CalOptima

Registered Dietitian CalOptima CalOptima Health is seeking a highly motivated an experienced Registered Dietitian to join our team. The Registered Dietitian will be responsible for providing nutrition care, education and oversight of food services to CalOptima Health's Program for All-Inclusive Care for the Elderly (PACE) participants. The incumbent will evaluate the participant's nutritional status, develop and implement nutritional care plans, assess nutrient requirements and recommend nutritional prescriptions. The incumbent will be responsible for assessing the participant's nutritional care, communicating nutritional data and providing information to the primary care staff and other interdisciplinary team members. Position Information: Department: PACE Salary Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582) Work Arrangement: Full Office Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Collects participant data and completes required forms with responses according to department and industry standards, identifies participant's overt nutritional problems/needs, including proper intake and diet texture and sets reasonable priorities. Identifies problems requiring further referral and/or follow-up, assesses participants' responses and satisfaction with nutrition services. Develops a plan of care based on the nutritional therapeutic process and Academy of Nutrition and Dietetics (AND) standards, which incorporates the plans of other disciplines and continuing care needs, including the participant/family in developing or revising the nutrition plan of care and makes referrals to interdisciplinary support services. Completes initial/annual and periodic assessments prior to the scheduled team meetings, communicates participant changes to team members and coordinates care with Registered Dietitians at outside dialysis centers and skilled nursing facilities as required for continuity of care. Provides in-services and group education classes to participants, families/caregivers, residential care facilities, PACE staff and contractors regarding nutritional requirements and special dietary regimens as prescribed by the physician or Registered Dietitian. Documents all nutrition interventions and recommendations accurately and within departmental time requirements into participant's charts. Reviews daily diet list as assigned and assists in meal service delivery to participants attending day health center. Monitors and records participant's nutritional intake as planned and recommends variation to nutritional plan with appropriate rationale. Monitors participant's weight and notes significant changes to recommend dietary changes as appropriate. Reviews diet orders in charts to ensure appropriateness and updates the supervisor with any changes. Responsible for supporting the kitchen assistants to ensure meal delivery is on time and support meal tray distributions. Recognizes department problems and takes responsibility for documentation, demonstrates active participation in Quality Initiative processes and proactively reports any deficiencies or issues with food service vendor(s), other contracted vendors or environmental health issues to the supervisor. Stays current with knowledge and expertise regarding industry standards in nutrition. Participates as an active member of the interdisciplinary team, attends staff meetings and takes part in participant care planning as assigned. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in nutrition from an American Dietetic Association (ADA) accredited institution required PLUS 2 years of work experience as a Registered Dietitian required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Preferred Qualifications: Certified Diabetes Educator (CDE) status. 1 year of experience working with the frail or elderly population. Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) certification by the Commission on Dietetic Registration required. CPR and First-Aid Certification required or must be obtained within six (6) months of date of hire. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is October 1, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/registered-dietitian-pace-garden-grove-california-united-states-e5c709b8-2335-4df9-9115-50e821f5f595 Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-56b50eb27143914e84068a15951615d3

Supervisor, Therapy Services (PACE) CalOptima CalOptima Health is seeking a highly motivated an experienced Supervisor, Therapy Services (PACE) to join our team. Under the direct supervision of the Manager for the Program for All-Inclusive Care for the Elderly (PACE) Center, the Supervisor for Home Care will be responsible for the direct supervision and oversight of the CalOptima Health Home Care staff. The incumbent will manage and provide home care services for PACE participants to ensure effective and efficient systems are in place to provide optimal utilization of resources working in collaboration with the Center Manager and the interdisciplinary team (IDT). The incumbent will lead the CalOptima Health PACE Home Care department, including the development of home care policies and procedures for the CalOptima Health PACE program. Position Information: Department: PACE Salary Grade: 314 - $99,902 - $159,843 ($48.03 - $76.8476) Work Arrangement: Full Office Duties & Responsibilities: 50% - Supervision Provides supervision to home care staff and operations of the Home Care Department; responsible for competency checks and training of home care staff. Hires, develops, trains, supervises and evaluates performance of the CalOptima Health PACE home care staff. Leads home care staff to provide high quality home care services and for maintaining high standards within the Home Care department. Supports a home care team case load and conducts home care responsibilities and tasks. Participates in the development of care planning in collaboration with IDT. Reviews and oversees documentation by home care staff. Works with PACE administration and direct care staff to develop and revise CalOptima Health's PACE policies and procedures related to the Home Care department and the provision of home care services. Maintains knowledge of and relationships with appropriate contracted agencies or facilities, acts as a liaison with such organizations and as an advocate for participants. Encourages effective relationships among staff geared to team building and maintenance of a cohesive team. Works closely with Manager PACE Center to oversee home care staff at the PACE Center. Ensures oversight of all home care hours authorized by the IDT. Schedules and coordinates home care staff for in-home care delivery and implements all personal care services to ensure that quality services are provided to meet participant needs. 45% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Evaluates the home environment and identifies the different areas where the participant needs home care staff to assist. Works with the IDT to develop specific plans of care to address the participant's home care needs. Receives reports from home care staff and communicates participant changes to the IDT in a timely manner. Coordinates all durable medical equipment (DME) provisions in the home setting and collaborates with the IDT on DME authorization requests. Coordinates 24-hour care delivery. Holds and supports a home care case load. Completes initial and annual evaluations of the home environment for coordination of care and completion of participants care plan. Documents participant changes appropriately in the medical records and communicates participant changes to the IDT. Maintains current knowledge of standards and best practices for home care. Visits various community locations and residences to provide on-site training and competency checks of home care staff. Provides effective leadership by coordinating and integrating services within the department, with other departments and with the IDT's primary functions. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required PLUS 1 year of experience working with the frail or elderly population; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 3 years supervisory experience required. 1 year of nursing experience with home or community health provider experience required. Relevant experience must be within the last 3 years. Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 40% of the time or more. Preferred Qualifications: Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current LVN license in good standing to practice in the state of California is required, which is typically obtained through graduation from an accredited vocational nursing school. CPR and First-Aid Certification required or must be obtained within six (6) months of date of hire. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment more than 50 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 30, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/supervisor-therapy-services-pace-pace-garden-grove-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-0d6a9f0c4a248e44a8fbe9162f460ec3

