CalOptima

Manager Case Management CalOptima CalOptima Health is seeking a highly motivated an experienced Manager Case Management to join our team. The Manager Case Management provides shared responsibility for the daily operations, activities and projects for the Case Management department. The incumbent works under the general direction of the Director of Case Management and in partnership with the other department managers to provide performance management and development of the case management staff and projects associated with the department to ensure compliance with department policies and procedures, along with the implementation of assigned projects. The incumbent may be required to attend joint operational and community meetings. The incumbent is responsible for monitoring of case management reports and reporting to management or committees. Position Information: Department: Case Management Salary Grade: P - $117,000 - $192,390 ($56.25 - $92.4952) 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 sets goals for department and staff. Works with the director in the development, implementation and evaluation of the department's case management policies and procedures. Ensures programs, policies and procedures, and desktop procedures are aligned with Centers for Medicare & Medicaid Services (CMS), Department of Health Care Services (DHCS) and National Committee for Quality Assurance (NCQA) standards. 45% - Program Oversight Collects, analyzes and responds to data regarding overall and individual case management effectiveness. Develops and implements complex project plans for current or new programs which will assist with improving efficiencies, outcomes and satisfaction according to federal and/or state regulations. Develops and maintains relationships with providers, networks and groups to serve as a liaison between the health plan and the provider. Forwards cases requiring director or Medical Director review or intervention and routes appropriately. Partners with the other Managers of Case Management to meet all project deadlines. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in a healthcare related field and a current unrestricted Registered Nurse (RN) license to practice in the state of California required. For non-RN's, a master's degree in healthcare, social work or related field required. 5 years of experience in managed care, preferably with Medicare and Medicaid/Medi-Cal populations required. 3 years of experience in ambulatory case management 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: 3 years of supervisory/management level experience. Active Certified Case Management (CCM) certification. 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 May 6, 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/manager-case-management-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-bbb85c967773e6459266ceef782b5e8c

Supervisor Long Term Support Services CalOptima CalOptima Health is seeking a highly motivated an experienced Supervisor Long Term Support Services to join our team. The Supervisor, Long Term Support Services will be responsible for planning, organizing, developing and implementing the principles, programs, policies and procedures employed in the delivery of Long Term Services and Supports (LTSS) to members in the community and institutionalized settings. The incumbent will be responsible for the management of the day-to-day operational activities for LTSS programs: Long Term Care (LTC), Community Based Adult Services (CBAS) and CalAIM (Enhanced Care Management (ECM) and Community Supports (CS)), while interacting with internal/external management staff, providers, vendors, health networks and other internal and external customers in a professional, positive and competent manner. The incumbent will be responsible for supervising and monitoring the ongoing and daily activities of the department staff. In addition, the incumbent will resolve members' and providers' issues and barriers ensuring excellent customer service. The incumbent will manage staff coverage in all areas of LTSS to complete all assignments, the orienting and training of new employees and ensure contractual and regulatory requirements are met. Position Information: Department: Long Term Care Salary Grade: N - $95,000 - $155,078 ($45.67 - $74.5567) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 80% - Supervisory 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. Supervises, trains and audits the LTSS Medical Case Managers, Social Workers, Program Specialists and non-clinical staff such as Personal Care Coordinators (PCC), Medical Authorization Assistants (MAA) and Administrative Assistants (AA) per Medi-Cal processing guidelines. Serves as a resource to departmental and organizational staff which includes internal departments and affiliated health networks, regarding authorization rules and processes. Manages the day-to-day activities of the department to ensure compliance with company policies and regulatory requirements. Attends all LTSS required meetings, Concurrent Review and Case Management clinical rounds and other meetings, including internal and external interdisciplinary care team meetings as needed or assigned. Makes staffing assignments and recommendations based on authorization priority, overall workload and staffing needs per program to ensure daily workloads are fulfilled with a cost-effective use of resources and time. Provides on-going/periodic in-service training for all staff based on audit findings and facilitates the on-going development and education of staff. Trains, evaluates and provides performance feedback to staff as needed, including day-to-day coaching and performance feedback to individuals, annual and 90-day appraisals and Performance Improvement Plans based on individual needs; involves Human Resources as necessary. Establishes and maintains effective working relationships with public and private agencies providing long term support services to members, including assisting health networks and other departments to minimize barriers to discharge planning. Resolves provider/vendor/member problems related to the delivery of LTSS. 15% - Program Support Conducts audits as assigned by LTSS management team as required by policy and procedure, including auditing for quantity and quality of work completed and timeliness required by regulations. Provides assistance in the development and implementation of policies and procedures, as well as orientation. Identifies areas of improvement in workflows, assists in the creation of desktop procedures and new workflows for corrective action and educates the LTSS staff on new/revised workflow processes. Assists the Manager of LTSS in all areas of the department to ensure departmental and organizational goals are met, including the requirement to be able to complete authorization approvals for CBAS, LTC, ECM and CS programs. Works with the Information Technology Services (ITS) and reporting departments to support the department in the creation of reports that ensures monitoring and reporting of LTSS program activities to regulatory agencies as required by the organization and regulatory entities. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in a healthcare related field required. Current unrestricted Registered Nurse (RN) License to practice in the State of California required. For non-RNs, a master's degree in healthcare, social work or related field required. 3 years of experience in applying Managed Care, Medicare, and Medi-Cal guidelines to skilled nursing facilities, CBAS, or CalAIM. Experience working with Long Term Care, Health Facilities, Managed Care, Geriatrics, or persons with disabilities 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. 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 25% of the time or more required. Preferred Qualifications: 1 year of supervisory and/or lead 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 May 6, 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-long-term-support-services-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-5765d9899afb5041bc842ddfac880846

