L.A. Care Health Plan jobs - 394 jobs

Salary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (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 Physical Accessibility Review Survey (PARS) Reviewer II is responsible for the coordination, execution, and report completion of the tri-annual physical accessibility review survey assessments required by the Department of Health Care Services (DHCS) and the Centers for Medicaid and Medicare Services (CMS). The assessment is conducted at all Primary Care Physicians (PCP) and high volume specialist sites and ancillary providers that include but not limited to behavioral health providers, Community Based Adult Services agencies, skilled nursing facilities, dialysis and others. This position also verifies primary care provider's availability onsite based on L.A. Care's minimum site hours requirements which is also required by DHCS. This position is responsible for completing and uploading audit findings which are shared with other Medi-Cal health plans in Los Angeles County. Duties Ensure SHCS compliance by inspecting and assessing physical site/facility for potential issues concerns using the DHCS Policy Letter 12-006 Attachment C and All Plan Letter 15-023 Attachments D and E and their respective guidelines or current versions. Data entry of plan-partner audits including but not limited to: PARS assessments, FSR Survey up to 150 points, and Medical Record Review up to 30 charts. Participation in PARS collaborative with plan-partners to improve efficiency and implementation of PARS assessment through various health plans. Educate L.A. Care's FSR staff on new policies and guidelines implemented by PARS collaborative. Monitor, track and distribute PARS assessment as they are tasked in. Ensure all PARS assessments are completed timely when first assigned and PARS assessments are redone every 3 years. Work with Plan Partners to ensure data is reconciled and duplicate work is not done. (60%) Complete audit reports accurately and timely. This includes but not limited to conducting secret shopper phone calls, completing unannounced verification site visits to, and making compliance recommendations. (15%) Provide technical assistance and resources and conduct education to providers and their staff regarding accessibility standards and Americans with Disabilities Act (ADA) requirements. (5%) Actively contribute to improve FSR department processes and outcomes. (5%) Attend trainings as appropriate and as directed. (5%) Perform other duties as assigned. (10%) Duties Continued Education Required High School Diploma/or High School Equivalency Certificate Education Preferred Experience Required: Minimum of 6 months of professional work experience interacting with professional level clients. Skills Required: Excellent writing and communication skills. Proficient in using Microsoft Word, Excel and others. Excellent organizational and time-management skills. Excellent attention to detail. Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Required: Travel to offsite locations for work. 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) Nearest Major Market: Los Angeles Job Segment: Data Entry, Travel Nurse, Behavioral Health, Dialysis, Medicaid, Administrative, Healthcare

Salary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (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 Lead Community Resource Center (CRC) is 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. The Lead will assist the CRC Manager with developing a successful and cohesive CRC team. The CRCs serve anyone in the community in which they are located; and therefore, this role will additionally provide expertise on developing and monitoring effective referral processes to connect non-member cases to the appropriate external resources. The lead will monitor and assess the planning, development, implementation, and analysis of CRC services, programming, and vendor management. The Lead will support manager with immediate urgent decisions for center operations as applicable if manager is not available. 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. Duties Leads the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training and feedback on performance to department management. Oversees the daily office workflow, develops and recommends enhancements to process and procedures. 10% Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval. 10% Mentors and trains staff on special projects and processes that support the overall operation of the CRC to provide an excellent customer experience, represent the CRC brand, and implement innovative programs. Proactively monitors risks and provides recommendations and implements mitigation plans to keep initiatives on-track. Implements continuous process improvements to workflows, processes, and customer-centric support and member engagement are well as propose solutions for the implementation of new services. 10% Oversees member-centric customer service to respond to a wide range of simple to complex inquiries and bridges members to appropriate resources. Monitors implementation of child development activities and programs to support children development while parents and guardians attend a class or service appointment at the CRC. 10% Leads implementation of extended-hour schedule by providing operational support and demonstrated commitment to offering high quality in-person service supporting CRC staff working extended-hour schedules to support members and visitors that may need services outside of regular operating hours and days based on business needs. Escalates complex member/visitor or staffing issues to manager as appropriate. 10% Create desk level procedures and provides extensive consultation on health care access issues and identification of resource needs based on social drivers identified through a health assessment process. Leads cross-functional collaboration with multiple L.A. Care health plan departments. Implements the coordination of member service support across L.A. Care departments to ensure accountability and promote positive health care outcomes. 10% Duties Continued Leads work plan development to define building, maintaining, and nurturing meaningful relationships with key internal and external stakeholders; and, monitors the growth of the CRC partnership brand recognition. 10% Assesses partnership opportunities and identifies key community stakeholders, assesses community needs, and gathers and analyzes data to inform an integrated approach to outreach activities and targeted member engagement. Makes recommendations for bridging members of the community to physical and health education programs and classes that will enhance health outcomes and member experience. 5% Provides support to the CRC management in developing strategies and tactics to implement community and provider outreach and engagement initiatives to increase member traffic at a CRC and bridge members of the community to classes and resources. Oversees the member engagement platforms by developing and implementing a strategy for CRC staff to act as a liaison to the L.A. Care departments that play a role on CRC-specific marketing, communications, and promotional initiatives to promote member and community engagement. 10% Creates and leads community initiatives leveraging relationships within L.A. Care and Blue Shield Promise Health Plan and with community stakeholders to promote access to health care programs, classes, and preventative services offered at the CRC. 5% Provides training and education to other L.A. Care departments on the necessary steps to implement relevant services and activities that will resonate with and engage members of the CRC community. 5% Performs other duties as assigned. 5% Education Required Associate's Degree In lieu of degree, equivalent education and/or experience may be considered. Education Preferred Bachelor's Degree Experience Required: A minimum of 4 years of experience in community events and leading projects focused on health care, public health, or health education. At least 6 months of experience leading projects and/or staff, managing relationships with multiple stakeholders and have worked as a senior CRC Specialist. Health care product experience including one of the following health care programs: Medicaid/Medi-Cal, Covered California, or Medicare Special Needs Plan. Experience working cross-functionally with Care Management, Social Services, Health Education, and other social service or clinical teams. Preferred: Experience with Salesforce Customer Relationship Management (CRM) platform. Skills Required: Strong verbal and written communication and presentation skills Excellent organizational skills. Must be a detail-oriented, collaborative and enthusiastic team player. Strong ability to garner consensus on and support for new partnerships and initiatives, particularly when projects rely on participation by multiple internal or external stakeholders. Demonstrated ability to solve complex issues and identify creative solutions to assist members and community stakeholders. Demonstrated ability to troubleshoot problem areas, recommend effective alternative solutions, and provide optimal customer service for internal and external customers. Demonstrates action oriented leadership ability to take on new opportunities and rewarding challenges with a sense of urgency, high energy, and enthusiasm. Strong ability to multi-task and meet competing deadlines while maintaining attention to detail and accuracy. Strong ability to build effective teams with persuasive skills and ability to motivate others. Must be able to work independently or as part of a diverse team while being business-minded as well as empathetic towards members. Ability to take initiative and act on anticipated business needs without prompting from management. Exceptional customer service skills. Strong ability to adapt quickly to a fast-changing environment. Advanced proficiency in MS Office including Outlook, Word, Excel, and PowerPoint. Strong interpersonal skills and ability to read non-verbal cues with a high level of situational adaptability. Ability to make sound decisions with incomplete information. Preferred: Knowledge and understanding of the unique needs of the Medi-Cal beneficiary populations within a social service, healthcare, not-for-profit, or government setting. Knowledge of public agencies, organizations, and other resources that support Community Resource Center visitors. Licenses/Certifications Required Cardiopulmonary Resuscitation (CPR) Certified within 120 days of hire. Licenses/Certifications Preferred Required Training Required: Within 120 days of hire: Cardiopulmonary resuscitation (CPR) and California Mandated Reporter. Management of Aggressive Behavior (MOAB), de-escalation techniques training, safe lifting practices training. Emergency Action Plan (EAP). Physical Requirements Light Additional Information Required: Requires walking, standing to a significant degree, dexterity of hands and fingers to operate a variety of standard office equipment. Requires sitting most of the time, but entails bending/ lifting, pushing and/or pulling of arm or leg controls. The job may require working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible.) Travel to offsite locations for work Ability to work some evenings and weekends. Preferred: Bilingual in one of LA Care Health Plan's threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese 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) Nearest Major Market: Los Angeles Job Segment: Medicaid, Medicare, Public Health, Behavioral Health, Social Services, Healthcare, Service

