L.A. Care Health Plan - United States, On-site work

Seeking an experienced **Supervisor, Utilization Management RN** in **Los Angeles, CA**. This role leads daily UM operations, supervises Care Management staff, and ensures optimal departmental efficiency. Requires an active California RN license, 7+ years of acute care experience, and 2+ years in...

Seeking a Technical Product Manager III in Los Angeles to bridge business and IT within a health plan. You will own product domains, drive digital solutions, and align roadmaps with enterprise strategy. Requires 10+ years in a payer organization and expertise in healthcare domains like care manag...

Lead ETL Data Integration Developer role in Los Angeles, US. Seeking 6+ years of ETL, data warehousing, and data modeling experience with Erwin. Lead development teams, mentor staff, and design scalable data solutions for enterprise BI and migration projects. Benefits include PTO, tuition reimbur...

MLTSS Nurse Specialist RN II needed in Los Angeles to apply advanced clinical judgment in managing long-term services for members with chronic conditions. Key duties include care coordination, UM authorizations, and telephonic follow-up. Requires an Associate's in Nursing and 3+ years of clinical...

Join our team as a Transitional Care Services Community Health Worker II in Los Angeles. You will guide members through care transitions, coordinate with facilities, and connect them to vital health services. Ideal candidates have a High School diploma, 6+ months of health navigation experience, ...

Domain Transformation Lead (Business-Technology) sought for a Health Plan/Payer in Los Angeles. This Technical Product Manager role bridges business and IT, driving digital solutions for member and provider experience. Requires 6+ years in healthcare domains like Customer Engagement or Claims, wi...

Domain Transformation Lead (Business-Technology) sought for a Health Plan/Payer in Los Angeles. This Technical Product Manager bridges business and IT, owning a primary domain to deliver measurable outcomes. Requires 6+ years in healthcare, expertise in Customer Engagement or Provider Operations,...

Senior Applied AI Scientist role in Los Angeles designing and deploying production-grade ML solutions for healthcare. Requires 6+ years experience with Python, MLOps, and predictive modeling using structured/unstructured data. Lead full AI lifecycles to improve quality and member outcomes. Benefi...

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 detail-oriented **Utilization Management Claims Review Nurse RN II** in **Los Angeles, CA**. This role conducts clinical reviews of medical claims for medical necessity, accuracy, and compliance, supporting payment integrity and FWA prevention. Requires an active **California RN license...

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...