Data and Reporting Analyst Lead CalOptima CalOptima Health is seeking a highly motivated an experienced Data and Reporting Analyst - Lead to join our team. The Data and Reporting Analyst - Lead (HEDIS) will be responsible for developing and maintaining Healthcare Effectiveness Data and Information Set (HEDIS) data reports to support the regulatory requirements from the Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA) and California Department of Healthcare Services (DHCS). The incumbent will be responsible for continually improving data acquisition, enhancing data processing, assurance on data reporting and providing data analysis. The incumbent will provide expertise in business requirements and train other Analysts for the HEDIS data system in the Quality Analytics department. Position Information: Department: Quality Analytics Salary Grade: M - $85,000 - $141,089 Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 80% - Data and Reporting Support Maps multiple internal data sources (e.g., claims, encounters, pharmacy, providers, enrollment, lab, etc.) and external data sources (registry, electronic medical record (EMR), etc.) for HEDIS reporting. Ensures data integrity from the data warehouse and HEDIS software. Researches data integrity issues and provides solutions. Provides expertise in HEDIS data analysis, including member, provider, claims and encounters. Maintains a thorough knowledge of HEDIS reporting specifications, DHCS specific reporting requirements and CMS data reporting requirements. Writes detailed Scope of Design documents for HEDIS data processing and auditing. Conducts quality assurance on data loaded into the HEDIS software, reviews results for accuracy and prepares for annual HEDIS compliance audits. Maintains a thorough knowledge of CalOptima Health's data, provides feedback to Information Technology Services (ITS) to resolve data integrity issues and to support reporting requirements. Prepares ad-hoc analyses and works on special projects. Reviews proposed HEDIS measure requirements and implements changes for plan level or program-specific reporting as requested. Provides technical support for HEDIS hybrid sampling, medical records retrieval and reviewing. 15% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Provides guidance and training on HEDIS repository to the other Data Analysts within the department. Acts as the point of contact for data requests, assigns requests to other Data Analysts as appropriate and monitors timeliness and outcomes. 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: Bachelor's degree in healthcare administration, public health or related field required. 5 years of HEDIS reporting experience required. 3 years of Microsoft Access/Structured Query Language (SQL) experience required. 3 years of experience in a managed care or health care organization required. Health care data reporting and analysis 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 public health, informatics or related field. Experience with HEDIS software. 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 April 8, 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/data-and-reporting-analyst-lead-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-8235582966235149bf370d6ebb9f92e4

Customer Service Rep - Lead (Bilingual) CalOptima CalOptima Health is seeking a highly motivated an experienced Customer Service Rep - Lead (Bilingual) to join our team. The Customer Service Rep - Lead will provide services to CalOptima Health members and providers. The incumbent will assist members and providers with questions related to the Medi-Cal and OneCare programs for Orange County. The incumbent will provide information regarding eligibility, enrollment and benefits to CalOptima Health members and member eligibility information to CalOptima Health providers and will serve as a mentor and resource for Customer Service Representatives (CSRs). Position Information: Department: Customer Service Salary Grade: G - $55,000 - $82,786 ($26.44 - $39.8010) 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. Monitors key performance indicators to ensure regulatory requirements are achieved and maintained. Processes member and provider information. Answers member and provider questions in-person or telephonically. Refers issues interdepartmentally and makes recommendations for further contacts within CalOptima Health. Documents contact information via the Facets computer system. Functions efficiently and productively in a high-volume telephone call center and maintains departmental performance and productivity standards. Handles or routes escalated calls appropriately. Assists supervisor with daily monitoring of customer service tasks, projects and case queues. Assists supervisor with CSR monthly performance reports and provides feedback for annual CSR evaluations. Monitors and addresses queue volume and wait times. Aids leadership in identifying and resolving operational problems using defined processes, expertise and judgement. Collaborates with supervisors and interdepartmentally to develop strategies to reinforce, train and disseminate information to meet operational and service performance requirements. Contributes subject matter expertise and carries out project assignments in a timely and effective manner by adhering to company and departmental policies and procedures. 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. Sends daily call center reports. Helps in coordination of staff meetings and presentations. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required. 3 years of customer/member services experience, including 2 years of 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. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required. Preferred Qualifications: 2 years of experience in Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services 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 May 2, 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-rep-lead-bilingual-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-4719fb27e68dc0439735400b8d375034

