The Senior Director is responsible for leadership, operational execution, clinical and regulatory oversight, and enterprise governance of L.A. Care’s grievance, appeal, and State Fair Hearing functions across all product lines
Job Summary
The Senior Director is responsible for leadership, operational execution, clinical and regulatory oversight, and enterprise governance of L.A. Care’s grievance, appeal, and State Fair Hearing functions across all product lines.
This position ensures all cases are processed accurately and consistently with exceptional quality, and within required timeframes in alignment with federal and state regulations, contractual obligations, accreditation standards, and internal policies.
The Senior Director collaborates extensively with cross-functional key stakeholders to address systemic issues, strengthen preventive controls, improve service delivery, and support enterprise audit readiness.
Matching Summary
The Senior Director is responsible for leadership, operational execution, clinical and regulatory oversight, and enterprise governance of L.A. Care’s grievance, appeal, and State Fair Hearing functions across all product lines.
Salary
$171,925.00 (Min.); $232,100.00 (Mid.); $292,274.00 (Max.); Not specified
Skills & Requirements
Must-have
Grievance and appeal requirements
Regulatory compliance and auditing
Clinical decision stewardship
Operational excellence and accountability
Enterprise governance
Nice-to-have
Equitable member experience
Data-driven insights
Continuous operational improvement
Cross-functional collaboration
Key Requirements
Bachelor's Degree or equivalent experience
9+ years in health plan operations, managed care, A&G, UM, clinical ops, or regulatory compliance
8+ years of leadership/management experience
Extensive leadership in Medicaid, Medicare, and Commercial managed care
Experience navigating regulatory and accreditation requirements