Manager, Enterprise and Network Oversight Clinical Operations

Salary Range:  $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (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.

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.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Manager of Enterprise and Network Oversight Clinical Operations is an integral part of ensuring the success of the Enterprise Performance Optimization Program (Enterprise POP) and the Network Performance Optimization Program (Network POP). The Manager will support internal and external oversight and monitoring of delegated and non-delegated medical management and clinical operations' functions. This position is responsible for helping execute and monitor projects, strategic plans, and programs designed to achieve the Department's goals and L.A. Care's clinical compliance and quality standards. Within an assigned scope and projects, the Manager helps lead initiatives that optimize Enterprise and Network clinical operations performance. The Manager helps lead efforts to implement and maintain the clinical components of EPO's integrated, proactive performance measurement and management activities, including metric-based programs, gap and risk analyses, focused audits, case file reviews, and spot investigations to ensure Plan and Network performance excellence.

 

The Manager must maintain subject matter expertise in health care quality and delivery, including utilization management, care management, clinical operations, and initiatives and programs related to health care delivery. This position manages a team that will aggregate federal, state, contractual, accreditation, and Plan-imposed requirements and best practices in managed care applicable to the Enterprise and L.A. Care's Plan Partners and Provider Network for all lines of business (Medi-Cal, Personal Assistance Services Council (PASC-SEIU), L.A. Care Covered (LACC) and LACC Direct (LACC/D), and the Cal MediConnect Program (CMC) and Dual-Eligible Special Needs Plan (D-SNP)).  In collaboration with key stakeholders, this position generates performance intelligence through case file reviews and routine and ad hoc oversight and monitoring activities track, trend, analyze, and report results to enable leadership to make evidence-based decisions to remediate extant deficiencies and engage in process improvement to achieve optimal internal and external clinical operations performance.

 

Specific to an assigned scope, this position manages a team to establish and oversee the development and maintenance of Key Performance Indicators (KPIs or Metrics) to systematically assess, track, and trend internal L.A. Care performance and external delegate performance.  This position is responsible for ensuring that remediation planning is both satisfactory and implemented for all detected issues, in collaboration with internal units and providers.  This position manages a clinical team as they examine, and as necessary, strengthen process integrity and controls to manage accountabilities, mitigate risks, and protect the Plan from process waste, enforcement actions, sanctions, and other adverse outcomes, in collaboration with key stakeholders. Manages all aspects of running an efficient clinical team, including hiring, supervising, coaching, training, disciplining, and motivating direct and indirect staff reports.

 

 

Duties

Provides leadership to a team responsible for assurance of Plan and Network clinical performance, including proactively performing impact, gap, and risk analyses, developing and monitoring the process to track ongoing fidelity to these requirements, and collaborating to ensure all performance deficiencies are remediated.

 

Oversees efforts and ensures the effectiveness of efforts to gather, analyze, communicate, validate, and systematically track all federal and state law, contractual provisions, accreditation standards, and Plan-imposed policy applicable to the Enterprise and Provider Networks, including the Direct Network, in order to establish performance crit