Director, Privacy Compliance (Director II) Job Description Department(s): Office of Compliance Reports to: Chief Compliance Officer FLSA status : Exempt Salary Schedule: R - $144,000 - $237,864 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 on Thursday, February 01, 2023 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Director II (Privacy Compliance) will direct and oversee privacy compliance activities and processes for CalOptima Health, including CalOptima Health Direct and its subcontracted health networks. The incumbent will be responsible for Health Insurance Portability and Accountability Act (HIPAA) compliance with the Privacy Rule and the Health Information Technology for Economic and Clinical Health Act (HITECH Act) as well as applicable state and federal regulations under CalOptima Health's Medi-Cal and Medicare lines of business. The incumbent will ensure CalOptima Health and its subcontracted health networks comply with appropriate standards, regulations, contractual provisions, federal waivers and laws. The incumbent will collaborate and interact with CalOptima Health executives and management, health network management, legal counsel, state and federal representatives and others as needed. Duties & Responsibilities: 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. Manages and oversees staff, including assigning and evaluating work, making recommendations on hiring, training and setting goals, conducting performance evaluations and recommending and implementing corrective actions up to and including termination. Plans, develops and implements strategies, processes, policies, procedures and other activities to ensure CalOptima Health and its subcontracted health networks follow state and federal standards and requirements. Serves as the HIPAA Privacy Compliance Officer and ensures compliance with all HIPAA privacy rules, statutes and regulations. These activities include developing and implementing privacy policies, procedures and practices, including training, communication, compliance monitoring, handling complaints and compliance issues and resolving any issues involving the use or disclosure of Protected Health Information (PHI). Develops mechanisms to monitor CalOptima Health's application of its privacy policies including its compliance with policies. Collaborates with Information Technology Services (ITS) to determine appropriate levels of user security access and assists in monitoring this access as needed. Develops mechanisms to limit access to PHI and to identify any unnecessary collection of PHI through ongoing monitoring processes. Develops and monitors the process for reviewing requests to use PHI. Develops and oversees CalOptima Health's Notice of Privacy Practices Oversees the implementation of corrective action plans, monitors internal staff or health networks to ensure appropriate compliance with corrective action plans and makes recommendations for completion. Reviews new or modified HIPAA regulations and related laws to determine if policy modifications are required and performs initial and periodic privacy gap and risk assessments. Revises the privacy program in light of changes in laws, regulatory or company policy. Interacts with and responds to state and federal regulators and representatives on HIPAA/HITECH Privacy compliance-related issues. Works with all organizational personnel involved with any aspect of the release of PHI to ensure full coordination and cooperation pursuant to the policies, procedures and legal requirements. Coordinates with the Cyber Security department to integrate privacy assessment, planning, policies and procedures with the related security efforts and reports to senior management on new privacy legislation and regulations. Mitigates effects of a use or disclosure of PHI by members of CalOptima Health's workforce or business partners. Oversees processes established for receiving, investigating, acting on and documenting all complaints related to the organization's privacy policies and procedures in coordination with management, Human Resources and/or legal counsel. Resolves allegations of non-compliance with the corporate privacy policies or notice of information practices. Partners with Internal Audit and Delegation Oversight management, including privacy focused components to internal audits and audits of business partners. Reports on the status of the privacy program to the Compliance Committee and the Board of Directors or Chief Executive Officer, as requested or deemed appropriate. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in Public Policy, Public Administration, Health Care Administration or related field required. 7 years of managerial experience in a managed care organization and interacting with governmental requirements and regulations with an extensive knowledge and understanding of HIPAA regulations, related federal and state laws and health care accreditation standards 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: Master's degree in Public Policy, Public Administration, Health Care Administration or related field. Certified in Healthcare Privacy Compliance (CHPC) or Certified in Healthcare Privacy and Security (CHPS). Experience as a Health Plan Privacy Officer or equivalent experience. Experience managing data privacy incidents and data breaches. Experience in conducting investigations. Experience in analyzing and interpreting data. Experience in developing and delivering educational presentations. Medi-Cal experience. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4511 Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-9943cf876b4d5a42a943e7c6e4bf2554

Program Manager (Real Estate and Grant Management) CalOptima CalOptima Health is seeking a highly motivated an experienced Program Manager (Real Estate and Grant Management) to join our team. The Program Manager for Real Estate and Grant Management is responsible for supporting and tracking oversight of CalOptima Health's real estate initiatives throughout the project lifecycle. The incumbent will codify, track and report on all housing and building initiatives and projects that are partially or fully funded by CalOptima Health through incentives or grants. Position Information: Department: Facilities Salary Grade: L - $77,000 - $127,094 ($37.02 - $61.1029) Work Arrangement: Full Office Duties & Responsibilities: 85% - Program Support Participates in CalOptima Health's real estate initiatives and project management, including proposal review, site visits and other real estate related activities. Ensures that the quality and timeline of CalOptima Health's initiatives and project requirements meet operational and organizational needs. Coordinates with leadership, project managers and third parties to monitor and report that housing and building projects are tracked for completion and use within the established guidelines and timelines, while also identifying issues or risks. Serves as a project and financial controls subject matter expert in the evaluation and tracking of housing and building initiatives progress, providing compliance oversight and effective communication, in a cross-functional and multi-disciplinary capacity. Conducts routine monitoring and on-site visits, using written instructions for program and project grants review, to analyze required reporting, photo-document project status and test for risks, errors, waste and required compliance. Monitors all housing and building projects that are partially or fully funded by either incentives or grants in accordance with CalOptima Health contracts or grant agreements. These duties include, but are not limited to tracking, site visits, status reports, and compliance review. Develops summary reports and presentations for review by management and the board of directors as requested. Simultaneously tracks multiple housing and building projects of varied scale. Manages relationships with all stakeholders and ensures collaboration on projects. 10% - Administrative Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, collaboration, 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: Bachelor's degree in construction management, accounting-finance, real estate or a related field required. 3 years in construction management, project financial controls, real estate asset management or property/facilities management with increasing levels of responsibility 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: 5 years of experience and understanding of financial and nonfinancial data and the integration of information for real estate and facilities development, construction, property management and related transactions. 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 April 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/program-manager-real-estate-and-grant-management-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-bd52b5cb9b57174b8db0a086556883dc

