Director, Configuration

Morgan Consulting Resources, Inc. has been retained by L.A. Care Health Plan to conduct the search for a Director, Configuration . 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. About the Director, Configuration Reporting to the Senior Director, Core Administrative Operations, the Director, Configuration will play a key leadership role in L.A. Care’s multi-year transformation of its core administrative operations, focused on improving accuracy, reliability, and performance across the claims ecosystem. This role is central to repositioning configuration as a true preventative control function, strengthening upstream processes to reduce downstream defects and drive more consistent, high-quality claims outcomes. This leader will be responsible for building and advancing a more disciplined, scalable, and enterprise-integrated configuration capability within the QNXT platform. With broad cross-functional visibility, the Director will partner across operations, IT, and compliance to elevate governance, standardization, and execution, helping shape a more predictable, efficient, and high-performing operating environment. Experience Requirements 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. 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. Compensation & Benefits Salary range: $135,136 (min.) - $175,676 (mid.) - $216,218 (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. Benefits: Paid Time Off (PTO); tuition reimbursement; retirement plans; medical, dental & vision; wellness program; volunteer time off (VTO). Erica Eikelboom, Principal & Executive Search Consultant View email address on click.appcast.io

FULL POSITION DESCRIPTION

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. 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. 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. 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. Education – Required Bachelor’s Degree. In 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. #J-18808-Ljbffr LA Care Health Plan