L.A. Care Health Plan

Lead RN for Appeals & Grievances in Los Angeles. Leverage 8+ years of clinical managed care experience to mentor a team and resolve complex cases. Ensure regulatory compliance and improve audit outcomes for Medicare/Medicaid members. Enjoy benefits like PTO, tuition reimbursement, and wellness pr...

Seeking a Supervisor, Community Based Care in Los Angeles to lead Community Health Workers (CHW) and optimize care management operations. Requires an RN with an Associate's or an LCSW with a Master's, plus 3+ years of community-based experience and supervisory skills. Key duties include staffing,...

Seeking a detail-oriented **Delegation Oversight Clinical Auditor RN II** in **Los Angeles, CA**. Ensure delegate compliance with **Utilization Management (UM)** regulations and **Medi-Cal** requirements. Requires an **Associate's Degree in Nursing**, an active **California RN license**, and 7+ y...

Seeking a strategic **Manager, Utilization Management Claims Review** in **Los Angeles, CA**. This role leads a clinical team, driving **payment integrity** and ensuring regulatory compliance for **Medi-Cal** and **Medicare**. Requires an **RN with a California license** and 4+ years of managemen...

Authorization Technician II role in Los Angeles supporting Utilization Management with authorization processing, data entry, and compliance reporting. Requires 6+ months healthcare experience, medical terminology proficiency, and Microsoft Office skills. Offers PTO, tuition reimbursement, retirem...

Seeking a **Care Management Coordinator II** in **Los Angeles, CA** to engage high-need members via telephonic outreach and Health Risk Assessments. Requires a High School Diploma, 6+ months of healthcare admin experience, and medical terminology knowledge. Join a collaborative team to support ca...

Join L.A. Care Health Plan as a Managed Care Pharmacy Resident II in Los Angeles. This advanced residency develops leadership in managed care through formulary design, drug utilization review, and quality improvement. Requires a Bachelor’s in Pharmacy, intern license, and NMS match participation....

Medical Director, Clinical Policy sought in Los Angeles to lead evidence-based policy development and utilization management. This physician leadership role requires an M.D., 8+ years in managed care, and a California license. Oversee clinical architecture, authorization strategy, and regulatory ...

Seeking a Clinical Policy Clinical Coder RN II in Los Angeles to translate medical policies into accurate coding and claims logic. Requires an Associate's Degree in Nursing, 8+ years of clinical experience, and 3+ years in Medi-Cal/Medicare managed care. Key duties include developing codified cla...

L.A. Care Health Plan seeks a Care Management Specialist II in Los Angeles to manage complex cases for vulnerable populations. Requires an RN or LCSW with 3+ years of care management experience in managed care or hospice settings. Bilingual skills (Spanish, Chinese, Armenian, etc.) and CCM/ACM ce...

Seeking an experienced **ETL Data Integration Developer III** in **Los Angeles, United States** to manage and optimize our **Informatica PowerCenter** environment. You will develop complex ETL processes for our **Enterprise Data Warehouse** and **Data Marts**, requiring 5+ years of experience wit...

Senior Software QA Engineer III role in Los Angeles, driving quality for L.A. Care. Requires 5+ years experience in functional/non-functional testing, test automation, and DevOps initiatives. Lead test strategy, review business requirements, and mentor teams. Benefits include PTO, tuition reimbur...