Program Specialist CalOptima CalOptima Health is seeking a highly motivated an experienced Program Specialist to join our team. The Program Specialist will provide administrative clinical support services to the Grievance and Appeals Nurse Specialists in the investigation and preparation of cases for review based on clinical information, benefits, applicable regulations related to member or provider dispute of decisions. The incumbent will collect additional medical information from CalOptima Health members, and/or providers to complete appeal case reviews. The incumbent will support the department with the external medical review request process as it relates to appeals. Position Information: Department: Grievance & Appeals Salary Grade: 305 - $55,966 - $83,949 ($26.91 - $40.3601) Work Arrangement: Full Office Duties & Responsibilities: 85% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists with case pre-analysis and procures appropriate medical records and supporting documentation prior to sending appeal to internal stakeholders for case review. Supports the external medical review request process as it relates to appeals. Maintains departmental database and records' integrity by accurately entering case actions to assigned cases. Works with internal and external departments to gather additional information such as claims copies, referrals, authorization or resolution and other related procedures. Assists with State Fair Hearing preparation. Assists with the notification process to members or providers on the clinical decision issued. Works with Grievance and Appeals Nurse Specialists and Medical Directors, who oversee clinical aspects of the business, to ensure that the clinical issues are appropriately evaluated. 10% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Participates in departmental meetings, trainings and audits as needed. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required PLUS 3 years of clinical experience required, preferably in a managed care environment; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 1 year of experience with Medi-Cal, Healthy Families and Medicare reporting requirements including data validation audits required. Preferred Qualifications: Certified Medical Assistant (CMA). Bilingual in English and in one of CalOptima's defined threshold language (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 25, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/program-specialist-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-c852a5c07b64f641a76cf45eefa5869e

Customer Service Representative CalOptima CalOptima Health is seeking a highly motivated an experienced Customer Service Representative to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Health's members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers. Position Information: Department: Customer Service Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) Work Arrangement: Full Office Duties & Responsibilities: 80% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Maintains departmental productivity and quality standards. Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Serves as a resource for other team members. 15% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department. Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically. Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction. Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery. Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required PLUS 6 months of experience in a call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Typing speed of 35 words per minute (WPM) required. Preferred Qualifications: 6 months of Medi-Cal/Medicaid or health services experience. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required. Required Licensure / Certifications: N/A Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 20, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/customer-service-representative-505-city-parkway-west-california-united-states-680cbd94-bf25-4a08-b16c-e8f122c7e1b7 Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-05f240df4599894f9767eb9bb5f61b31

Actuary CalOptima CalOptima Health is seeking a highly motivated an experienced Actuary to join our team. The Actuary will ensure the fiscal integrity of CalOptima Health's program and policy decisions and facilitate executive decision making by providing timely and accurate actuarial and financial analyses. The incumbent will be responsible for the ongoing financial planning and analysis needs of the organization, including the review and analysis of revenue, medical costs and their underlying trends. Position Information: Department: Financial Analysis Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 80% - Financial Analysis Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Develops clinical utilization, cost profiles and other indicators for all areas of medical costs, including but not limited to CalOptima Health Direct, pharmacy and skilled nursing facilities. Completes analysis to support regulatory filings, including state rate development models and Medicare Advantage bids. Supports operating budget development and monthly reporting analysis. Responsible for incurred but not reported reserves (IBNR) modeling and analysis. Advises management of significant changes or unusual trends in medical costs and proposes recommendations for management consideration. Supports activities related to regulatory and financial audits and findings. Assists with the development of appropriate reimbursement rates and other financial contract provisions for CalOptima Health with the state of California. Assists in evaluation of decision support and analysis tools, as well as improvements to the data warehouse. Supports management with budgeting and forecasting duties. 15% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Provides direction and guidance to Financial Analysis staff in accordance with established departmental and organizational policies. Serves as primary liaison with external actuarial services and support. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in health care economics/planning, business, mathematics or related field required. 3 years of health care informatics or actuarial experience required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Master's degree in health care economics/planning, business, mathematics or related field required. Required Licensure / Certifications: Associate of the Society of Actuaries (ASA) certification required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 20, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/actuary-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-0e09af5a9f8f304aa5dd33eb77854535

ITS Analyst, Sr. (ServiceNow) CalOptima CalOptima Health is seeking a highly motivated an experienced ITS Analyst, Sr. (ServiceNow) to join our team. The ITS Analyst Sr (Corporate Applications (ServiceNow)) will facilitate the coordination and integration of program related activities through vendor-supported corporate applications. The incumbent will define system scope, objectives and business requirements to meet user needs. The incumbent will assist business customers in making informed decisions regarding the development, configuration and functionality of various applications and provide technical consulting to end users on systems projects. The incumbent will provide coordination and services relevant to key functions of software supported by the Information Technology Services (ITS) department, which supports a variety of end users and software, usually provided by a third-party vendor. The incumbent will contribute to the support and maintenance of assigned applications and serve as a technical point-of-contact. Position Information: Department: ITS - Infrastructure Salary Grade: 314 - $99,902 - $159,843 ($48.03 - $76.8476) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 70% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Optimizes existing and develops new service catalog offerings and associated flows with a focus on continual improvement and automation. Leverages Flow Designer to further mature the service catalog and migrates away from workflows. Identifies inefficiencies to ultimately implement areas of automation. Supports the design of custom catalog items; works with business partners and the Service Catalog manager and application owner for implementation. Maintains an ongoing knowledge of the ServiceNow product, version upgrades, enhancements, new features, etc. 25% - Technical Support Processes core system configuration as well as day-to-day user requests and incidents. Creates technical design, ServiceNow code and architecture, and works with key business units to build solutions and processes, supporting maintenance, continual service improvement, and new capabilities on the ServiceNow platform. Provides technical guidance on existing workflows for streamlining and improved efficiencies. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in information services or related field required PLUS 5 years of direct experience as a ServiceNow admin or application owner; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 5 years of ITS technical application support experience required. 5 years of computer hardware and/or software troubleshooting techniques and system support required. Preferred Qualifications: ServiceNow Certified Implementation Specialist a plus. ServiceNow Certified Application Developer a plus. ITIL Certification is highly desirable. Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 20, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/its-analyst-sr-servicenow-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-14d829e26b4b1746b6993e02fd550844