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Looking for a chance to drive measurable and meaningful improvement in the use of evidence-based medicine, patient safety, practice variation and affordability? You can make a difference at UnitedHealth Group and our family of businesses in serving our Medicare, Medicaid and commercial members and plan sponsors. Be part of changing the way health care is delivered while working with a Fortune 4 industry leader. We are currently seeking a Utilization Management Medical Director to join our Clinical Performance team. This team is responsible for conducting hospital and post-acute utilization reviews for the state of California. The Medical Directors work with groups of nurses and support staff to manage inpatient care utilization. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Work to improve quality and promote evidence-based medicine * Provide information on quality and efficiency to doctors, patients and customers to inform care choices and drive improvement * Support initiatives that enhance quality throughout our national network * Ensure the right service is provided at the right time for each member * Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review Success in this technology-heavy role requires exceptional leadership skills, the knowledge and confidence to make autonomous decisions and an ability to thrive in a production-driven setting. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * MD or DO degree * Active, unrestricted CA medical license * Current board certification in ABMS or AOA specialty * 5+ years of clinical practice experience post residency * 2+ years of Hospitalist Experience * Proven solid understanding of and concurrence with evidence-based medicine (EBM) and managed care principles Preferred Qualifications: * Utilization Management experience * Quality management experience * Project management or active project participation experience * Substantial experience in using electronic clinical systems * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

The Payer Systems Applications team plays a critical role in enhancing customer and technical collaboration while delivering all application development through a Platform and Technology Product Operation Model. The candidate will report to the Sr. IT Manager, Application Services Lead. In this role, you will be responsible for leading, facilitating, and driving continuous improvement of Agile practices for the team or teams that you'll be supporting. The Portfolio is responsible for the development and support of complex technology solutions from claims processing to benefit enrollment. The Agile team that this role will lead has representation from across our matrixed organization, including IT, business & vendor partners, to deliver value & capabilities that meet the needs of our customers. We strive to deliver sustainable solutions that optimize cost, quality, and fit for purpose. This role specifically is planned to support Agile delivery related to our Member Customer Experience area as part of our Membership and Support Platform. Your Knowledge and Experience Requires bachelor's degree or equivalent experience and Scaled Agile (SAFe) Certification and 7 years of Project Management skills or Scrum Master experience Requires Scaled Agile (SAFe) certification: Scrum Master or Product Owner/Product Manager (POPM) Preferred Scrum Master certification (PSM II, PSM III, CSP, CTC); CSM, A-CSM (Scrum Alliance certifications) Preferred experience as a Scrum Master role for minimum of two years for a Scrum team Preferred experience using JIRA and AgilePlace Preferred Healthcare experience Preferred experience on the Pegasystems platform #LI-JA1 In this role, you will: Provide Agile team support by serving as the Scrum Master and Team Coach for Agile teams, ensuring smooth operation and adherence to Agile principles Educate and lead one or more Agile teams in Scrum, Built-in Quality, Kanban, and Scaled Agile (SAFe) principles and practices, fostering a culture of continuous improvement Facilitate Program Increment (PI) Planning readiness by preparing Agile teams for PI Planning sessions, guiding the creation of PI plans, objectives, and business values, ensuring alignment with organizational goals Collaborate with other Scrum Masters, Agile Coaches, and Product Management roles across the enterprise, contributing to the maturation of business units along with IT agile teams on the path towards our business agility Lead iteration execution by facilitating key team events, including backlog refinement, team planning, team synchronization, team review, demo, and retrospective sessions, fostering collaboration, transparency, and continuous improvement within the team

