Advisor Provider Operations and Process Optimization

Job Category: Provider Relations

Department: Provider Network Management

Location:

Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 13344

Salary Range: $110,279.00 (Min.) - $146,120.00 (Mid.) - $181,961.00 (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.

Duties

2 available positions

Advances organizational excellence through strategic partnership, regulatory stewardship, managed care program support, and provider engagement.

Translates enterprise strategy into operational execution by conducting independent assessments of provider workflows, identifying and recommending improvements that enhance efficiency, scalability, regulatory alignment, and provider experience, and developing performance metrics, dashboards, and reporting tools that provide leadership with actionable insights into operational performance, emerging risks, and opportunities for continuous improvement.

Serves as a subject matter expert on regulatory and contractual requirements. Facilitates cross-functional collaboration with key stakeholders to ensure the organization is prepared for regulatory changes, conducts thorough impact assessments, and maintains post-implementation monitoring. Collaborates and promotes regulatory updates into provider-facing materials, operational controls, and communication strategies, ensuring compliance and organizational integrity.

Provides guidance throughout the lifecycle of managed care programs, from design and implementation through evaluation, including support for targeted rate increases and supplemental payment initiatives. Maintains rigorous oversight of timelines, resources, and deliverables. Establishes robust frameworks for program controls, reconciliation, and executive reporting. Identifies and mitigate operational risks to support the achievement of managed care program objectives and financial targets.

Partners with key stakeholders to elevate communication strategies. Reviews and enhances provider notices, bulletins, newsletters, and portal announcements to ensure they are clear, accurate, and aligned with regulatory requirements. Supports management and publication strategy for the Universal Provider Manual (UPM), maintaining its integrity and accessibility for all stakeholders.

Acts as the point of contact for key strategic initiatives. Identifies areas where technical solutions would improve business performance. Ensures that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices.

Develops reports, analyzes data and provides presentation on status of areas of responsibilities on an as needed basis in support of department operations.

Provides expert advice to various business units on relevant topics within the organizational standards, national and state-wide compliance.

Performs other duties as assigned.

Job Summary

The Advisor Provider Operations and Process Optimization partners with senior leadership to translate enterprise strategy into operational reality, ensuring alignment with organizational goals and regulatory mandates. The Advisor assesses workflows, implements improvements for efficiency and provider experience, and delivers real-time operational insights to leadership through refined metrics and reporting tools.

The Advisor supports complex mandate implementation, facilitates cross-functional collaboration, and integrates regulatory updates into operational controls and provider communications. The Advisor guides managed care program design, launch, and evaluation, establishes frameworks for transparency and accountability, and mitigates operational risks to achieve program and financial targets.

The Advisor elevates provider engagement by enhancing communication strategies and supporting the Universal Provider Manual’s content management and accessibility.

Provides expert advice to various teams and collaborates with key stakeholders to review programs, projects, processes, procedures, and policies.

Duties Continued

Education Required

Bachelor's Degree in Business Administration or Related Field

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience

Required:

At least 5 years of experience in managed care operations, regulatory compliance, provider relations, or project management.

Experience driving continuous improvement, supporting the implementation of complex regulatory and operational requirements, and fostering collaborative relationships across cross-functional teams.

Skills

Required:

Strong analytical and problem-solving skills to dissect complex operational challenges and devise effective solutions.

Strong communication and interpersonal skills, with the ability to build productive relationships across diverse stakeholder groups, communicate information clearly, and facilitate effective collaboration.

Ability to interpret and apply regulatory requirements, safeguarding compliance and integrating mandates into operational processes and provider-facing materials.

Ability to navigate regulatory complexities and advance enterprise goals.

Strong strategic thinking, attention to detail, and commitment to quality, with the ability to align operational enhancements with organizational goals and deliver sustainable, measurable value.

Ability to clearly and effectively convey information.

Ability to identify improvement opportunities and adjust to changing trends, industries, and client needs.

Possess extensive, specialized knowledge in their field.

Preferred:

Proficient in leveraging digital tools and process automation to enhance operational efficiency.

Strong change management skills to guide teams through transitions and foster a culture of continuous improvement.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Required:

Travel to offsite locations for work required.

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

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