Grievance & Appeals Nurse Specialist CalOptima CalOptima Health is seeking a highly motivated an experienced Grievance & Appeals Nurse Specialist to join our team. The Grievance and Appeals Nurse Specialist participates in managing CalOptima Health's medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests. The incumbent will ensure appeals and state hearing requests are processed in accordance with regulations, compliance standards and policies and procedures. The incumbent will investigate and prepare case narratives and statements of position based on clinical information, benefits and applicable regulations related to member or provider disputes of decisions. The incumbent will clearly articulate the facts and CalOptima Health's position regarding disputes to the Administrative Law Judge hearing the case. The incumbent will be responsible for creating and reviewing resolution letters for appropriateness of clinical criteria and regulatory requirements. Position Information: Department: Grievance & Appeals Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 80% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions. Ensures all cases are completed in accordance with state and federal regulatory requirements including timelines. Presents recommendations based on clinical review, criteria and organizational policies to CalOptima Health's physician reviewers for final determination. Resolves complex and sensitive member issues within established timelines. Maintains departmental database and the integrity of records by accurately entering case actions to assigned cases. Analyzes and reports cases through GARS' subcommittee. Oversees state hearing cases. Discusses appeal process, medical decisions and hearing rights with members. Assists members in coordinating their services with providers and communicates the status and outcome to members. Assigns position statements and represents CalOptima Health at state hearings. 15% - Administrative Support Participates in departmental meetings, trainings and audits as requested. Assists with the notification process to members or providers on the clinical decision issued. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma required PLUS 5 years of health care or managed care experience required; preferably in the following related areas of responsibility: grievances and appeals, utilization management and/or quality management; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Active Registered Nurse (RN) license to practice in the state of California. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Active Licensed Vocational Nurse (LVN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 23, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/grievance-appeals-nurse-specialist-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-43fe6d6f43ac9b4fbf081cb334080af6

QI Nurse Specialist (LVN) CalOptima CalOptima Health is seeking a highly motivated an experienced QI Nurse Specialist (LVN) to join our team. The Quality Improvement (QI) Nurse Specialist (LVN) for Utilization Management (UM) is responsible for overseeing UM for CalOptima Health's direct network and delegated Health Network teams. The incumbent will be responsible for ensuring standards are met for operational and oversight compliance and UM operations are consistent with regulatory requirements, accreditation standards and CalOptima Health's policies and procedures. The incumbent will be responsible for staying current with regulatory reports, audit requirements (internal and regulatory body) and regulatory requirements from All Plan Letters (APLs) and CCS Number Letters (NLs) for the management of the UM department. The incumbent will interact with other internal CalOptima Health departments, health networks and external agencies. Position Information: Department: Utilization Management Salary Grade: 312 - $84,092 - $134,548 ($40.43 - $64.6865) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Independently performs and manages internal UM department audits, drafts corrective action plans (CAPs) if necessary and tracks to closure, presents findings to UM leadership and committee members, identifies opportunities for improvement, makes improvement recommendations to UM leadership and develops and deploys staff training. Analyzes internal audit findings to develop key performance indicators (KPI) dashboard or other like dashboards. Serves as subject matter expert (SME) for clinical areas including but not limited to Jiva. Prepares reports and presents findings in a clear and concise manner, both written and verbal for management review and approval. Assists to analyze and interpret regulatory requirements and the impact on the UM department based on analysis and interpretation. Assists with reviewing and responding to Regulatory Affairs and Compliance (RAC) requests including but not limited to a request for validation (RVD). Develops training materials in reference to clinical decisioning and rationale, inter rater-reliability (IRR), policy and procedure updates, desktop procedure (DTP)updates, regulatory audit findings remediation and changes to regulatory requirements. Collects and analyzes data for regulatory reports (federal and state mandated), audits and forwards to RAC for final review and submission to the regulatory body including but not limited to the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) or the National Committee for Quality Assurance (NCQA). Evaluates reports for data integrity, accuracy and appropriateness and assists in the timely production of reports. Participates in internal and external audits including but not limited to gathering and reviewing documents for submission, preparing files consistent with regulatory requirements, reviewing files and identifying areas of potential risk, participating as the driver or presenter at the time of the audit and assisting with CAP/Blue Sheet responses. Drafts policy and procedure revisions to align with regulatory requirements from entities including but not limited to CMS, DHCS and NCQA and presents changes to committee members. Assists with the development and oversight of the Utilization Management program and work plan. 10% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Provides support to committees working on Quality Improvement activities. Serves as a liaison and resource between CalOptima Health, delegated health networks and external agencies. Partners with CalOptima Health internal data/reporting teams to meet all reporting and project deadlines. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High school diploma or equivalent required PLUS 3 years of clinical/UM experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 2 years of UM experience in an auditor role. 2 years of experience in a health care delivery system, including a health plan, medical group or IPA. 2 years of managed care experience required. Preferred Qualifications: Associate or bachelor's degree in health sciences or related field. Required Licensure / Certifications: Licensed Vocational Nurse (LVN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 19, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/qi-nurse-specialist-lvn-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-aff4b7e81a8ce04b968c4eb5c8ab2549