ITS Analyst, Sr. (Quality Assurance) CalOptima CalOptima Health is seeking a highly motivated an experienced ITS Analyst, Sr. (Quality Assurance) to join our team. The ITS Analyst, Sr. (Quality Assurance) will be responsible for testing web-based, mobile and desktop applications in a hybrid cloud environment. The incumbent will assess and test web services and other application programming interface (APIs)/data interfaces to ensure they perform according to specification, evaluate and test new or modified software programs and verify programs function according to user requirements and conform to Information Technology Services (ITS) establishment guidelines/standards. The incumbent will review new or modified user stories and program documentation to determine if the program performs according to specifications and conforms to architectural guidelines. The incumbent will work side by side with developers on agile/scrum teams. Additionally, the incumbent will write documentation to describe program evaluation, testing and correction. The incumbent will assist in evaluating proposed software or software enhancements for feasibility. The incumbent will participate in the development of utility programs to test, track and verify defects in software programs as needed. Position Information: Department: ITS - Applications Development Salary Grade: N - $95,000 - $155,078 ($45.67 - $74.5567) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Program Development and Testing 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. Collaborates with Agile Application Development teams to perform application testing, such as system, unit, regression, load and acceptance testing. Writes and validates positive test scenarios as well as alternative/negative test scenarios. Tests any new software to ensure integration into company systems meets functional requirements, system compliance and technical specifications. Reports the defects found during testing to development team. Ensures that reported bugs are fixed before the end of sprint, when applicable. Creates and executes test plans and scripts that will ensure application functionality meets user requirements specified in user stories. Analyzes formal test results in order to discover and report any defects, bugs, errors, configuration issues and interoperability flaws. Communicates test progress, test results and other relevant information to project stakeholders and management. Develops and establishes quality assurance measures and testing standards for new applications, products and/or enhancements to existing applications throughout their development/product lifecycles. Assists with production support problem identification and resolution. Assists with testing of periodic (monthly) maintenance activities. Performs Quality Assurance (QA) functions for/in using .NET, SQL, HTML, XML, SOAP, Java Script and AJAX programming environments. Installs and integrates new QA software programs into existing environments. 10% - Program Analysis and Support Analyzes documentation and technical specifications of any new application under deployment or consideration to determine its intended functionality. Reviews documentation to ensure that requirements stated are correct, unambiguous and verifiable. Prepares and delivers reports, recommendations or alternatives that address existing and potential trouble areas in ITS systems and projects across the organization. Conducts internal audits to measure and assure adherence to established quality assurance standards for software development, application integration and information system performance and corresponding documentation. Makes recommendations for improvement of applications to programmers and software developers or engineers. Collaborates with Programmer Sr to build on automation suites and to execute automated regression suites as needed including running them through Jenkins. Collaborates with business stakeholders to coordinate or facilitate User Acceptance Testing. Performs and recommends security audits/enhancements on assigned systems. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in information systems, computer science or related field required. 5 years of experience testing for major applications, integrations and/or major application product release required. 2 years of experience with testing tools, test plans and building test cases required. 2 years of experience writing queries for Microsoft SQL server 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: 3 years of experience in the health care industry. 2 years of experience with Visual Studio. 2 years of experience with Azure/DevOps and/or Team Foundation Server. 2 years of experience testing Electronic Data Interchange (EDI) and Data Warehouse Extract, transform, and load (ETL). 1 year of experience with Browser Stack or similar mobile device testing tools. 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 April 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/its-analyst-sr-quality-assurance-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-a95dcae8059e2840b223564763630476

