L.A. Care Health Plan · 20 hours ago
Provider Data Services 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, dedicated to providing health coverage to low-income Los Angeles County residents. The Provider Data Services Program Manager II leads data remediation efforts and manages compliance processes within the organization, collaborating with various departments to ensure the integrity of provider data and successful program implementation.
FitnessGovernmentHealth Care
Responsibilities
Formulate and propose recommended solutions/ options to address moderately complex operational and programmatic challenges with Cactus provider data remediation, with moderate guidance from Senior Director
Assume ownership of data remediation initiatives for Cactus, under direction of Senior Director, for successful development, planning, and execution of programs, data reporting, analysis and improvements to infrastructure, from initial concept to implementation stage, with moderate guidance and supervision from Senior Director
Represent Cactus database interests and initiate engagement of existing internal and external business partners colleagues, to jointly problem-solve complex member and provider issues. Facilitate constructive dialogue among internal and external stakeholders to ensure problems are properly assessed, analyzed and resolved, with moderate guidance and supervision from Senior Director
In concert with other departments, work to draft work plans, policies and procedures that define business needs for Cactus data remediation, including , scope, key milestones and tasks necessary to guide the implementation of new program initiatives, such as Target State, Data Governance, and development of an Appeals & Grievances process for the Direct Network. Maintain work plan updates to capture any changes that arise throughout from each initiative, ensuring Cactus alignment with downstream business processes across the organization
Manage progress and performance as it relates to Cactus tasks; track and report on program status. Identify issues that must be escalated in order to ensure timely completion of program. Manage internal and external meetings, including the development of agendas and objectives. Propose solutions to address and mitigate any anticipated program delays and steer program in positive direction. Execute workflow processes developed by Provider Data Services (PDS) Director for Appeals and Grievances processes; ensure oversight monitoring process in place. Lead oversight and monitoring of Credentialing provider data reports for regulatory audits
Serve as L.A. Care business program lead in external stakeholder meetings on behalf of the Provider Data Management team, as required. Serve as L.A. Care business program lead and actively participate in L.A. Care committee standing meetings and management meetings on behalf of the Provider Data Services team, as required with moderate guidance and supervision from Senior Director
Perform other duties as assigned
Qualification
Required
Bachelor's Degree
At least 5 years of credentialing auditing experience in a managed care or hospital setting
Proven experience conducting root-cause analyses, policy requirements, and managing highly visible organizational programs
Experience building relationships with organizations and business partners
Strong knowledge of NCQA Credentialing Standards, CMS and DHCS regulatory requirements
Strong knowledge of Symplr Cactus database systems
Knowledge of metric management methodology
Demonstrated critical thinking, problem solving, and program planning and implementation skills
Demonstrated strong writing and communication skills
Demonstrated ability to synthesize and analyze qualitative and/or quantitative data
Proven knowledge of data entry and reporting management within Symplr Cactus database
Preferred
Master's Degree
Experience working with managing programs or other managerial experience
Managed care experience
Certified Provider Credentialing Specialist (CPCS)
Project Management Professional (PMP)
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
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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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