Sr. Director, Health Equity (Sr. Director) CalOptima CalOptima Health is seeking a highly motivated an experienced Sr. Director, Health Equity (Sr. Director) to join our team. The Sr. Director of Health Equity is responsible for leading the development and implementation of community outreach and member engagement strategies designed to address identified health inequities. The incumbent will be responsible for directly assisting the Chief Health Equity Officer (CHEO) in developing, implementing, analyzing, and refining the CalOptima Health goals and objectives related to health equity (HE). The incumbent will partner with the CHEO, Executive Director of Equity and Community Health and other leaders to strengthen the organization's commitment and strategy to advance health equity and reduce health disparities of our member population, as well as to remain a diverse, equitable, and inclusive organization. The incumbent will assist in raising awareness of health inequities within our membership and establish plans to address them. The incumbent will drive the imbedding and communication of health equity strategies across stakeholder groups, such as CalOptima Health's Board of Directors, employees, members, and the local community. The incumbent will build and maintain strong relationships with CalOptima Health employees, providers, and local stakeholders who will help to combat inequities. Position Information: Department: Equity and Community Health Salary Grade: 324 - $216,737 - $346,778 ($104.20 - $166.7201) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 50% - Leadership Functions Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Plans, organizes, directs, and coordinates the CalOptima Health approach to health equity. Manages direct reports, including hiring, planning, design, implementation, training, and reporting of specified health equity initiatives. Mentors the professional performance and development of subordinate staff. Works collaboratively and promotes teamwork within assigned departments as well as with other departments to achieve effective message delivery, both internally and externally, through a variety of communication tools. Promotes a positive, mission-driven, public image of CalOptima Health with local and federal (as applicable) leaders. Serves as primary backup for the CHEO and attends regular health equity meetings with key constituents to build relationships, share best practices and health equity tactics, hear feedback, continually improve the health equity plan, and provide quality resources or services that add value for CalOptima Health members. Oversees the development of department policies and procedures to ensure health equity focus. Helps ensure employees, subcontractors, and Network Provider department staff receive mandatory diversity, equity, inclusion, and belonging (DEIB) training. Serves as a resource to departmental staff, internal departments, CalOptima Health providers, health networks, and the community. Provides oversight to the creation and implementation of programs and initiatives that support underrepresented populations, promote health equity, and address social determinants of health. 45% - Program Oversight Coordinates community initiatives aimed at advancing and aligning the health equity strategy and tactical workplan to reduce health disparities among specified populations. Researches evidence-based practices and nationally recognized criteria. Helps design and recommends opportunities to enhance efforts through scaling best practices, technology platforms or other culturally relevant modes of communication, and insights and perspectives generated by impacted and diverse stakeholders. Works collaboratively with internal and external partners and with external stakeholders and community organizations to address identified priority disparities and improve health quality and outcomes. Participates in strategy and program development across the organization and in the community to ensure that health equity is prioritized and addressed through internal health plan functions, operations, and external partnerships and initiatives. Works collaboratively with senior management teams at CalOptima Health and partners with agencies to ensure the strategic priorities of the organization are met. Facilitates community outreach strategies and partnerships towards health equity and best practices by identifying and addressing ethnic, cultural, or racial disparities in health quality and outcomes. Provides support in the design and implementation of CalOptima Health strategies and programs to ensure health equity is prioritized and addressed. Works with the CHEO and other leaders to ensure CalOptima Health's compliance with the California Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC) on regulatory and contractual requirements. Tracks and analyze trends in healthcare disparities that impact our members. Engages and collaborates with the CHEO, leaders and staff, subcontractors, network providers and entities, including but not limited to, local community-based organizations, the local health department, behavioral health and social services, child welfare systems, and members of health equity efforts and initiatives. Assists with reviewing CalOptima Health policies and procedures to ensure they continually promote health equity where possible. Interprets research and helps implement strategies designed to identify and address root causes of health inequities throughout CalOptima Health's service area, which includes but is not limited to systemic racism, social determinants of health, and infrastructure barriers. Supports the development and implementation of targeted interventions to address and eliminate health inequities and disparities. Participates in state and industry work groups such as DHCS, DMHC, California Health Care Foundation (CHCF), National Committee for Quality Assurance (NCQA), Association for Community Affiliated Plans (ACAP), and California Association of Health Plans (CAHP)to expand influence on benefit design, regulations, and policy direction. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Master's degree in social work promoting equity, inclusion and social justice is required PLUS 6 years of related experience in the health care industry required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 5 years of progressive supervisory/management experience. 5 years of experience in advocating for diversity, equity, and inclusion in health care and/or other settings, and an interest and involvement in the affairs of the health care community. 5 years of experience in developing and implementing initiatives/programs related to health equity. Preferred Qualifications: Direct work experience with the vulnerable and at-risk communities in Orange County. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). 5 years of experience advocating for and implementing change within a multicultural environment, preferably with some experience in project planning, developing, and implementing diversity, equity, and inclusion programs, managing outcomes, and using data to inform continuous decision-making and improvement. Experience facilitating large multi-stakeholder collaborations related to health equity is a plus. Proven track record of successful project and program leadership. Experience with historically underrepresented, low-income, traditionally disenfranchised, and differently labeled populations in diverse environments. Required Licensure / Certifications: Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office approximately 40% of the time. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 19, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/sr-director-health-equity-sr-director-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-831eb5f187d0be429363dee4377aa0f7