Administrative Assistant (Street Medicine) CalOptima CalOptima Health is seeking a highly motivated an experienced Administrative Assistant (Street Medicine) to join our team. The Administrative Assistant (Street Medicine) will play a crucial role in supporting the effective operation of CalOptima Health's Street Medicine Program by providing administrative and logistical assistance. The incumbent requires a combination of organizational skills, compassion, and the ability to work in a dynamic and often changing environment. The incumbent will work closely with the Director of Street Medicine as well as contracted providers to ensure the smooth functioning of street medicine initiatives. The incumbent will provide key clerical and/or administrative responsibilities with the ability to exercise discretion, use good judgment and maintain confidentiality. Additionally, the incumbent will primarily work in an office setting but may also need to accompany Outreach teams to various locations. Position Information: Department: Medi-Cal & CalAIM Salary Grade: D - $44,000 - $67,628 ($21.15 - $32.5135) 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. Coordinates calendars and schedules of the department as assigned, including but not limited to scheduling appointments, coordinating travel, meetings and events, evaluating needs and scheduling meeting arrangements. Prepares meeting materials, meeting set-up, minute taking, photocopying, etc. Provides support and assistance for presentations on Street Medicine. Assists in the planning and execution of any media events or general awareness events related to Street Medicine. Collaborates with CalOptima Health Facilities and Information Technology Services department for any Street Medicine program needs. Coordinates and schedules Street Medicine shadowing requests. Actively supports the achievement of CalOptima Health's vision and goals for its Street Medicine Program as defined in the Street Medicine Operations Manual. Provides administrative support for specific and/or ongoing projects, such as generating reports, collecting data, maintaining project tracking logs and updating calendars. Applies general business practices, as well as CalOptima Health policies and procedures to the completion of daily tasks. Prepares memos, documents, reports and forms as needed. Handles incoming and outgoing correspondence per administrative policy. Assists with project tracking, reporting, budgeting and communications with external project stakeholders. Maintains an inventory of supplies, including monitoring needs and ordering. May determine priority of matters of attention for the Director, redirects matters to other staff members or handles matters personally, as appropriate. 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. Coordinates all incoming invoices and expense reports for the department. Maintains confidential and sensitive information and files regarding management projects, policies and personnel while ensuring appropriate follow-up. Answers the Street Medicine referral phone and directs calls to the appropriate Street Medicine provider. Answers telephone calls, meets visitors and answers a variety of questions with tact and diplomacy. Triages calls to appropriate staff for resolution. Coordinates travel arrangements and completes registration for conferences and seminars as needed. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required. 2 years of administrative support 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. Have access to means of transportation for work away from the primary office approximately 20% of the time. Preferred Qualifications: Bachelor's degree in business administration or related field. 2 years of experience working with community-based organizations. 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 April 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/administrative-assistant-street-medicine-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-99148848fe971f479cf1b57be4dbec74

Medical Case Manager (Long Term Support Services) CalOptima CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (Long Term Support Services) to join our team. The Medical Case Manager (Long Term Support Services) is part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization and utilization management of the assigned population of focus (Community Adult Based Services (CBAS), CalAIM, complex discharge and long term care (LTC) members residing in nursing facilities under custodial care) including members in the OneCare Programs, Medi-Cal only members or members living in the intermediate care facilities under regional center guidelines. The incumbent will perform utilization functions and authorizations, provide coordination of care and ongoing case management services for CalOptima Health members discharging from LTC facilities. Discharge planning may include services for CalAIM, LTC and CBAS. The incumbent will review and determine medical eligibility based on approved criteria/guidelines, National Committee for Quality Assurance (NCQA) standards, Medicare, Medi-Cal and CDA guidelines and will facilitate communication and coordination among all participants of the health care team and the member to ensure services are provided to promote quality cost-effective outcomes. The incumbent will provide intensive case management in a collaborative process that includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. The incumbent will be the subject matter expert and acts as a liaison to Orange County based community agencies, CalAIM program and providers, CBAS centers, In-Home Support Services (IHSS) liaisons, skilled nursing facilities, members and providers. Position Information: Department: Long Term Care Salary Grade: K - $70,000 - $114,268 ($33.65 - $54.9365) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Medical Review 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. Applies utilization management, authorizations and case management/nursing processes that include assessment, care planning collaboration, advocacy, implementation/intervention, monitoring and evaluation of a member's status. Performs and/or reviews clinical assessments by using CalAIM, CalOptima Health and DHCS approved standardized tools such as Pre-Admission Screening and Resident Review (PASRR), Minimum Data Set (MDS), CBAS Eligibility Determination Tool (CEDT), Health Risk Assessment (HRA), Individual Plans of Care, etc. Participates in hospital rounds. Collaborates with hospitals on complex discharges. Communicates timely with CalAIM providers and members to coordinate and initiate Community Support (CS) services and (ECM) Enhanced Case Management. Completes all documentation accurately and appropriately for data entry into the utilization management or care management system at the time of the telephone call or fax to include any authorization updates. Reviews and evaluates proposed services utilizing medical criteria, established policies and procedures, Title 22, Medicare and/or Medi-Cal guidelines. This includes review of submitted medical documentation. Determines the appropriate action regarding the service being requested for approval, modification or denial and refers to the Medical Director for review when necessary. Initiates contact with patient, family and treating physicians as needed to obtain additional information or to introduce the role of CalAIM and case management. Analyzes all requests with the objective of monitoring utilization of services, which includes medical appropriateness and identify potentially high cost, complex cases for high level case management intervention. For short-term cases, conducts a thorough and objective assessment of the member's current physical, psychosocial and environmental status and gathers all information pertinent to the case. Develops, implements and monitors a care plan through the interdisciplinary team process in conjunction with the individual member and family in internal and external settings across the continuum of care. Assesses member's status and progress routinely; if progress is static or regressive, determines reason and proactively encourages appropriate referrals to a higher level of case management or makes appropriate adjustments in the care plan, providers and/or services to promote better outcomes. Reports cost analysis, quality of care and/or quality of life improvements as measured against the case management goals. Establishes means of communication and collaboration with CalAIM providers, other team members, physicians, CBAS centers, IHSS liaisons, community agencies, health networks, skilled nursing facilities and administrators. Prepares and maintains appropriate documentation of patient care and progress within the care plan. Acts as an advocate in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem-solving complex cases. Documents case notes and rationale for all decisions in the Medical Management System (i.e., JIVA, CCMS system, Altruista Guiding Care, etc). Conducts assessments by collecting in-depth information about a member's situation, identifies high-risk needs, issues and resources and gathers all information pertinent to the case to write referrals for any gaps in services. Plans and determines specific objectives, goals and actions as identified through the assessment process and makes recommendations to nursing facilities for the care of the patients. Implements by conducting specific interventions, including referring members to outside resources and/or community agencies that will result in meeting the goals established in the care plan. Supports implementation of the care plan through an interdisciplinary team process in conjunction with the member, family and all participants of the health care team. Monitors established measurable goals and routinely assesses the member's status and progress to proactively make appropriate recommendations for adjustments in the care plan, providers and/or services to promote better outcomes. Performs utilization review of services requested for members in case management by reviewing all pertinent medical records for medical necessity, applying medical review protocols and criteria and meeting the timeframes per the Utilization Management policies and procedures. 10% - Administrative Support Assists the Manager, Long-Term Support Services in identifying areas of needed staff training and in maintaining current data resources. Maintains confidentiality of the member's medical information. 5% - Other Completes other projects and duties as assigned. Minimum Qualifications: Associate degree in nursing (ADN) required. 3 years of clinical experience with the health needs of the population served 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 nursing (BSN). 2 years of experience in Long Term Care, Community Health, Managed Care Medi-Cal, Medicare programs. Active Commission for Case Manager (CCM) certification. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. A 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 50% 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 April 29, 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-long-term-support-services-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-84064ecd94c56741ac890d47513dd445

