Salary Range:  $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (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, we make sure our members get the right care at the right place at the right time.

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 Supervisor, Quality Configuration Assurance works with the Manager, Systems Configuration Performance Improvement and Director, Quality Configuration to oversee the daily operations of the Quality Configuration Assurance staff for the L.A. Care core and surround systems.  This position is responsible to maintain a high performing team of Quality Configuration Assurance Analysts of various knowledge and technical skill levels by ensuring that each team member meets or exceeds all metrics and standards of quality. This position supervises all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports. 

The Supervisor, Quality Configuration Assurance engages, measures, and helps to facilitate improvements in the team's performance by conducting continual improvement activities such as training, coaching and quality assurance. This position will collaborate with the Quality Configuration Assurance leads to support new programs, system implementations and upgrades, quality measures to improve claims mass adjudication and configuration performance improvements,  etc.

Duties

Responsible for the daily workflow and leading the work of assigned staff.  This role will mentor, coach, act as a resource and provide feedback on performance of assigned staff.  Hire, train, coach, and evaluate staff (under the guidance of the Manager, Systems Configuration Performance Improvement). 

Maintain quality goals and production levels within the department.  Develop procedure changes to improve results.

Track and trend the metrics associated with the systems configuration quality and production.  Prepare and present written and verbal reports.

Maintain and monitor departmental documents including policies, procedures, desktop procedures, workflow documents and job aids to ensure these documents are current and meet organizational requirements.

Serve as back-up for the Manager, Systems Configuration Performance Improvement and effectively interface with various personnel within and outside of the department and the organization.  Collaborate timely and effectively with various internal and external staff to ensure the smooth execution of functions to support configuration best practices.

Assure the team completes related quality configuration work timely and in accordance with business requirements, testing methodologies, and systems specifications.

Provide direction with handling of questions, issues, etc. raised by staff.   Serve as an informational resource for staff.  

Lead and troubleshoot simple to moderate issues for the Quality Configuration Assurance Analysts and collaborate with the Quality Configuration Assurance leads on complex issues.   Ensure that complex issues are resolved within established guidelines.  Ensure that appropriate follow-through is completed timely.

Oversee and lead initiatives and projects. Ensure that tasks are completed within the specified timeframes.

Perform other duties as assigned.

Duties Continued Education Required Bachelor's Degree in Business Administration or Healthcare Related FieldIn lieu of degree, equivalent education and/or experience may be considered.Education Preferred Experience

Required:

At least 5 years of experience in a quality configuration supporting a managed care system, especially related to quality measures for benefit, contract configuration, and mass adjudication in a healthcare or health plan environment.

 

At least 2 years of leading process, program, or staff or supervisory experience.

 

Experience with the quality review of the configuration of health services/population health as well as appeals and grievances systems, applications, etc.

 

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

 

Preferred:

At least 5 years of experience working with a California Medi-Cal managed care plan or commercial health plan, medical group, or management services organization.

Skills

Required:

Advanced knowledge of QNXT or comparable claims processing system.

 

Advanced knowledge of the healthcare domain, focusing on claims processing, membership, contracts, and benefits.

 

Advanced knowledge of and experience with interpreting and analyzing complex pricing mechanisms.

 

Strong coaching and mentoring skills. Able to build teams and allocate staffing resources based on work priorities.

 

Strong written and verbal communication skills.

 

Proficient in using Microsoft Word and Excel.

 

Able to multi-task in a high production environment.

 

Able to streamline day-to-day operations, policies, and procedures.

 

Able to draw conclusions from data analysis and formulate corrective action plans, as warranted.  

 

Able to troubleshoot problem areas and recommend, develop, and implement system and process improvements.

Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements LightAdditional 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)