Sr Manager, CalAIM (Sr Manager II) CalOptima CalOptima Health is seeking a highly motivated an experienced Sr. Manager, CalAIM (Sr. Manager II) to join our team. The Sr Manager II (CalAIM) will be responsible for overall management and oversight of the grants management lifecycle, including grant program development and approval, grant application and award and grants monitoring and close-out. The incumbent will work across all program areas, including collaborating with business owners, finance, compliance and senior leadership to ensure effective and efficient grantmaking processes. The incumbent will be responsible for grant project oversight, reporting, financial tracking and record keeping. The incumbent will also meet regularly with grantee organizations and provide monitoring and oversight to ensure compliant and successful completion of grant programs. The incumbent will support outcomes reporting on the impact of grantmaking and will help to fulfill any other requirements set by the source from which grantmaking funds originate. The incumbent will also support the development of new programs as directed by the board and senior leadership. Position Information: Department: Medi-Cal & CalAIM Salary Grade: 317 - $132,969 - $212,751 ($63.93 - $102.2841) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 50% - Leadership Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department. Hires, manages, trains, reviews and set goals for staff. Leads and manages all aspects of the grant development and award process, including development of approval documents for the board, briefing documents, grant notice of funding opportunity documents, stakeholder engagement efforts, application review, award development and grant agreement processing. 45% - Program Oversight Manages end-to-end grants operations, including initiation, grant agreement execution, planning, implementation, payment, monitoring, reporting, extensions, and close out procedures. Develops, establishes and updates grants management processes, policies and procedures, desktop protocols, forms, templates, reports and data as needed to maintain quality controls. Guides the operation of grant making and assures full compliance with regulatory and legal requirements. Develops work plans and requirements to support successful implementation and execution of grants and strategic initiatives. Partners with the Compliance department on grant audit functions. Problem-solves complex grant scenarios and works with grantees to ensure grant-funded programs come to fruition. Works with the Finance department to ensure timely payment of grantees and to generate reporting required for compliance and financial statement audits. Develops quarterly progress reports for the Board of Directors and Committees. Collaborates with Communications department on the publication of announcements related to grant programs. Fosters ongoing relationships and mutually beneficial partnerships with internal CalOptima Health departments and external organizations. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in health administration, public health, psychology, sociology, public relations, applied or community health, organizational leadership or a related field PLUS five (5) years of experience at a grantmaking organization that awards funding to grantees and oversees grant administration such as a foundation, health system, non-profit organization, government or other agency or equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 3 years of management level experience required. Experience and aptitude for working in a highly matrixed, mission-driven public agency required. Preferred Qualifications: Master's degree. Project and program management experience. Experience in new program development in the health care space. Program implementation and performance monitoring experience. Required Licensure / Certifications: N/A Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 18, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/sr-manager-calaim-sr-manager-ii-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-6e1576c7d6c5dd41ad3d63d52a92033c

Medical Case Manager CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager to join our team. Case Management is an advanced specialty collaborative practice responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and CalOptima Health's members to ensure the services provided promote quality and cost-effective outcomes for all members. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Position Information: Department: Case Management Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Care Management Assesses member needs using a standardized health needs assessment or health risk assessment. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Performs post-discharge assessments to identify member's post-hospital or post-emergency department discharge needs including but not limited to: Member's physical, functional, social and psychological status Member's cultural and linguistic needs Caregiver resources and available benefits Follow-up provider care and ensuring scheduled appointments Durable medical equipment and supplies Community resources Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals. Reviews, modifies and updates care plans continuously to reflect the member's needs, at minimum, annually or upon change in condition. Schedules follow-ups to assess progress towards goals and identifies barriers to meeting goal. Provides regular outreach to assigned members along with members from a worklist and evaluates quality of service given to members according to department contact standards. Coordinates care and services with members, members' family members/representatives and other providers, as appropriate, including community supports and Long-Term Services and Supports (LTSS). Communicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services. Facilitates referrals to behavioral health/substance use disorder services and identifies and makes referrals to LTSS department, community supports and community resources. Facilitates and participates in Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing supervisor, manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. 10% - Administrative Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Follows CalOptima Health's protocol for documenting all case interventions. Prepares and maintains appropriate documentation of patient care and progress within the care plan. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) or related field required PLUS 3 years of clinical experience and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree or related field. Case Management Certification (CCM). Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 18, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/medical-case-manager-505-city-parkway-west-california-united-states-f37057b8-db66-4021-958f-eedb698e17f5 Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-75d9641c78fa8f42becd14ba50dadc02

Sr. Tableau BI Developer (Enterprise Analytics Manager) CalOptima CalOptima Health is seeking a highly motivated an experienced Sr. Tableau BI Developer (Enterprise Analytics Manager) to join our team. The Enterprise Analytics (EA) Manager will provide a "one-stop shop" for analysis, visualization, reporting, guidance and expert knowledge on health care analytics for various departments within CalOptima Health. The incumbent will work independently and in collaboration with other knowledge experts to develop report suites that are accurate in transforming various data sets into information as well as high-impact presentations utilizing Tableau to visualize results in a framework that enables decision-makers to drill-down. The incumbent will evaluate various issues, perform detailed analysis as it relates to those issues and communicate well-reasoned solutions to all levels of management within CalOptima Health. The incumbent will work with large amounts of claims, authorizations, case management, enrollment and provider data. The incumbent will have strong database, spreadsheet and business intelligence (BI) presentation skills. Position Information: Department: Financial Analysis Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Provides clinical and utilization analysis to assist medical management with improving outcomes and quality of care for CalOptima Health's members. Researches, assesses and develops advanced tools, models, visualizations, reports and approaches to increase accuracy and timeliness of data-driven projects. Develops return on investment and business case analyses for program initiatives under consideration by senior management. Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse. Mentors, trains and acts as a lead for more junior analytical staff. Creates models to answer "what-if" questions for changes to programs or initiatives. Partners with CalOptima Health's leaders to establish measurable improvement goals. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in computer science, data science, data analytics, business administration, economics, statistics, applied mathematics or related field required PLUS 3 years of applied expert knowledge in Tableau Desktop developing and designing dashboards to provide analytical insights; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. 1 year of applied expert knowledge in SQL development (e.g., SQL queries, stored procedures and functions) required, preferably in a Microsoft SQL Server environment. Preferred Qualifications: Experience working in a healthcare analytics role. Experience working with Medi-Cal and/or Medicare payer information (e.g., claims, encounters, eligibility, authorizations, case management levels, HEDIS, etc.). Experience with ETL tools, preferably SQL Server Integration Services (SSIS). Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 17, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/sr-tableau-bi-developer-enterprise-analytics-manager-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-a8f94b5395427c48a94cdd0df4026f18

