Director, Configuration

LA Care Health Plan

Los Angeles, CA, US
$135,136.00 (min.) - $216,218.00 (max.); not speci...
On-site
Qnxt core administrative platforms
Configuration life cycle management
Claims adjudication rules
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

Job Summary

  • 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.
  • L.A. Care offers a wide range of benefits including Paid Time Off (PTO), Tuition Reimbursement, Retirement Plans, Medical, Dental and Vision, Wellness Program, and Volunteer Time Off (VTO).

Matching Summary

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.

Salary

$135,136.00 (Min.) - $216,218.00 (Max.); Not specified; Not specified

Skills & Requirements

Must-have

  • QNXT core administrative platforms
  • Configuration life cycle management
  • Claims adjudication rules
  • Provider reimbursement logic
  • SDLC configuration change management

Nice-to-have

  • Continuous improvement culture
  • Cross-functional collaboration
  • Proactive issue identification
  • Strategic planning and execution

Key Requirements

  • Bachelor's Degree or equivalent experience
  • 7+ years system configuration experience
  • 5+ years leadership/management experience
  • Experience configuring benefits, pricing, provider payment logic
  • Knowledge of CPT, HCPCS, ICD-10, DRG/APC, pricing methodologies
  • AHIMA coding standards knowledge
  • SDLC, change management, testing protocols experience
  • Experience supporting audits and regulatory reviews

Work Rights

Not specified

Tailored Resume

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