Provider Network Engagement and Strategy Training and Communications Specialist III
Provider Network Management
Los Angeles, CA, US, 90017
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care's mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Provider Network Engagement and Strategy Training and Communications Specialist III is a critical thinker who is responsible for eliciting, analyzing, communicating, testing and verifying requirements for engagement (i.e. required and general communications; training; manuals; etc.) and strategy services delivered or coordinated by the L.A. Care (LAC) Provider Network Management (PNM) organization. This position will use strong organizational and communication skills to build and foster effective relationships to support the elicitation and communication of business requirements from and to leadership of LACs lines of business (Medi-Cal; Medicare; and Commercial). The position is responsible for maintaining a subject matter expertise of the operational, reporting, and accrediting requirements for all lines of business (Medicaid, Medicare, and Commercial) and support his or her team in ensuring the LAC PNM organization is compliant.
This position will conduct needs assessments and instructional analysis to ensure conformity with all engagement and strategy objectives, and develop corresponding work plans and project schedules as needed.
This position will serve as a Train-the-Trainer to the PNM Organization, and other internal staff, to effectively deploy network training and messaging. They will assist in providing internal LAC support to all departments that partner in the delivery of engagement and strategy materials to the provider network. The position will conduct monthly and quarterly audits on provider network engagement and strategy materials, and participation to ensure LAC adherence to, and validate LAC contracted entity compliance with, all requirements. The position is required to quality check information that is submitted by internal PNM and external LAC teams to ensure the requesting department has submitted all necessary documentation for compliance purposes, and is required to serve as a liaison and subject matter expert for all provider network engagement request(s).
Prepare auxiliary plans for completing comprehensive scripting and thematic outlines in support of the creation of provider engagement materials, and coordinates related instructional documentation with supporting and requesting LAC staff. Conduct performance-based measurement assessments for objective evaluation of engagement and strategy materials in support of organizational and departmental strategy and initiatives. Elicit, document, analyze, communicate, test and verify requirements for engagement and strategy department responsibilities. Assess the requirements of the organization with respect to its operations and functions for improved provider engagement. Review the LAC PNM organization, the LAC contracted Plan Partners, and LAC delegated entity policies, procedures, internal controls, and materials. Review transactions, source documents, disclosures, and outcomes for compliance with contractual, regulatory, and accrediting requirements, and LAC business policies.
Assist with the analysis of training and communication requests and deliverables, to identify content gaps and opportunities for improvements, and is responsible for maintaining documentation to support evidence of compliance with all requirements, and for the reporting of performance data. Analyze the business processes in an organization for inefficiencies. Make recommendations for solutions or improvements that can be accomplished through new process or technology, or alternative uses of existing processes or technology. Track the LAC PNM organization, the LAC contracted Plan Partners, and LAC delegated entity audit or other regulatory findings and ensure corrective action taken is appropriate and effective.
Conduct monthly and quarterly audits on provider network engagement and strategy materials and participation to ensure LAC adherence to, and validate LAC contracted entity compliance with, all requirements. Performs quality check information that is submitted by internal PNM and external LAC teams to ensure the requesting department has submitted all necessary documentation for compliance purposes, and is required to serve as a liaison and subject matter expert for all provider network engagement request(s).
Provide valuable input for developing key performance indicators, alerting requirements, and supporting metrics, to proactively inform the internal LAC leadership of possible risks and issues with compliance as it pertains to engagement and strategy requirements, and inform remediation and corrective action plans as appropriate. Monitor and analyze remediation plans and activities, using critical thinking, and problem solving skills to help ensure successful and complaint engagement material quality. Leverage and communicate all analysis to aid a diverse set of stakeholders in making informed decisions about which engagement and strategy initiatives to implement and suggestions on how to implement them. Report analytical performance metrics on requirements, which may be in the form of visualizations such as graphs, charts and dashboards, detailing the significant results they deduced to inform senior-level business stakeholders, so they may make informed decisions. Partner with internal L.A. Care departments and others, to ensure providers are compliant with all engagement requirements. Take proactive preventative steps to resolve issues and manage risk(s).
Bachelor's Degree in Communications
In lieu of degree, equivalent education and/or experience may be considered.
At least 3-5 years responsible work experience in provider engagement specifically in communications, marketing, education or public relations and in managed care or health care industry.
Expert in Microsoft Office applications.
Demonstration of both qualitative and quantitative analytical skills.
Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.
Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.
Demonstrated critical thinking and problem solving skills.
Strong written and verbal communication skills.
Strong elicitation and process documentation skills.
Strong organizational and communication skills to build and foster effective relationships.
Must possess a robust knowledge of all contracted PNM entities, including provider groups (PPG's), Management Service Organizations (MSO's), Vendors, Subcontractors, and directly contracted practitioners.
Strong critical thinking and problem solving skills to help ensure successful partnerships and department quality.
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)