Care Manager CalOptima CalOptima Health is seeking a highly motivated an experienced Care Manager to join our team. The Care Manager will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes. 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: K - $70,000 - $114,268 ($33.65 - $54.9365) 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 with member. Performs comprehensive, disease specific, clinical assessments of all identified cases, at minimum, annually 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 assessment to identify member's post-hospital or post-ED 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 SMART goals. Care plan will be continuously reviewed, modified and updated 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 goals. 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 LTSS. Conducts face-to-face meetings at settings outside of CalOptima Health's locations such as in hospitals, skilled nursing facilities, long-term acute care hospitals, recuperative care and in member's home settings with members, members' family members/representatives and other providers, as appropriate. 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 Long-Term Support Services (LTSS) department, Community Supports and community resources. Facilitates and participates in Interdisciplinary Care Team meetings, as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Prepares and maintains appropriate documentation of patient care and progress within the documentation platform or care plan as appropriate. 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. Ensures reporting of productivity metrics to supervisor. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in social work, psychology, gerontology, public health or related field required. 5 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 is also qualifying. 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 20% of the time or more. Preferred Qualifications: Licensed Vocational Nurse, Registered Nurse or master's degree in social work, gerontology, public health or related field. Certified Case Manager (CCM) certificate. Bilingual in English and 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 April 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/care-manager-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-5706853eb60c514da26ae22ee3d321b1

Communications Specialist - Lead (Digital Communications) CalOptima CalOptima Health is seeking a highly motivated an experienced Communications Specialist - Lead (Digital Communications) to join our team. The Communications Specialist - Lead (Digital Communications) will work closely with CalOptima Health staff to ensure effective digital communication to members and other audiences about CalOptima Health programs and activities. The incumbent will be responsible for the content and messaging of digital communications, including texts, emails, website and other electronic formats. The incumbent will also work collaboratively across the organization in a lead capacity to coordinate electronic external communications in consideration of member needs and regulatory requirements. The incumbent will be detail-oriented, deadline-driven and technology-savvy to ensure the overall effectiveness of CalOptima Health's digital communications. Position Information: Department: Communications Salary Grade: J - $65,000 - $106,106 ($31.25 - $51.0125) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 60% - Lead Duties Leads diverse digital communication projects with minimal supervision in support of CalOptima Health's mission, vision and strategic plan. Leads the digital communications coordination effort across the organization to ensure effectiveness in consideration of member needs and regulatory requirements, including establishing and leading a governance committee to effectively schedule and prioritize outbound messaging. Works with internal clients to provide counsel and document review of written materials to ensure accuracy, consistent messaging and appropriate writing style. Works with internal clients to review, edit and approve website content prior to implementation and coordinates with website team on content updates. Develops creative communication resources for deployment on the website, including but not limited to videos, motion graphics and other digital elements. Helps ensure the accessibility of website content and digital communications in consideration of language, page design and functionality, including structuring the content to optimize for screen readers and other assistive technology. 35% - Communications Administration Participates in a mission-driven culture of high-quality performance, with a 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. Oversees and maintains files related to digital communications, including records needed to ensure compliance with policies and regulatory requirements. Develops metrics and captures performance data related to digital communications. Maintains an understanding of search engine content optimization, keyword research and user intent, and supports training of content contributors to ensure best practices. Maintains a thorough understanding of the most current industry technology, tools and trends to implement CalOptima Health's digital communications. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in communications, public relations, journalism, English or related field required. 5 years of experience in professional editing and writing required. Demonstrated capability with technology tools, including but not limited to project management tools, digital communications platforms, website content management system and basic HTML. 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 communications, public relations, journalism, English or related field. Professional experience in the health care or human services environment using effective verbal and written skills. Familiarity with communicating to low-literacy populations, meeting technical accessibility needs and following guidelines/regulations related to Medi-Cal/Medicare. 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 April 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/communications-specialist-lead-digital-communications-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-28d3536aa741634ca3a4d0bde67a82fb

