Salary Range: $77,265.00 (Min.) - $94,425.00 (Mid.) - $123,625.00 (Max.)
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.
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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.Job Summary
The Quality Improvement (QI) Specialist III will coordinate the development of QI program documents, evaluation and assigned National Committee for Quality Assurance (NCQA) standards, quality of care issue/concern, and regulatory and compliance documentation. This position will be responsible for auditing and ensuring the accuracy of all collected all relevant materials, updates, data and evidence of compliance with all quality related requirements and NCQA standards. This position will develop and produce reports/presentations to clearly convey the current state of the project/process in relation to timelines, deliverables, barriers etc. The position updates policies and work with QI staff to ensure policies and procedures are thoroughly reviewed and are compliant with internal and external regulations.
This position will work closely with the QI Director, manager and support QI project managers to help lead quality initiatives that positively impact L.A. Care members. In addition, this position will also facilitate assigned QI committee and assigned work group to ensure accurate documentation and required elements are reported timely. Acts as a Subject Matter Expert, serves as a resource and mentor for other staff.
Duties
Works interdepartmentally to organize and manage the QI program, evaluation and maintain the QI program documents to ensure regulatory compliance and accuracy and reflection of QI activities across the organization.
Develops templates and tools to assist with facilitating tasks including using various databases and platforms to compile data and produce reports including desktop procedures as well as executive summaries to assist the QI department.
Manages regulatory audits and delegation documentation processes for the department for CMS, Medi-Cal, DHCS, Covered California, DMHC, and NCQA. Managing documentation which includes: coordinating, collecting and reporting appropriate evidence of compliance.
Provides well thought-out recommendations for enhancements, new strategies, etc., as well as related informative presentations (as warranted).
Assists QI leadership as needed, QI project managers and independently facilitate assigned QI committees.
Develops and manage complex, interdepartmental projects and ad hoc reports.
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.
Perform other duties and training as assigned.
Duties Continued
Education Required
Education Preferred
Experience
Required:
At least 3-5 years relevant QI health care experience.
Skills
Required:
Self-motivated with the ability to work independently with minimal supervision and seek solution proactively.
Excellent interpersonal skills to work alongside other project employees to meet all client specifications and requirements.
Excellent verbal, written communication and presentation skills.
Advanced skill level in Microsoft Office and project management software tools.
Must be able to present data in the format that is appropriate for analysis.
Must be able to handle multiple priorities and have time management and ability to set priority skills.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
