Network Operations Specialist III
L.A. Care Health Plan — Los Angeles, CA
Posted: 2026-10-13
Job Description
• Leads managed care network initiatives, including Targeted Rate Increase (TRI), Hospital-Directed Payment Programs, and related projects, by managing work packages, milestones, deliverables, and evidence.
• Translates All Plan Letters (APLs), legislative directives, and regulatory requirements into business requirements, workflows, controls, corrective actions, and measurable outcomes.
• Builds KPIs and dashboards, analyzes operational trends, logs issues and risks, prepares executive briefings, and maintains audit evidence and readiness.
• Coordinates Provider Relations, Credentialing, Provider Data, Compliance, Legal, IT/Data, communications, and other stakeholders; supports provider notices, portal adoption, UPM updates, system changes, UAT, and production validation.
• Requires a Bachelor's Degree or equivalent education/experience, at least 3 years in managed care/network operations, data analysis, or regulatory operationalization, and travel to offsite locations; no specific license or certification is stated.