Accounting Clerk, Sr. CalOptima CalOptima Health is seeking a highly motivated an experienced Accounting Clerk, Sr. to join our team. Under general direction, the Accounting Clerk Sr will be responsible for performing general accounting and administrative support duties for various specialties including accounts payable (A/P) and account reconciliations. The incumbent will coordinate work with external vendors and various departments within CalOptima Health to ensure that payments are processed timely, accurately and efficiently. Position Information: Department: Accounting Salary Grade: E - $48,000 - $72,292 ($23.08 - $34.7558) Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Accounting 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 incoming vendor invoices received via e-mail or mail. Completes payments and controls expenses by receiving, processing, verifying and reconciling invoices. Reviews all approved invoices for proper signature and invoice details. Inputs and processes approved vendor invoices via A/P or purchasing batch. Processes escheat and health network capitation payments. Uploads electronic funds transfer file via bank portal and confirms the automated clearing house confirmation email is received. Notifies business owners and buyers when purchase order lacks funding to process invoices. Reviews and resolves complex issues and exceptions on vendor and provider related invoices. Researches and responds to business owner and vendor check status inquiries. Completes Great Plains stop pay and check re-issues. Reviews and processes check tracers from the Claims department. Processes Facets void/no re-issue or void/re-issue checks. Requests and coordinates new vendor setups or updates with the Great Plains Administrator. Maintains and updates the current and prior year's onsite filing systems. Assists with all internal and external audit requests. Interacts with stores, vendors and other departments to research problems and correct errors. Verifies vendor accounts by reconciling monthly statements and related transactions. 10% - Administrative Support Researches and makes recommendations on how to resolve complex customer service problems. Provides formal and informal training and cross training to subordinates in various functions of programs/processes. Answers questions from business owners on policies, procedures and directives by utilizing knowledge of program, or researching and gathering information. 5% - Completes other projects and duties as assigned. Minimum Qualifications: High School diploma or equivalent required. 3 years of experience in accounts payable or related 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's degree in business administration or related field. 5 years of experience in accounts payable and or related experience. Experience with Great Plains accounting software, enterprise resource planning (ERP) and/or claims software. 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 April 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/accounting-clerk-sr-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-5ebfd1d0f4f4c6478e1e0623b3c27ddb

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: M - $85,000 - $141,086 ($40.87 - $67.8298) Work Arrangement: Full 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. 5 years of health care/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 is also 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 April 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/grievance-appeals-nurse-specialist-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-67196570d7d3ff44929de4569674e46a

Care Manager (Transitional Care Services) CalOptima CalOptima Health is seeking a highly motivated an experienced Care Manager (Transitional Care Services) to join our team. The Care Manager of Transitional Care Services (TCS) will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for members who have recently discharged from the hospital or emergency department (ED). 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: K - $70,000 - $114,268 ($33.65 - $54.9365) 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 with member or member's representative. Performs post-discharge assessment to identify member's post-hospital or post-ED 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 SMART goals. Care plan will be continuously reviewed, modified and updated to reflect the member's needs. Schedules weekly follow-ups with member or member's representative to assess progress towards goals and identifies barriers to meeting goals. Provides regular outreach to assigned members along with assigned 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 LTSS. Conducts face-to-face meetings at settings outside of CalOptima Health's locations such as in hospitals, skilled nursing facilities, long-term acute care hospitals, recuperative care and in member's home settings with members, members' family members/representatives and other providers, as appropriate. 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 Long-Term Support Services (LTSS) department, Community Supports and community resources. Facilitates and participates in Interdisciplinary Care Team meetings, as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Prepares and maintains appropriate documentation of patient care and progress within the documentation platform or care plan as appropriate. 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. Ensures reporting of productivity metrics to supervisor. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in social work, psychology, gerontology, public health or related field required. 5 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. 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 20% of the time or more. Preferred Qualifications: Licensed Vocational Nurse, Registered Nurse or master's degree in social work, gerontology, public health or related field. Certified Case Manager (CCM) certificate. Bilingual in English and 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 April 24, 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/care-manager-transitional-care-services-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-76aea38e35971c4e8dad4b7017bdf5ce

