work plans for all assigned projects. Complete business requirements for analytical tools used to measure project improvement.</p> <p>Lead vendor selection processes, implement and manage vendor contracts by: A successful selection of vendors with positive Return of Investment (ROI) analysis. Comply with Request for Proposal (RFP) process for vendors every three years, followed by Request for Quotation (RFQ) in interim years. Documentation must be in compliance with company protocol.</p> <p>Perform other duties as assigned.</p> </div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Duties Continued</H2> </div><div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Education Required</H2> </div><div><div>Bachelor's Degree</div><div>In lieu of degree, equivalent education and/or experience may be considered.</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Education Preferred</H2> </div><div><div>Master's Degree in Business Administration or Related Field</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Experience</H2> </div><div><p><b>Required:</b></p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">At least 3 years of experience in a managed health care environment.</span></span></p> <p style="margin-bottom:2.0px;margin-top:2.0px"> </p> <p><span style="font-size:10.0pt"><span style="font-family:'Calibri', sans-serif">Experience with health care program design, implementation, and evaluation.</span></span></p> </div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Skills</H2> </div><div><p><b>Required:</b><br> Knowledge of regulatory requirements for Medicaid, Medicare, and NCQA standards.</p> <p>Strong data management and analytic skills (including basic statistics or better).</p> <p>Proficiency in analytical tools (SPSS) and Microsoft office (Excel, MS Project, Access, Visio); including the ability to develop databases, forms, letters, and advanced queries.</p> <p>Ability to lead project team, meet or exceed deadlines and work with other dependencies outside the department related to the project.</p> <p>Excellent written and oral communication skills.</p> <p>Strong interpersonal communication skills with ability to effectively work with staff at all levels of the organization.</p> <p>Persuasion Skills: Persuade internal L.A. Care staff to attend and participate in collaboration of service improvement activities and complete tasks and activities in timely manner. Obtain reports from internal staff.</p> <p><b>Preferred:</b><br> Project Management and analytical/problem solving skills.</p> <p>Statistical Analysis System (SAS) preferred</p> </div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Licenses/Certifications Required</H2> </div><div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Licenses/Certifications Preferred</H2> </div><div><div>Certified Professional in Healthcare Quality (CPHQ)</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Required Training</H2> </div><div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Physical Requirements</H2> </div><div><div>Light</div></div></div><div style="padding:10.0px 0.0px;border:1.0px solid transparent"><div style="font-size:16.0px;word-wrap:break-word"><H2 style="font-size:1.0em;margin:0.0px">Additional Information</H2> </div><div><p><b>Quality Improvement Accreditation: </b></p> <p>Staff working in this area reports to the Manager, Quality Improvement Accreditation.</p> <p><b>Quality Improvement Intiatives: </b></p> <p>Staff working in this area reports to the Manager, Quality Improvement Intiatives.</p> <p> </p> <p><u><b>Required:</b></u> </p> <p style="margin-bottom:2.0px;margin-top:2.0px"><span style="font-size:10.0pt"><span style="font-family:Calibri, sans-serif">Travel to offsite locations for work required.</span></span></p> <p> </p> </div></div></div><p><b>Salary Range Disclaimer:</b> The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.</p> <p> </p> <p><b>L.A. Care offers a wide range of benefits including</b></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> <p> </p>