Salary Range: $46,800.00 (Min.) - $52,597.00 (Mid.) - $62,270.00 (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 Quality and Population Health Coordinator I (QPHC) is responsible for outreaching to members to close care gaps. The QPHC also outreaches to providers for medical record pursuit and retrieval. This position supports the L.A. Care medical groups by assisting with scheduling member appointments. While this role is a combination of remote and in office work, this role is intended to support L.A. Care medical groups by being embedded in the provider offices and providing direct outreach to L.A. Care members. The QPHC is an important member of L.A. Care's quality improvement team, helping to drive improvement in health outcomes, population health, and health equity, as well as member and provider experience. Duties Make outbound calls to members to assist with scheduling and coordinating services (e.g. appointments, lab tests, health screenings, other diagnostic studies, transportation, etc.). (25%) Educate members on missing gaps in care. Encourage them to close care gaps and pursue preventative health and health promotion activities such as health fairs. (25%) Outreach to providers to request medical reports by fax, electronic medical records, or on-site visits if needed. (15%) Review medical records, claims, and encounter data to identify key information to help close gaps in care. (15%) Provide support as needed for care gap closure campaigns and other quality improvement programs. (10%) Perform other duties as assigned. (10%) Duties Continued Education Required High School Diploma/or High School Equivalency Certificate Education Preferred Associate's Degree Experience Required: At least 3 months of experience following basic workflows, procedures, and standards related to patient or provider communication and outreach. Previous experience working in an office setting with basic office equipment such as telephones, fax machines, computers, etc. Preferred: Health Plan, provider practice, or health education experience. Skills Required: Demonstrates deep compassion and sensitivity towards patient needs and community well-being. Driven by strong motivation to positively impact people's lives. Excellent verbal and written communication skills. Excellent interpersonal skills. Proficient with Microsoft Word, Excel, PowerPoint, and Outlook. Skills in utilizing various online platforms and search engines to efficiently gather accurate and relevant information. Highly organized with ability to maintain accurate notes and records. Demonstrates high efficiency in managing tasks and consistently delivering projects to successful and reliable completion. Ability to communicate effectively with patients and health care providers. Preferred: Some knowledge of HEDIS and other quality measures. Some knowledge of quality improvement processes. Bilingual in one of L.A. Care Health Plan's threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese Licenses/Certifications Required Active & Current Driver's License, with a clean record and Auto Insurance. Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information Required: Travel to offsite locations for work. 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. This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits. 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) Nearest Major Market: Los Angeles Job Segment: EMR, Claims, Equity, Medical, Healthcare, Insurance, Finance

Salary Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (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 Care Management Specialist II utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines. Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases, which are those with the severest acuities or care needs and requiring the highest clinical skills and judgement. Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner. Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit: Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team. Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines. Uses claims processing and care management software to look up member information, document contacts, and track member progress. Duties Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs. Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives; reviewing member claims histories and identifies intervention opportunities through the professional standards of practice; contacting and interviewing members to conduct a baseline assessment, assess self-care ability, assess knowledge and adherence deficits; conducting comprehensive clinical assessments as indicated; developing a member centric plan of care. Maintains assigned care management caseload for with a focus on the most complex, highest-risk members particularly those with advanced chronic conditions, co-occurring mental and/or substance abuse and complex social issues (e.g. homelessness, domestic violence). Collaborates with primary care physician and other treating professionals as appropriate. Authorizes initiation of care management services and specialized program services for members and specific populations, and develops interventions designed to meet member or population desired outcomes. Provides comprehensive education and resources to members about accessing services, in-network use, national guidelines for care, community resources, and self-management skills and strategies. Employs engagement techniques to build relationships with members and their authorized representatives. Encourages participants to participate in their health care decisions and assists member with researching treatment options in order to communicate effectively with providers and to make informed decisions. Notifies Care Coordinators and CHWs of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines. Performs field assessment and care coordination functions in community settings with members, such as at the L.A. Care Community Resource Centers, medical clinics, and member homes. Duties Continued Meets and assesses members at L.A. Care Community Resource Centers, as needed. Provides effective care management for Individualized Care Plan summary and interventions during the Interdisciplinary Care Team meetings based on department guidelines. Facilitates appropriate use of resources and coordinates necessary services to improve health status and impact the cost of care. Identifies member needs for and refers to appropriate internal and external programs, as appropriate. Encourages member and family empowerment through education and use of reliable resources. Monitors and evaluates member progress: evaluates member response to interventions and refines action plan to produce desired outcomes. Identifies complex care management issues and discusses possible solutions with management. Assesses effectiveness of care plan's goals and interventions on a regular basis. Uses claims and care management software to document interactions and interventions with members, vendors, and providers. Maintains case information in the member's clinical records to promote care coordination. Provides ongoing direction and support to internal customers regarding Care Management programs, processes, and benefit coverage. Responsible for staying current with best practices, identifying areas for personal growth opportunities and works with management to develop a plan for obtaining the necessary training. Performs other duties as assigned. Education Required Associate's Degree in Nursing for Registered Nurses Master's Degree in Social Work for Licensed Clinical Social Workers Education Preferred Bachelor's Degree in Nursing for Registered Nurses Experience Required: Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments. Experience providing care management with complex/catastrophic conditions. Skills Required: Current knowledge of clinical standards of care and disease processes. Critical thinking skill. Excellent customer service skills. Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions. Ability to triage immediate member health and safety risks. Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping. Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders. Ability to use a personal computer, and knowledge of medical information systems. Knowledge of and ability to comply with HIPAA compliance. Ability to interview, assess and coordinate care. Ability to prioritize caseload. Knowledge of community resources. Knowledge of Medi-Cal and Medicare regulations. Ability to work as a part of a diverse team and gain consensus and resolution of problems. Preferred: Bilingual in one of L.A. Care Health Plan's threshold languages is highly desirable. English, Spanish, Chinese, Armenian, Arabic, Farsi, Khmer, Korean, Russian, Tagalog, Vietnamese. Licenses/Certifications Required Registered Nurse (RN);current and unrestricted California License OR Licensed Clinical Social Worker; current and unrestricted California License. Licenses/Certifications Preferred Certified Case Manager (CCM) Accredited Case Manager (ACM) Certification Case Management Nurse - Board Certified (CMGT-BC) Required Training Physical Requirements Light Additional Information Required: Travel to offsite locations for work. 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. This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits. 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) Nearest Major Market: Los Angeles Job Segment: Social Worker, Nursing, Travel Nurse, Substance Abuse, Behavioral Health, Service, Healthcare