Claims Resolution Specialist (Claims) CalOptima CalOptima Health is seeking a highly motivated an experienced Claims Resolution Specialist (Claims) to join our team. The Claims Resolution Specialist (Claims) will be responsible for overseeing and managing the claims resolution process. The incumbent will follow regulatory and internal guidelines in conjunction with CalOptima Health's policies and procedures that apply to claims adjudication and adjustment of claims. The incumbent will work closely with claims management and trainers to identify training opportunities from trend reports. The incumbent will also process Medi-Cal and OneCare claims. Position Information: Department: Claims Administration Salary Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Claims Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department. Responsible for accurate and timely adjudication of claims according to AB1455 regulatory guidelines. Processes claims based upon contractual and/or CalOptima Health's agreements involving the use of established payment methodologies, division of financial responsibility, applicable regulatory legislation, claim processing guidelines and company policies and procedures. Informs the supervisor or manager of issues impacting production and quality (i.e., incorrect database configurations, incorrect claim payments, etc.). Analyzes, processes, researches and adjusts all provider reconsideration requests and correspondence. 5% - Completes other duties or projects as assigned. Minimum Qualifications: High School diploma or equivalent required. 2 years of experience processing on-line claims in a health care/managed care setting specifically in adjudicating and adjusting claims required. 1 year of experience in both Medicare and Medi-Cal billing required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bachelor's degree in business administration, health care management or related field. Experience in claims billing systems. Required Licensure / Certifications: N/A Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 17, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/claims-resolution-specialist-claims-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-68cfda419b152c4e9b3a9b15f780e07d

Prior Authorization Review Coordinator (Medical Authorization Assistant) CalOptima CalOptima Health is seeking a highly motivated an experienced Prior Authorization Review Coordinator (Medical Authorization Assistant) to join our team. The Medical Authorization Assistant (Prior Authorization) will provide office and referral management services and serve as a contact between members, physicians, providers and CalOptima Health staff. The incumbent will process initial intake of information, assist with authorization functions and gather information. The incumbent will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers. The incumbent monitor tasks related to CalOptima Health's prior authorization and referral process. Additionally, the incumbent will be responsible for applying CalOptima Health's medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent will directly interact with provider callers, acting as a resource for their needs. The incumbent will operate under the direction of the licensed nurse. Position Information: Department: Utilization Management Salary Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Medical Authorization Receives referral requests via fax, phone or electronically and enters new service request information into the authorization system. Collects additional information from CalOptima Health members and providers to complete referral information. Authorizes requested services according to CalOptima Health's authorization guidelines, performing data entry into the authorization system and verifying eligibility. Contacts the health networks and CalOptima Health Customer Service regarding health network enrollments. Assists the Medical Case Managers in gathering medical records, obtains appropriate coding for diagnosis and procedures and follows up on phone calls as directed by the authorization nurse. Documents all contacts and case information in the system using the standard charting format. Performs data entry into the appropriate databases for monitoring, tracking and trending of events and other relevant databases as needed. 10% - Administrative Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required. 2 years of experience in a health care or managed care setting required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Prior authorization and utilization management process experience. Required Licensure / Certifications: N/A Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 17, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/prior-authorization-review-coordinator-medical-authorization-assistant-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-b4bc1c81ac224b49911fbd7f7174b708

Sr. Manager Provider Data Analytics (Sr. Manager I) CalOptima CalOptima Health is seeking a highly motivated an experienced Sr. Manager Provider Data Analytics (Sr. Manager I) to join our team. The Sr Manager (Provider Data Analytics) will provide technical and tactical management oversight and leadership for moderate to complex activities involving data reporting and analytics in support of provider data operation processes as well as regulatory requirements. The incumbent will provide day-to-day leadership and technical guidance to an analytics team including on-going data clean up, analysis of the provider network, requirements review, reporting and dashboard creation and enhancement. The Sr Manager will be responsible for supporting data integrity, ensuring reporting accuracy and enabling optimization of reporting processes. The incumbent will be responsible for overall stability, timeliness and quality of reports and analyses. Position Information: Department: Provider Data Management Services Salary Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 50% - Leadership Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department. Hires, trains, retains and manages a team of analytic professionals. Sets goals, objectives and key performance indicators (KPI) and manages overall team performance. Provides technical guidance and support to the team on complex issues and analytics request. Provides leadership, innovation and oversight for data analytics operations to produce the data sets required to inform and develop insights and strategies for operational and business initiatives. Leads the effort to document and refine processes and procedures and establishes reporting standards and presentation. Anticipates future demands of initiatives, strategic plans and regulatory updates, and designs/implements solutions to meet these needs. Establishes and manages teams to a set of standards and governance to improve performance and support effective development and outputs. 45% - Program Oversight Defines data management best practices. Manages and monitors Department of Health Care Services (DHCS) and Centers for Medicare & Medicaid Services (CMS) network adequacy requirements for all networks, identify and presents gaps and trends for network enhancement. Leads efforts to systematically collect, review, assess, analyze and report on plan and health network level performance related to provider data and network adequacy to provide to leadership and stakeholders. Directs the annual development and changes to policies and procedures for reporting requirements or other policies as assigned, consistent with, but not limited to, regulatory requirements and National Committee for Quality Assurance (NCQA) guidelines. Supports efforts in provider data verification and reconciliation processes and coordinate with vendors and internal functional areas for issue resolutions. Identifies new ways to support and improve analytics and data accuracy, which includes traditional business intelligence (BI), Tableau and other data validation and tracking technologies; works with internal departments to implement new data initiatives, conduct regression tests, etc. Develops the data standards and deploys automation tools to obtain and process data from different sources. Constructs datasets to analyze, inform, identify trends and support stakeholder decision-making. Stays current with regulatory guidelines impacting essential functions and data requirements. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in a related field PLUS 5 years of work experience in health care industry in operations, claims, risk adjustment, or other data related functions; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. 2 years of experience working directly with business users in gathering requirements, refining and completing meaningful data/report requests required. 2 years of experience supervising analysts. Preferred Qualifications: 2 years of experience developing reports and completing data analysis using business intelligence tools (e.g.: SSRS, Tableau). 3 years of experience working with health care data such as encounters, claims, risk adjustment, provider data, and QI. Experience using SQL to extract data, understand data structures and run queries. Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 17, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/sr-manager-provider-data-analytics-sr-manager-i-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-441ebd51f5b44445a3035e456a202834

