Job Description

Salary Range: $135,136.00 (Min.) - $175,676.00 (Mid.) - $216,218.00 (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.

The Director, Configuration develops and leads the strategy, execution, and continuous enhancement of authorization, benefit, pricing, provider, and configuration governance framework across L.A. Care’s core administrative platforms (QNXT) and associated tools. This position ensures that configuration is accurate, efficient, and designed to function as a preventative control mechanism mitigating downstream defects by strengthening upstream processes, validating requirements, and building predictable, repeatable system behaviors.

The Director oversees the full configuration life cycle – from impact assessment and requirements analysis through design, build, testing, and post-implementation validation, ensuring that changes are implemented with discipline and high reliability. The Director partners closely with cross-functional teams and other operational departments to ensure configuration supports a high-performing claims environment with strong control points, reduced rework, and timely, accurate adjudication.

The Director is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Develops strategic plans, drives change and influences critical business outcomes.

The Director drives skill development, accountability, and operational consistency within the team. This position also serves a key role in supporting enterprise initiatives that require coordinated, scalable, and well-governed configuration changes.

Duties

Develops, and implements standards, quality gates and governance frameworks. Ensures that the core system configuration is executed with rigor, transparency, and precision. Strengthens upstream quality and operational readiness by leading disciplined change processes, anticipating downstream impacts, and establishing a consistent framework that reduces defects, improves accuracy, and enhances the reliability of the claims environment. Through active planning, structured governance, and strong cross-functional partnerships, ensures configuration supports a more standardized, predictable, and efficient operational ecosystem.

Oversees the end-to-end configuration life cycle including analysis, requirements validation, design, build, testing, migration, and post-deployment monitoring. Establishes standardized processes, documentation requirements, and quality gates to ensure accuracy, traceability, and reliable execution of configuration changes. Ensures configuration solutions support accurate adjudication and align with operational needs, regulatory requirements, and enterprise readiness. Leads development and maintenance of configuration standards, controls, and governance frameworks that promote consistency and reduce manual rework.

Collaborates with cross functional teams on configuration priorities, impacts, and implementation timelines. Partners in configuration quality assurance (QA) activities to validate accuracy, completeness, and compliance with internal standards and regulatory expectations and to ensure clarity of requirements, appropriate test scenarios, and full understanding of configuration logic. Supports operational readiness by coordinating clarification, defect research, requirement updates, and post-deployment validation support.

Ensures configuration work meets established quality gates. Leads issue identification and root-cause analysis for configuration-related errors, ensuring sustainable upstream fixes. Establishes and monitors process-level controls that prevent recurring defects and improve configuration accuracy over time. Tracks and trends configuration errors, collaborating on remediation planning, systemic improvements, and prevention strategies.

Duties Continued

Oversees benefit configuration, pricing methodologies, provider reimbursement logic, and other adjudication rules requiring technical precision. Ensures configuration environments support stable performance, controlled releases, and effective integration with system enhancements and updates. Partners with key stakeholders to support migrations, module updates, automation opportunities, and system changes that strengthen functional performance.

Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees. Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Develops, and manages budgets, utilizing resources effectively.

Conducts strategic planning to utilize resources in order to meet current and future departmental and Enterprise-wide goals. Identifies and actualizes enhancements to support company vision.

Develops and maintains relationships with key stakeholders. Leads discussions on policy operationalization and oversees key policy perspective sharing.

Leads, trains, and develops staff, ensuring technical competence, consistency, and high-quality execution. Fosters a culture of proactive issue identification, cross-functional communication, accountability, transparency, and continuous operational improvement.

Performs other duties as assigned.

Education Required

Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Business Administration or Related Field

Experience

Required:

At least 7 years of experience in a system configuration or managed care operations involving core administrative platforms (e.g. Cognizant QNXT).

At least 5 years of experience leading, supervising and/or managing staff in technical or operational environments.

Significant experience configuring benefits, pricing methodologies, provider payment logic, and related adjudication rules.

Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD)-10, DRG/ Ambulatory Payment Classification (APC), and pricing methodologies.

Advanced knowledge of and experience with American Health Information Management Association (AHIMA) coding standards.

Knowledge of and experience with utilizing Systems Development Life Cycle (SDLC), configuration change management methodologies, testing protocols, document standards, and best practices.

Experience supporting audits, corrective actions, and regulatory reviews.

Skills

Required:

Strong interpersonal leadership skills and an ability to motivate and develop talent while driving accountability.

Extensive understanding of the application of the Division of Financial Responsibility (DoFR) to claims processing.

Knowledge of SDLC procedures in planning system configuration changes (i.e., use of rigorous documentation, testing and quality assurance protocols prior to deployment of changes into production).

Advanced knowledge of standard programming and logic to facilitate the maintenance of system configuration files and tables, along with supporting documentation.

Strong ability to translate regulatory requirements and operational needs into clear, accurate system configuration.

Exceptional analytical, planning, organization, and communication skills.

Exceptional presentation skills, written and verbal communication skills, including executive communication skills with the ability to produce audit-ready documentation.

Proficiency with Microsoft Office and data/reporting tools.

Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.

Demonstrated ability to make sound and timely decisions.

Demonstrated ability to adapt to changing situations and adjust strategies accordingly.

Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.

Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.

Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

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)