Your Role The Compliance and Ethics team ensures adherence to the BSC Code of Conduct and owns and coordinates the Company's compliance and ethics program across the enterprise, including all business units, products, services and activities. This includes the implementation and maintenance of proper preventive, detective and remedial programs and controls; the execution of relevant policies and procedures; training and educating the workforce; implementing an effective communications program; ensuring effective testing, auditing, monitoring, tracking and reporting; and remediate control deficiencies. This Senior Level Compliance and Ethics Specialist is a critical individual contributor and program lead who will report to the Senior Manager, Compliance and Ethics. In this role you will work closely with the Senior Manager and department to drive and lead the department's strategic priorities and projects, including advancing the compliance training program, developing and implementing compliance policies such as the Conflict of Interest, Gifts and Entertainment, Anti-Corruption, etc., and serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Requires a Bachelor's degree; Masters in relevant field or Juris Doctor preferred Requires a minimum of 5 years of prior relevant experience (experience in a health plan or related health care organization preferred) Certification in Healthcare Compliance (CHC) or Certified Ethics and Compliance Professional (CCEP) preferred Exceptional written and verbal communication skills, including the ability to explain complex regulatory requirements to diverse audiences Experience with project management preferred. Excellent execution skills required Working knowledge of healthcare regulations and compliance requirements, including the DOJ Federal Sentencing Guidelines, OIG Compliance Plan, Privacy Rules, Stark Law, Anti-kickback statute, and Fraud and Abuse Experience collecting and analyzing data and developing sophisticated reports on compliance and ethics data and metrics Advanced presentation skills, including PowerPoint, Excel, Word Experience and success in program/project management and driving change Key necessary competencies include critical thinking, business acumen, collaboration, ability to influence others, strong written and verbal communication, efficient time management, and excellent organizational & problem-solving skills Your Work In this role, you will: Provide guidance, quality review and execution of compliance and ethics case management and compliance activities Responds to inquiries and provides advice and guidance regarding BSC's Code of Conduct, Corporate Compliance owned policies, and C&E Program operations. Triage and refer cases or inquiries to other BSC compliance resources (e.g., Privacy Office, SIU, Employee Relations) Support the coordination and management of the Corporate Compliance & Ethics communication portals including email boxes, web applications, and Navex EthicsPoint hotlines Designs and develops presentations and resources, implements and promotes awareness of the organization's compliance and ethics policies and the Code of Conduct. Review and analyze compliance metrics, performance data, and monitoring results to identify trends and areas requiring improvement Proactively supports Conflict of Interest (COI) disclosure and assessment activities, including reviewing and responding to guidance requests pertaining to COIs and handling of disclosures Serve as a subject matter expert on compliance issues, providing guidance and support to various departments within the organization. This includes staying current with industry trends and regulatory changes, proactively and continuously improving the compliance program to address new challenges and requirements. Coordinate and respond to requests for Compliance Program documentation and records including surveys, assessments, compliance certifications, attestations, and audit related requests for C&E records Collaborate with colleagues and stakeholders across the BSC enterprise to drive compliance and ethics workplans and projects and exercise independent drive and judgment to suggest and move forward program improvements and priorities Collaborate, as necessary, with other compliance resources (e.g., Privacy, IT Security, Human Resources, operational management) with respect to identified compliance issues Develops and delivers compliance training curricula that are focused on the essential elements of the compliance program Collaborate with colleagues and stakeholders to draft and deliver presentations related to compliance and ethics program work and priorities, risks, and metrics May manage major/complex projects involving delegation of work and review of work products

Director of Development and Communications (Santa Barbara) Director of Development and Communications - Santa Barbara June 17, 2013 Family Service Agency (FSA) seeks an expert and engaging Director of Development and Communications. The position reports to the Executive Director and also works closely with the Development/Marketing Committee to develop, implement and evaluate a comprehensive fundraising program that includes major gift solicitations, public, foundation and corporate support, special events, planned giving, and public relations/communications. Must possess integrity, astute interpersonal skills, and the ability to leverage key relationships and contacts to ensure meeting revenue goals. At least five years demonstrated success in nonprofit fundraising and effective collaborative relationships with staff, board, and donors required. Personnel management experience and strong analytical, organizational, written and verbal communication skills are imperative. Must be familiar with and passionate about FSA's mission and long tradition of service and commitment to the most vulnerable in our community. F/T position. Salary commensurate with experience. Excellent benefits. Please send cover letter of interest and resumes to: Attention: HR Family Service Agency 123 W. Gutierrez St. Santa Barbara, CA 93101 Fax: ************ *************** EOE

Salary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (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 Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up. The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management department in meeting regulatory time lines by maintaining an accurate database inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance/appeal requests, and prepares UM Activity and Weekly Compliance Reports. In addition, the position performs data entry and processing of referrals/authorizations in the system, authorizes request consistent with auto authorization criteria, maintains confidentiality when communicating member information, and assists with the communication of determinations by preparing template letters for members/ providers, with other duties as assigned. Duties Functional Elements: Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely processing referrals/authorizations and distribute a complete file to UM Specialist within 2 hours of receipt; identify duplicate requests using the claims and verify existing authorization. Independently identifying and appropriately returning to claims or member services any file that is a duplicate to one already processed in the system; appropriately documenting what information was used in making this determination within 4 hours of receipt. Appropriate identification and timely notification of time sensitive requests; appropriately identifying for the staff which you support, request that are priority based on date of receipt and established Turnaround Time criteria for compliance. Accurate filing/maintenance of confidential member information. Creating secure, complete, files. Interface with members, medical personnel and other internal and external agencies; ensure all comply with L.A. Care requirements such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information i.e.: ICD 10 codes, CPT, HCPC codes. (35%) Assist in the preparation of communication for authorization determinations, including, but not limited to preparing template letters for members and providers (authorization approval, denial, deferral, modification and pay/education). (30%) Assist in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals, including, but not limited to computer data entry, logging, copying, preparing of template letters for communication of appeal determinations to members, providers and partners (appeal uphold or overturn) and filing: Set up GNA files for review, log and keep track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and Appeals response letters to Grievances Specialist on daily basis. (20%) Support UM Committee and Audit activity via Department performance reporting. Assure the accuracy of reports concerning inventory and department proficiency in maintaining regulatory standards and time frames. (5%) Perform other duties as assigned. (10%) Duties Continued Education Required High School Diploma/or High School Equivalency Certificate Education Preferred Experience Required: At least 6 months of health care experience. Experience working in a cross functional work environment. Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM/Prior Authorization. Skills Required: Demonstrated proficiency in Medical Terminology required. Strong verbal and written office communication skills. Proficient with Microsoft Office Suite and Adobe PDF. and Excellent organizational, interpersonal and time management skills. Must be detail-oriented and an enthusiastic team player. Preferred: Knowledge of QNXT computer systems a plus. Knowledge of the UM patient referral process. Knowledge of member's health plan eligibility. Knowledge of member's benefits coverage. Knowledge of Health Plan regulations. Knowledge of HMO/UM functions. Knowledge of ICD-10/CPT coding. Proficient utilizing electronic medical records and documentation programs. Licenses/Certifications Required Licenses/Certifications Preferred Medical Coding Certification Required Training Physical Requirements Light Additional Information Required: Weekends and holidays hours may be required, as well as OT based on a business need. 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. This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits. 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) Nearest Major Market: Los Angeles Job Segment: Data Entry, Claims, Medical Coding, EMR, Administrative, Insurance, Healthcare