Pharmacy Services Specialist, Sr. (Clinical Programs) CalOptima CalOptima Health is seeking a highly motivated an experienced Pharmacy Services Specialist Sr to join our team. The Pharmacy Services Specialist Sr will be responsible for utilizing specialized pharmacy knowledge and expertise to assist participating pharmacies, members, providers, CalOptima Health departments, health networks and other entities in assuring the efficient, timely and effective provision of pharmaceutical products and services to CalOptima Health members. The incumbent will interact with other staff throughout the organization, as well as external contacts daily. The incumbent will be responsible for ongoing public contacts including, but not limited to, members, individual pharmacies, member advocates, family members, health networks, Public Guardian's Office, Regional Centers and other agencies. The incumbent will have the authority to make and carry out decisions on behalf of the Pharmacy department within established policies and procedures. Position Information: Department: Pharmacy Management Salary Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Serves as lead for pharmacy services operations activities for the Medication Therapy Management (MTM) program in various systems such as Guiding Care, MTM vendor software and Facets. Coordinates outbound call efforts to MTM eligible members in accordance with MTM program desktops. Maintains documentation of member and pharmacy cases in MTM vendor software and manages case load to ensure completion within departmental standards as needed. Functions efficiently and productively in the pharmacy call center as needed. Using a pharmacy computer program, retrieves drug-specific technical data and information necessary for the completion of departmental and interdepartmental pharmacy-related functions and operations. Coordinates resolution of provider and member pharmacy issues requiring specialized technical and professional knowledge and expertise, including pharmacy authorizations. Resolves claims disputes between providing pharmacies, the pharmacy claims administrator, CalOptima Health Claims Department and other entities as necessary. Interprets and articulates Pharmacy Management program policies and procedures to pharmacy providers, other providers, other CalOptima Health staff, external agencies and others as required. Assists in the processing of pharmaceutical prior authorization and appeals requests as per the CalOptima Health Prior Authorization Guidelines as needed. Establishes and maintains key contacts both internally and externally to assure appropriate coordination and provision of pharmacy services to CalOptima Health Members. Accepts referrals from Member Services and work in conjunction with employees from this department to resolve all pharmacy-related member complaints, including those related to the MTM program process. Assists pharmacies and health plans in resolving member-specific pharmacy services access issues, removing barriers to access to pharmaceutical services. Runs daily, weekly and monthly pharmacy compliance report. Provides ongoing staff training to new hires as needed. 5% - Completes other duties as assigned by management. Minimum Qualifications: High School diploma or equivalent required PLUS 5 years of experience as a Pharmacy Technician in the ambulatory, community, home infusion, inpatient, long-term care or managed care setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: An associate degree in health-related field. Lead work experience in Clinical Programs. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: A current, valid and unrestricted California Pharmacy Technician license required. Pharmacy Technician Certification Board (PTCB) Certification required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 12, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/pharmacy-services-specialist-sr-clinical-programs-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-7af5f2522efec441859b7f5aea979d88

Program Manager (Operations) CalOptima CalOptima Health is seeking a highly motivated an experienced Program Manager (Operations) to join our team. Under the general direction of the Supervisor Quality Analytics, the Program Manager (Operations) will collaborate and coordinate with leadership to design, implement and evaluate quality programs. The incumbent will lead, coordinate, monitor and complete tasks supporting the development of quality programs and initiatives. The incumbent will monitor cross functional projects and other assignments, including those relating to department efficiency to ensure department strategic objectives and initiatives are met. The incumbent will interact with CalOptima Health's executives and management, legal counsel and state and federal regulatory agencies. Additionally, the incumbent will support CalOptima Health staff on related projects as needed. Position Information: Department: Quality Analytics Salary Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 80% - Program Support Leads program development, execution of activities and oversight of campaigns executed through vendors such as text messages, robocalls and member health rewards program. Tracks and monitors the impact and success of programs. Assists management in the development of specifications and scope of work for a Request for Proposal (RFP), Request for Quote (RFQ) or Request for Inquiry (RFI) to support new program development. Collaborates with other departments on program design, development and implementation of quality programs impacting, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS), Managed Care Accountability Sets (MCAS) and Centers for Medicare & Medicaid Services (CMS) STARs quality measures; ensures consistency with the quality program and workplan. Supports National Committee for Quality Assurance (NCQA) accreditation standard initiatives or projects and provides analysis and evaluation of related activities as needed. Produces documentation, summaries, root cause analyses, impact analyses and reports for department operations, audits, and responses to regulators. Reviews evidence-based literature for best practices to incorporate into strategy. Develops and oversees the process of written tools for programmatic use, including program plans, surveys and evaluation instruments. Collaborates with other departments in the development of program measures of success and outcome reports for programs. Maintains current knowledge of applicable regulations or clinical guidelines related to program development. Stays current on the local, state and federal health care environment and identifies issues that may impact CalOptima Health's quality program and workplan. 15% - Administration Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Reviews and assists in updating policies and procedures to ensure knowledge related to assigned programs and projects is kept up-to-date. Works with all CalOptima Health departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree required PLUS 3 years of health care related work experience in program development, including strategic planning for a start-up program, implementing the program and evaluating evidenced-based programs required, preferably in the health care industry or a managed care environment is required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Master's degree in public health, health administration or related field. 1 year of experience working in a highly matrixed, mission-driven organization. Required Licensure / Certifications: N/A Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 12, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/program-manager-operations-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-0d8ac2bd7c03a94e96940c3aa5d407b9

