Description

Morgan Consulting Resources, Inc. has been retained by L.A. Care Health Plan to conduct the search for a Senior Manager, Clinical and Regulatory Operations. This position is based in Los Angeles, CA, with a hybrid schedule.  

About L.A. Care Health Plan

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.

L.A. Care operates in a highly regulated environment where clinical decision-making and regulatory interpretation are central to ensuring compliance, quality of care, and member experience. The Clinical and Regulatory Operations function plays a critical role in maintaining defensible, consistent, and timely case handling across all lines of business, particularly in complex grievance and appeal scenarios.

About the Senior Manager, Clinical and Regulatory Operations.  

Reporting to the Senior Director and Grievance Officer, Appeals and Grievances, the Senior Manager, Clinical and Regulatory Operations will play a critical role in ensuring clinical defensibility, reducing regulatory risk, and strengthening audit readiness across L.A. Care’s Appeals & Grievances function. This leader oversees clinical case operations and regulatory interpretation, ensuring consistent, accurate, and compliant decision-making across all grievance, appeal, and State Fair Hearing cases.

This role partners closely with clinical, compliance, and operational leaders to reinforce high-quality case handling, elevate documentation standards, and ensure alignment with evolving regulatory requirements. The Senior Manager will help advance a more disciplined, reliable, and audit-ready environment, supporting the organization’s ability to deliver timely, equitable, and high-quality outcomes for members.

Education & Experience Requirements 

• Registered Nurse (RN), active, current and unrestricted California License required.
• Bachelors degree in nursing or related field required.
• Masters degree in business administration or related field preferred.
• 6+ years of experience working in managed care operations, quality assurance, audit readiness, compliance, or related regulatory roles.
• 5+ years of experience in leading, supervising and/or managing staff.
• Experience in Medicaid, Medicare, and Commercial managed care lines of business.
• Demonstrated experience overseeing quality assurance programs, internal controls, or audit readiness functions within a health plan or similar setting.
• Strong experience with DHCS, DMHC, CMS, and NCQA requirements related to grievances, appeals, quality-of-care processes, and audit expectations.
• Experience developing and managing corrective action plans and driving sustainable remediation.
• Experience collaborating with delegated entities, plan partners, or subcontracted networks.
• Experience leading teams, projects, initiatives, or cross-functional groups.
• Experience with analytic dashboards and visualization tools (Power BI, Tableau) preferred.

Mission · Vision · Values 

L.A. Care’s mission is to provide access to quality healthcare for Los Angeles County’s vulnerable and low-income residents to support the safety net required to achieve that purpose.

L.A. Care’s vision is a healthy community in which all have access to the health care they need.

Organizational Values:

• Accountable and responsive to the communities we serve and focus on making a difference.
• Reflects a commitment to cultural diversity and the knowledge necessary to serve our members with respect and competence.
• Driven by continuous improvement and innovation and aims for excellence and integrity.
• Demonstrates L.A. Care’s leadership by active engagement in community, statewide and national collaborations and initiatives aimed at improving the lives of vulnerable low income individuals and families.
• Fosters and honors strong relationships with our health care providers and the safety net.
• Empowers our members, by providing health care choices and education and encouraging their input as partners in improving their health.
• Puts people first, recognizing the centrality of our members and the staff who serve them.

Position Values:

• This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.
• This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned.

Benefits: Paid Time Off (PTO; tuition reimbursement; retirement plans; medical, dental & vision; wellness program; volunteer time off (VTO).

Salary range: $117,509 (min.) - $152,762 (mid.) - $188,015 (max.) with annual bonus potential. The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.