Your Role The Medi-Cal Operations and Performance team oversees the operations governance and regulatory oversight in a complex highly matrixed environment for Blue Shield of California Promise Health Plan . The Executive Assistant, Senior will report to the VP, Medi-Cal Operations and Performance . In this role you will serve as the primary point of contact for internal and external constituencies on all matters pertaining to the office of the executive. You will be the liaison to the Operations and Performance; monitor and respond to emails, heavy scheduling and calendaring meetings; organize and coordinate all travel and arrange special events and offsite events. organize and coordinate all travel and arrange special events and offsite events. organize and coordinate all travel and arrange special events and offsite events. The Executive Assistant must be creative, agile and nimble, and enjoy working in an entrepreneurial environment that is member-driven, results-driven, and service-oriented. The ideal individual will have the ability to exercise good judgment and high level of discretion, with strong written and verbal communication, scrupulous administrative and organizational skills, and the ability to maintain balance among multiple competing priorities. The Executive Assistant position requires the ability to work independently as well as within a team environment on projects from inception to completion and must be able to work under pressure to handle a wide variety of activities and confidential matters with discretion. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 5 years of prior relevant experience Requires at least 3 years of increasing professional level responsibility in executive support for C-level executives Requires expert proficiency with Microsoft Office applications including PowerPoint, electronic communications, and IT savvy Requires the ability to work executive hours and must be willing to work non-business hours when needed for special projects or events; must have excellent communication skills, both verbal and written, and work with a sense of urgency while applying well-honed attention to detail Requires the ability to be both service-oriented and behind the scenes leader; able to effectively manage multiple projects and tasks simultaneously; possess excellent organizational skills and ability to design, set-up and manage internal processes and protocols; manage collaboratively and thrive in a fast-paced, rapidly changing environment; possess a positive, can-do attitude and value continuous professional development; good judgement, attention to detail, keen sensitivity and responsiveness to executive's needs and requests Requires ability to travel to offsite team events and/or meetings as needed #LI-AD3 Your Work In this role, you will: Be responsible for providing analytical and specialized administrative support to relieve and assist executive managers with complex details and advanced administrative duties Collect and prepare information for use in discussions/meetings of executive staff and outside individuals Analyze problems, determine approach, compile and analyze data and prepare reports/recommendations Contact company personnel at all organizational levels to gather information and prepare reports Manage day-to-day organization of executive's calendar, appointments, meetings, and related schedule Compose and prepare correspondence; arrange meeting agendas; monitor and respond to emails; scheduling and calendaring meetings; Research required information or background on organizations and individuals; prepare travel arrangements, expense reports, plans/coordinates and ensure the executive's schedule is followed and respected; acts in a “gatekeeper” capacity, creating win-win situations for direct access to the executive Research, prioritize, and follow up on incoming issues and concerns addressed to the executive, including those of a sensitive or confidential nature; Consult with the executive in determining appropriate course of action, referral, or response; communicate directly, and on behalf of the executive with senior leaders and board members, and others on matters related to the organization's initiatives and activities; Provide a bridge for clear communication and maintains credibility, trust and support between the office of the executive and the internal staff Work closely and effectively with the executive to keep the leader well informed of upcoming commitments and responsibilities and follows up appropriately; Act as a “barometer,” having a sense for the issues taking place in the internal and external environments and keeps the executive updated; Draft correspondence to the team, and other tasks that facilitate the executive's ability to effectively lead the organization; Prioritize conflicting needs; handles all matter expeditiously, proactively, and follows through on projects to successful completion, often with deadline pressures Serve as the day-to-day manager of office logistics; manages accounts receivable and payable, maintains office supplies, mail processing, and manages office protocols including space requirements, IT, equipment, phone protocols, etc.; Update and edit Shield Central page and coordinate with the team members on upcoming updates to publicize; Perform several high-level review functions including department financial performance against budget, and processing payment for vendors and related service contracts; sets up internal systems and protocols ensuring standardization of processes and a high level of efficiency; Provide back-up support to the other Medi-Cal Executive Assistants and Administrative Support team as needed Other duties as assigned

Your Role The AI and Analytics team oversees the artificial intelligence platform and analytical functions. In this role, you will be providing critical analytics support to our healthcare insurance clients (BlueShield of California and other health plans). This role is responsible for driving data-informed strategies and delivering actionable insights to optimize marketing campaigns and improve business outcomes. The ideal candidate is a strategic thinker with a strong analytical mindset and a passion for using data to solve complex Marketing business problems. They would be leading projects end-to-end, independently presenting insights to senior leadership, and mentoring junior analysts. Your Knowledge and Experience Bachelor's degree in Statistics, Mathematics, Economics, Computer Science, Marketing, Business Analytics, or related quantitative field Master's degree in Data Science, Statistics or Business Analytics (preferred) Requires 10+ years of experience in a marketing analytics role Proven experience in providing analytics support to clients or internal stakeholders in a consultative capacity. Experience with meeting with senior stakeholders within or external to the company Demonstrated ability to communicate complex ideas clearly, with strong presentation skills and a proven track record of delivering impactful insight to diverse stakeholders. Strong proficiency in SQL for data extraction, manipulation, and analysis. Expertise in Python for statistical analysis, predictive modeling, and data automation. Advanced skills in Tableau for creating interactive dashboards and data visualizations. Demonstrable experience in building and deploying marketing mix models, acquisition and retention models and brand effectiveness models for marketing teams. Solid understanding of web analytics and customer journey analytics. Proven experience with experimentation methodologies (A/B, MAB, MVT) Requires five years of experience in Health Care (managed care, academic, or gov't payer) Experience with Generative AI (GenAI) and Large Language Models (LLMs) in a marketing or analytics context (preferred) Hands-on experience with the Databricks platform for large-scale data processing and analytics (preferred) Experience with CRM platforms (e.g., Salesforce) (preferred) Cloud Platforms: AWS, Azure, or Google Cloud experience (preferred) Certifications in analytics tools like Adobe Analytics and Databricks (preferred) #LI-EB1 Your Work In this role, you will: Design, execute, and analyze marketing campaigns across various channels to measure their effectiveness and provide recommendations for optimization. Develop and maintain dashboards and reports to track key performance indicators (KPIs) and communicate campaign performance to stakeholders. Utilize advanced analytical techniques to segment customer data, identify target audiences, and personalize marketing messages. Develop and refine customer personas to enhance campaign relevance and drive engagement. Build and deploy predictive models to forecast marketing outcomes, identify at-risk customers, and uncover new growth opportunities. Generate actionable insights from Marketing datasets to inform strategic decision-making and drive business growth. Develop marketing mix, brand effectiveness, and acquisition/retention models • Design and implement A/B and multivariate tests to optimize website performance, user experience, and conversion rates. Analyze test results and provide data-driven recommendations for continuous improvement. Create and maintain interactive dashboards and data visualizations using Tableau to provide real-time insights into marketing performance. Communicate complex data stories in a clear and compelling manner to both technical and non-technical audiences. Provide detailed specifications for the marketing Datamart to IT developers and ensure it is built in alignment with the analytics team's requirements. This DataMart will support key functions such as insights generation, dashboarding, model development, and facilitate self-serve Adhoc requests via agentic solutions. Independently lead and execute complex marketing analytics projects from start to finish, delivering insights and strategic recommendations to senior leadership with a sharp focus on uncovering opportunities that drive business growth. Serve as a trusted advisor to Stellarus clients, providing expert analytics support and strategic guidance. Collaborate with client teams to understand their business objectives and translate them into analytical requirements. Apply strong critical thinking and presentation skills to effectively communicate insights to stakeholders. You will also manage stakeholder relationships with professionalism, demonstrating the ability to navigate conflicts and foster collaboration. Mentor and guide junior analysts on the team.