Program Assistant (GARS) CalOptima CalOptima Health is seeking a highly motivated an experienced Program Assistant (GARS) to join our team. Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. The incumbent will work independently, exercising discretion and judgment and may assist in coordinating a function for the program assigned. The incumbent will be responsible for monitoring the GARS member and provider mailbox, fax, mail and processing appeals and grievances for assignment to key staff within the required timeframe. Position Information: Department: Grievance & Appeals Salary Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880) Work Arrangement: Full Office Duties & Responsibilities: 80% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Serves as the point of contact within or outside CalOptima Health for inquiries related to grievances and appeals. Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or via email from the website for members and providers. Monitors inquiry requests from the Department of Managed Health Care (DMHC), Medicare Complaint Tracking Module (CTM) from the Centers for Medicare Medicaid Services (CMS), Medicare Quality Improvement Organization (QIO) and the State Hearing Office from Department of Social Services (DSS). Responds to DMHC requests for information in a timely manner. Sets up complaint case files, enters cases in the GARS system with accurate classification and category types and assigns them to appropriate staff. 15% - Administrative Support Works with internal and external departments and providers in gathering supporting information relevant to the case. Generates acknowledgment letters for all lines of business per department and regulatory standards. Assists in the development of departmental forms and intake processes. Coordinates administrative support for state hearings, serves as a contact with DSS for incoming cases, enters cases in the GARS system, creates electronic files and routes the scanned documents to designated staff and fax required state hearing documentation to the local hearing office as necessary. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required PLUS 1 year of experience in appeal and grievance guidelines or Medi-Cal/Medicaid or Medicare programs required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 12, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/program-assistant-gars-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-c6187a5a1d33ba4d91771dd230bc414d

Supervisor, Behavioral Health (Utilization Management) CalOptima CalOptima Health is seeking a highly motivated an experienced Supervisor, Behavioral Health (Utilization Management) to join our team. The Supervisor Behavioral Health (Utilization Management) will be responsible for the daily operation of Behavioral Health Integration (BHI) Utilization Management (UM) functions. The incumbent will oversee the benefit's prior authorization, concurrent review processes and transition of care. The incumbent will be responsible for the direct supervision and oversight of the BHI staff. The incumbent will work under the direction of the Sr Manager II to implement processes to ensure effective delivery of behavioral health services. The incumbent will be accountable for establishing and achieving quality and productivity standards and ensuring compliance with CalOptima Health's policies and procedures. The incumbent will collaborate with other internal CalOptima Health departments to ensure all regulatory requirements are met. The incumbent will interact with contracted organizations and providers, health networks and other stakeholders in a manner that promotes collaborative working relationships. Position Information: Department: Behavioral Health Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 50% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Assists the Sr Manager II as needed to ensure departmental and agency goals are met. Participates and prepares for regular internal and external audits. Provides clinical support for cases with complex behavioral health needs. Participates in the development, implementation and improvement of departmental policies, procedures and workflows. Develops and prepares reports to meet internal, regulatory, contractual and accreditation requirements. Maintains current knowledge of regulatory requirements pertinent to BHI UM which includes the Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), Managed Risk Medical Insurance Board (MRMIB) and Department of Managed Health Care (DMHC). Ensures compliance with federal, state and county contracts and/or Memorandum of Understanding (MOUs) and other requirements set forth by regulatory agencies or funding sources specific to behavioral health care services. Acts as a liaison to community based and governmental providers that serve members. 45% - Supervision Supervises and assists with hiring, training, reviewing and setting goals for department and staff. Oversees and monitors the prior authorization and concurrent review process of the benefit and regulatory compliance. Provides direct oversight of the day-to-day operations of the behavioral health benefit. Facilitates staff meetings, including individual supervision. Provides coverage and expertise for other teams within the BHI UM department. Serves as a subject matter expert (SME) to departmental staff, internal departments and affiliated health networks regarding authorization rules and processes. Identifies and conducts performance feedback and/or counseling/corrective action meetings with the assistance of Human Resources as necessary. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Master's degree in social work, clinical psychology, marriage and family therapy or related field or graduation from an accredited School of Nursing required. 3 years of behavioral health experience (post licensure) required. 2 years of supervisory/management experience required. Experience in behavioral health audits, including CMS, DHCS, DMHC and NCQA required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: 2 years of utilization management (UM) experience. 2 years of managed care experience. Required Licensure / Certifications: Current and unrestricted California Board Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed professional Clinical Counselor (LPCC), Licensed Clinical Psychologist or an active Registered Nurse (RN) license to practice in the state of California required. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 13, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/supervisor-behavioral-health-utilization-management-505-city-parkway-west-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-6bfbafa42d863c4085390b042a27b790

Kitchen Assistant CalOptima CalOptima Health is seeking a highly motivated an experienced Kitchen Assistant to join our team. Under the supervision of the Supervisor Dietary Services, the Kitchen Assistant will ensure adequate amounts of food are planned for, purchased and served in compliance with food safety standards and clinical indications. The incumbent will ensure appropriate preparation and flow of food service to participants at the Program for All-Inclusive Care for the Elderly (PACE) center. Position Information: Department: PACE Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) Work Arrangement: Full Office **This position is eligible for telework in California.** Duties & Responsibilities: 95% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Serves meals at the designated times, along with service recording after food service is accomplished. Plans and coordinates the service of breakfast, lunch and snack menus, per dietitian guidelines. Reviews menus with the supervisor and adjusts as instructed for clinical indication, including textures, portions and other considerations. Ensures daily clean-up of dishes and kitchen area. Participates in ordering food for planned menus and other kitchen-related goods within budget. Completes food service-related logs, food temperatures, food inventory and other paperwork, as necessary and reports any abnormal findings to the supervisor in a timely manner. Assists in planning food service for special events and activities in the social day area. Collaborates with the supervisor to ensure kitchen practices meet the standards of PACE regulations and the county health department. Assists in diet tag production and preparation for meal service. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High school diploma or equivalent required PLUS 6 months of meal preparation service experience required, preferably in a health care setting; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Preferred Qualifications: N/A Required Licensure / Certifications: ServSafe certification required. CPR and First-Aid Certification required or must be obtained within six (6) months of date of hire. Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 26 to 50 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits & Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2024 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is September 10, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/kitchen-assistant-pace-garden-grove-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-fd8b7e62c6d2144ab8959d5c5d8c6410