Internships at UnitedHealth Group. If you want an intern experience that will dramatically shape your career, consider a company that's dramatically shaping our entire health care system. UnitedHealth Group internship opportunities will provide a hands-on view of a rapidly evolving, incredibly challenging marketplace of ideas, products and services. You'll work side by side with some of the smartest people in the business on assignments that matter. So here we are. You have a lot to learn. We have a lot to do. It's the perfect storm. Join us to start Caring. Connecting. Growing together. Actuaries are the decision-making engine for our business. That is why we support you from day one by offering guidance and assistance with exams. Our businesses serve the entire spectrum of health care participants: individual consumers and employers, commercial payers and intermediaries, physicians, hospitals, pharmaceutical and medical device manufacturers, and more, providing you with a career that is challenging, exciting, and integral in helping to write the history of healthcare. This position will be supporting UnitedHealthcare's Employer & Individual (E&I) line of business and be located on-site in Cypress, CA with a hybrid work arrangement model of four days in office and one day remote. Actuaries are the decision-making engine for our business. That is why we support you from day one by offering guidance and assistance with exams. Our businesses serve the entire spectrum of health care participants: individual consumers and employers, commercial payers and intermediaries, physicians, hospitals, pharmaceutical and medical device manufacturers, and more, providing you with a career that is challenging, exciting, and integral in helping to write the history of healthcare. The Actuarial Summer Internship Program offers: * Focused career development opportunities * Networking with senior leadership * Formal mentorship program * Sponsored social and volunteer activities * Meaningful, relevant, and current project work critical to managing our business * Potential areas of focus may include but are not limited to: * Healthcare Economics * Pricing * Reserving * Forecasting * Data Analytics * Consulting Primary Responsibilities: * Providing moderately complex analytical support to actuaries in the development and implementation of recommendations * Conducting and documenting moderately complex analysis and research * Preparing, forecasting, and analyzing trends * Initiating, compiling and preparing analytical models, tools and databases * Assisting in developing innovative strategies, policies, and procedures * Providing detailed summaries, reports, and recommendations to assist in managerial decision making You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualification: * Must be actively enrolled in an accredited college/university pursuing a bachelor's or master's degree throughout the duration of the internship - internships are not intended for graduating seniors * Pursuing a major in Actuarial Science, Mathematics, Statistics, Accounting, Finance, Economics, or another related technical field Preferred Qualifications: * Minimum 3.00 cumulative GPA * 1 or more actuarial exams passed * Demonstrated knowledge or interest in a career as an Actuary Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $27.00 to $37.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Your Role The Law Department Intern will work with the attorneys in the Law (Corporate Law, Litigation, Health Law, Privacy, and Compliance) and Government Affairs teams to support clients across the Company. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Must be a current 1st or 2nd year Law School Student Must reside in the state of California Requires strong research, analytical, writing skills and strong interpersonal and communication skills Requires at least 1 year of related professional experience, project, or coursework Requires strong communication skills, particularly writing for publication Experience analyzing and presenting sets of data and reports preferred Interest in health care preferred Proactive, solution focused mindset with demonstrated creative, problem-solving skills Pay: $25.00 per hour for Undergraduate $30.00 per hour for Graduate About Our Internships Our paid internship program is thoughtfully curated to provide students experience and exposure to the health professional industry. Interns will be given the opportunity to get hands-on experience with real work projects, build meaningful relationship and connections within the organization, and experience our mission and enterprise goals through our program curriculum centered on our leadership model (Personal, People, Thought, and Results Leadership). To see more about our internship program, check out this video. Our Summer 2026 Internship is June 8th or June 15th through August 14th, 2026. Application Process and Timeline: Now: Actively accepting applications November: If you meet the requirements, you will receive an invitation to complete Pre-Recorded Video Interview November - January: 2nd round interviews & offers extended As an intern at Blue Shield of California, you will: Participate in impactful projects during a 10-week internship program Undertake a 10-week curriculum designed to familiarize interns with BSC, leadership development, exposure to the healthcare industry, and more Be invited to participate in BSC employee events and networking opportunities such as Employee Resource Groups, employee volunteer activities, and more Your Work In this role, you will: Review and draft pleadings, contracts, board minutes, and legal memos Attend client meetings Conduct legal and policy research Perform other special assignments

Behavioral Health Counselor- LMFT LCSW LPC- Evernorth- San Diego, CA The Onsite Behavioral Health Counselor is responsible for counseling individuals to diagnose and treat mental health disorders. The responsibilities also include referring clients to specialists, monitoring progress during treatment and creating a comfortable environment where clients can be treated. This BH professional will treat clients with emotional, behavioral and mental disorders. They may work in conjunction with psychologists and psychiatrists, and refer patients to these specialists as they see fit. Responsibilities and Essential Functions Conduct regular appointments with clients who wish to converse with a mental health professional Establish positive and trusting relationships with clients Screen and assess patients for common mental health and substance use disorders, leveraging evidence based tools Provide patient education about common mental health and substance use disorders, as well as available evidenced based treatments. Implement various treatments and protocols to provide guidance and appropriately address client situations using evidenced based techniques Continually assess client situations and provide the proper ongoing treatments Educate and involve family members or other loved ones in the treatment process when necessary When required, partner with plan and community resources to make referrals to outside sources or agencies that can augment or better address their specific needs Coordinate care after an acute event including emergency department presentation or inpatient admission in collaboration with the patient's provider and population health team Coordinate with patient's care plan team in order to ensure holistic care Maintain the strictest confidentiality of each and every client situation Maintain all required licenses and the appropriate insurance Participate in clinical team meetings as assigned Ability to work in the office in San Diego, CA Minimum Qualifications LCSW, LPC or LMFT Current, unrestricted license(s) in California; additional state licenses a plus Must have an Independent License Must have at least 2 years of therapy experience Experience with population management The position is based in the office in San Diego, CA and the anticipated salary is 100-115,000 If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 65,600 - 109,400 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Your Role The Internal Audit Services team performs internal audits and advisory services to provide assurance on specific internal control objectives and emerging risk areas. The Internal Audit Principal will report to the Internal Audit Senior Director. In this role, you will be leading and managing financial, operational, and integrated audits and advisory engagements. You will also be assessing the design and effectiveness of internal controls for business processes, financial reporting and measurement activities, and related applications in accordance with laws, regulations, policies, standards, and procedures using established tools and techniques. Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires a minimum of 10 years of prior related experience Ability to communicate with executive leadership regarding matters of significant importance to the organization Extensive understanding of internal controls and the ability to leverage this knowledge to make effective audit and advisory recommendations Internal audit and risk assessment practices and methodologies. IT general and automated technical controls concepts, application controls and end-user computing controls. AI and data analysis techniques preferred Healthcare and pharmacy audit experience preferred Certified Internal Auditor (CIA) and/or Certified Information Systems Auditor (CISA) preferred Your Work In this role, you will: Execute the annual audit plan by independently performing audit procedures, including identifying and defining issues, developing criteria, reviewing, and analyzing evidence, and documenting management processes and procedures. Audits entail end to end process reviews, can be cross functional and complex. Provide expertise in internal controls including project management, business process analysis, financial control disciplines, and information technology Implement strategic goals established by Internal Audit Services leadership Support Internal Audit management is the annual risk assessment process to develop the annual audit plan Identify, develop, and document audit issues and recommendations using independent judgment concerning areas being reviewed Prepares and delivers reports and presentations to various levels of management Performs post-audit follow-up reviews to ensure management corrective action plans have been effectively implemented Provides measurable input into new products, processes, standards, and/or operational plans that impact Internal Audit Services, and proactively improves upon existing processes and systems using significant conceptualizing, reasoning, and interpretation Conducts extensive investigation and critical thinking to understand root causes of problems that span a wide range of difficult and unique issues across functions and/or businesses Manages large, complex project initiatives of strategic importance to the organization, involving large cross-functional teams. May direct the work of other individual contributors and/or act as a cross-functional team lead

EXPECTATIONS: This role partners with the sales team and requires travel to client offices based on location. GENERAL PURPOSE: Cigna's mission is to improve the health, well-being and sense of security for those we serve. The Clinical Sales and Network Organization, as Champions for affordable, predictable and simple health care, is dedicated to achievement of our Enterprise goals improving affordability and customer health outcomes, client growth and retention, and network performance. OVERVIEW: The Nurse Executive Sales Specialist, trusted Clinical Leader, Educator and Advocate, is closely aligned with Clients, Brokers, and other Key Stakeholders to promote improved healthcare quality and affordability for clients, members and communities we serve. This role executes on strategic priorities to meet enterprise targets related to Cigna Healthcare U.S. Sales Growth, Persistency and Total Medical Cost. RESPONSIBILITIES Stay current with healthcare industry trends and maintain a working knowledge of Cigna business segment strategies, clinical programs, services, and operational processes necessary to educate and provide consultative clinical insights to Sales, Clients, Brokers, and other key stakeholders. Foster deep collaborative relationships with Sales, Sales Operations, Clients, and Brokers, championing Cigna's differentiated clinical value proposition. Support achievement of business growth targets, including prospective review, request for proposal, finalist meetings, and new client onboarding. Support achievement of business persistence targets, including medical cost driver analysis and action, complex case review, referral and engagement, account renewal consultation, and recommendations to positively impact medical cost trend, healthcare quality, and outcomes. Collaborate and align across business units, working closely with Sales, clinical product and program teams, Marketing, Data and Analytics, Clinical Operations, Health Engagement, Evernorth Workplace Care, and others to design and deliver innovative client and market-specific solutions. Participate in cross-functional projects at the local or national level, implementing actions that improve organizational or enterprise effectiveness and affordability. In conjunction with Sales, Health Engagement, and others, facilitate Client and/or Broker external engagements (health forums, community and worksite events, educational presentations, corporate tours, etc.), promoting Cigna's integrated value proposition. Respond to and facilitate resolution of escalated case inquiries, benefit and coverage explanations, and non-standard client benefit requests. Ideal candidate must reside in one of the following locations: Glendale, CA; Irvine, CA; San Francisco Bay Area; Walnut Creek, CA; Seattle, WA; or Portland, OR. QUALIFICATIONS Active and unrestricted nursing license in your state of residence (required). BSN is required Advanced degree (preferred). Minimum of three (3) years of clinical practice experience. Proven industry experience in a health sector-related field (Health Insurance; Healthcare Professional and/or Delivery System Entities; Allied Health Industry; Pharmaceutical Sales; Medical Sales a plus). Strong leadership, organizational, critical thinking, and execution skills. Broad-based thinker with a solid understanding of overall approach to population health for employers. Ability to work effectively in a matrixed environment. Proven ability to foster, influence, and maintain collaborative, successful relationships with internal and external stakeholders. Excellent oral and written communication skills. Proficient in multiple forum presentations internally and externally. Skilled in using Microsoft and technology/software applications. Requires intermittent travel up to 50% of the time. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 116,200 - 193,600 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Your Role As a Clinical Coding Analyst-Experienced, specializing in code governance, you will play a pivotal role in ensuring coding standards, compliance, and best practices across development teams. Your responsibilities will include implementing and maintaining a code governance framework, conducting code reviews, optimizing development workflows, and ensuring adherence to industry standards. You will collaborate with cross-functional teams to establish coding guidelines, automate governance processes, and enhance overall software quality and security. Your expertise will drive efficiency, consistency, and compliance in coding practices, supporting scalable and maintainable solutions. Your Knowledge and Experience Requires a minimum of an AA degree; Bachelors' degree preferred AHIMA Certified CCS Preferred certification as CSS-P Possess deep technical abilities Work history in one of more of the following: 2 to 3 years of Provider billing experience in a lead, supervisory or management role; or 1 to 2 years in a payor environment working directly with payment quality and accuracy in a claims processing, providing contracting or audit capacity or; 1 to 2 years in a compliance or audit function within a health care system Requires broad theoretical job knowledge typically obtained through advanced education Intermittent proficiency in Microsoft Excel, Word and Powerpoint Your Work In this role, you will: Provide expert input to quarterly and annual industry standard code maintenance for multiple systems Research and prepare benefit files using industry standard codes that meet the intent of member benefit language and/or contracts, and regulatory mandates set forth by the state or federal agencies Develop payment policies based on industry or content expert-supported research Provide problem management recommendations on correct application of payment and benefits based on industry and internal research Conduct research and provide recommendations on industry standard editing for appropriate application in the current system in accordance with Blue Shield of CA payment policies and regulatory guidelines Collaborate with cross-functional departments to implement code governance framework

Your Role Reporting to the VP, Network Operations, the Director, Provider Services - Relations, Blue Shield of California and Promise Health Plan (BSCPHP), is responsible for creating and maintaining high integrity relationships with risk-baring medical providers, hospitals and health systems in their assigned region to enable BSCPHP to become the health plan of choice. The outcome of being the ideal partner for our providers will be to materially improve cost, quality, maintain compliance, service and together grow membership in service to our communities across BSCPHP business. The Director will lead in a highly matrixed environment across multiple internal business teams to provide strategic alignment, business planning, and effective execution of the business plans for all providers in their region for BSCPHP business as well as partner with all lines of business as they impact our Provider Network. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Requires a college degree or equivalent experience. Master's degree is preferred Requires 10 years prior relevant experience in Provider Relations or healthcare network contracting Requires 6 years of management experience and must be comfortable operating in a matrixed/collaborative environment Minimum 5 years of direct Medicare and Medi-Cal experience with a Managed Care Organization (MCO) preferred Previous experience in management of process analysis and improvement Experience in the development of policies and procedures pertaining to Network Management Strong experience and orientation to the quadruple aim coupled with knowledge of markets, sales, operations, product development, network management, clinical operations, finance, regulatory issues and compliance Able to collaborate and work strategically in a team setting with various professional, technical, and administrative staff, integrating resources in a timely and organized manner Comprehensive knowledge of managed care risk contracts and the operational requirements involved in managing a provider network Outstanding verbal and written communication abilities, with demonstrated effectiveness when engaging executive leadership Demonstrated ability to build enduring, trustworthy relationships and effectively interact across all organizational levels, both internally and externally Ability to lead and manage significant culture change. Demonstrated experience with change and organization management; possess a performance driven management style Strong leadership skills, including excellent interpersonal, communications, problem solving and negotiating skills Ability to think strategically while at the same time drive operational performance Proven project management experience applying industry methodologies and practices Technologically savvy and able to utilize information systems and Office software effectively Proven ability to mentor and coach leaders in their respective teams Your Work In this role, you will: Lead the Provider Relations team which serves as the primary liaison between BlueShield and Blue Shield Promise Health Plan and the contracted provider networks upholding transparency, integrity, and reliability in interactions with both internal and external stakeholders Oversee the management of provider concerns, including but not limited to contract interpretations, claims discrepancies, eligibility and capitation payment issues, credentialing challenges, service area changes, rate load corrections, retroactive member assignments, provider terminations, member moves and third-party disputes Develop and implement an operations engagement strategy that incorporates statewide Joint Operations Meetings, inclusive of Medi-Cal requirements, and includes interaction with provider leadership. The aim is to support provider satisfaction with Blue Shield, encourage provider wellness, and maintain operational performance in areas such as access to care, member experience, affordability, and sustainability Manage structured processes for claims disputes and appeals, driving research, root cause analysis, and corrective action plans to prevent recurring issues Deliver expert insight and guidance for strategic and operational initiatives impacting Provider Relations, driving effective execution of implementation tasks within the team's scope Provide effective and detailed thought leadership to inform the Blue Shield Provider Engagement Model working with the Performance Enablement Team Work collaboratively with Provider Partnerships and the Regional Medical Directors, along with other internal provider-facing partners, to execute an overall strategic engagement strategy Identify and implement process improvement as it pertains to provider operations, contract and regulatory compliance, efficient relationship management and other areas Establish operational Key Performance Indicators to assess the effectiveness and performance of the Provider Relations team. Define baseline metrics, set measurable targets, and drive achievement through ongoing process improvement Assess regulatory, government, or organizational mandates to ensure Blue Shield and Blue Shield Promise Health plans comply with all requirements. Work collaboratively with various departments to maintain internal compliance with regulations by leading workgroups and taskforces Build and lead a high-performing team that meets all operating goals, including cost of health care, clinical quality improvement, regulatory compliance, administrative costs and employee engagement Foster a culture of innovation and creativity to enable Blue Shield of California to meet changing market conditions and strategy Promote and model a collaborative and partnership-oriented culture by cultivating strong relationships with internal stakeholders to achieve collective success

Village Fertility Pharmacy Group (“VFP”) which is part of Freedom Fertility Pharmacy supports patients on their journey to parenthood through efficient, compassionate customer service and expert clinical support. As a Pharmacy Technician Representative, you will primarily support the Pharmacists and Patient Care Team by processing prescriptions and handling operations tasks and requests. Responsibilities: Accurately pick medication orders. Process, dispense, label prescriptions accurately and in timely order. Pack and shipping prescription orders. Time management to ensure all necessary packages make it out to the couriers on time. Complete patient prescription pick-ups. Provide excellent patient customer service. Knowledgeable about pharmacy inventory management. Assist with monitoring accurate inventory levels of drugs and supplies, including receiving, stocking, rotating and organizing medication within designated areas. Other pharmacy tasks as needed to ensure accuracy and a positive patient experience. Requirements: Ability to work daily onsite at: 10840 National Blvd Los Angeles, CA 90064. Ability to work Monday through Friday - 9AM to 5:30PM (alternating Saturday, 2 Saturdays per month, 9AM - 1:30PM.) Active State of CA Pharmacy Technician License. CPhT License a plus. Minimum of one year of pharmacy or healthcare experience. Comfortable talking with patients, insurance companies, and clinics. Ability to work independently, meet deadlines, and be flexible. Excellent data entry skills. Strong organizational skills, attention to detail, and problem-solving skills. Solid computer skills and ability to learn new systems. What we offer: Day 1 medical insurance 401(k) plan with employer match Paid Time Off Competitive Benefit package Growth and Advancement opportunities If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of 17.88 - 26 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.