Care Manager (Transitional Care Services) (Whole Child Model) CalOptima CalOptima Health is seeking a highly motivated an experienced Care Manager (Transitional Care Services) (Whole Child Model) to join our team. The Care Manager for Transitional Care Services (TCS) Whole Child Model (WCM) will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for pediatric and young adult members who have recently discharged from the hospital or emergency department (ED). 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: K - $70,000 - $114,268 ($33.65 - $54.9365) 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 with member or member's representative. Performs post-discharge assessment to identify member's post-hospital or post-ED 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. Collaboration with the member's Medical Therapy Program and Regional Center Service Coordinator if appropriate. Develops and implements a member's specific care plan which includes prioritized SMART goals. Care plan will be continuously reviewed, modified and updated to reflect the member's needs. Schedules weekly follow-ups with member or member's representative to assess progress towards goals and identifies barriers to meeting goals. Provides regular outreach to assigned members along with assigned 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 LTSS. Conducts face-to-face meetings at settings outside of CalOptima Health's locations such as in hospitals, skilled nursing facilities, long-term acute care hospitals, recuperative care and in member's home settings with members, members' family members/representatives and other providers, as appropriate. 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 Long-Term Support Services (LTSS) department, Community Supports and community resources. Facilitates and participates in Interdisciplinary Care Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Prepares and maintains appropriate documentation of patient care and progress within the documentation platform or care plan as appropriate. 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. Ensures reporting of productivity metrics to supervisor. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in social work, psychology, gerontology, public health or related field required. 5 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 is also qualifying. 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 20% of the time or more. Preferred Qualifications: Licensed Vocational Nurse, Registered Nurse or master's degree in social work, gerontology, public health or related field. 2 Years of pediatric experience. Certified Case Manager (CCM) certificate. Bilingual in English and 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 April 24, 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/care-manager-transitional-care-services-whole-child-model-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-dc454f01e49e3147966b60a0ce11df1c

Sr. Manager, Enterprise Analytics (Sr. Manager II) CalOptima CalOptima Health is seeking a highly motivated an experienced Sr Manager II to join our team. The Sr Manager II (Enterprise Analytics) will lead, develop and manage a team of expert Enterprise Analytics Managers that provide a "one-stop shop" for analysis, professional data visualizations, reporting and guidance in all areas of health plan data analytics. The incumbent will serve the information needs of the organization using advanced skills in relational database structured query language (SQL), spreadsheets for some ad hoc needs and reusable professional enterprise-wide Tableau dashboards. The incumbent will also develop more junior staff into Enterprise Analytics Managers. Position Information: Department: Financial Analysis Salary Grade: Q - $130,000 - $214,544 Work Arrangement: Partial Telework (Must Complete Telework Attestation) **This position is eligible for telework in California.** Duties & Responsibilities: 50% - Leadership Function 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 sets goals for the department and staff. Provides direction and guidance for staff in performing their duties in accordance with established departmental and organizational policies. Assists with developing department budget and resources. Presents, explains and effectively communicates methodologies, concepts and results to leadership. 45% - Program Oversight Proactively identifies the organization's enterprise-wide reporting needs and provides solutions through the use of SQL and Tableau for medical management programs and initiatives, works with leadership to research, assess and design metrics to measure effectiveness against goals. Prepares professional presentation quality exhibits to communicate outcomes and effectiveness to leadership. Oversees and ensures the timely distribution of accurate, thorough and user-friendly reports and analyses. Researches, assesses and develops advanced tools, models and approaches to increase the accuracy and timeliness of data-driven analytic projects. Develops clinical utilization, cost profile and other indicators for all areas of medical costs. Develops return on investment and business case analyses for program initiatives under consideration by leadership. Participates in the evaluation of decision support and analysis tools, as well as collaborates with the Data Warehouse team. 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. 5 years of payer health care data analysis required. 2 years of supervisory/management 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 computer science, data science, data analytics, business administration, economics, finance, statistics, applied mathematics or related field. 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 April 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-enterprise-analytics-sr-manager-ii-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-da9942548ae243428e0d5b0f80da4e87

Supervisor, Finance (Budget) CalOptima CalOptima Health is seeking a highly motivated an experienced Supervisor, Finance (Budget) to join our team. The Supervisor Finance (Budget) will be responsible for overseeing the development and management of CalOptima Health's annual budget process planning related to general and administrative, medical management and capital budgets. The incumbent will measure and track departmental expenditures against the budget and provide insights on monthly and quarterly variances. The incumbent will also provide support to the department leadership for budget related issues and concerns. Position Information: Department: Budget Salary Grade: N - $95,000 - $155,078 Work Arrangement: Partial Telework **This position is eligible for telework in California.** Duties & Responsibilities: 50% - Supervisory 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. Supervises and trains employees directly and assists in the hiring process, performance appraisal, performance goal setting and resource allocation. Assists in the development and/or updates CalOptima Health's policies and the team's desktop procedures. Identifies opportunities for operational efficiency improvements. 45% - Budget Oversight Oversees and manages the development of the annual administrative, medical management and capital budgets for each line of business by collaborating with the departments. Monitors and tracks operating and capital expenditures based on established measures to provide variances analysis for management review. Collaborates with the Information Technology Service (ITS) department to manage and monitor ITS budgets and Digital Transformation Strategy initiatives. Oversees monthly, quarterly and annual reports for the departments and the Board. Collaborates with Human Resources on the position control management for reporting, planning and budgeting. Responds to complex budget inquiries and related problems to assist in resolving budget issues. Provides guidance and support with ad-hoc analysis and projects. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in business administration, finance, accounting or related field required. 5 years of experience in accounting, finance or budget 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: 2 years of experience in a senior level and/or supervisory role. Experience in budgeting, forecasting and financial modeling. 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 April 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/supervisor-finance-budget-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-bf2f003d84d6d7448ca31915f3ac7305

Community Relations Specialist Job Description Department(s): Community Relations Reports to: Manager Community Relations FLSA status: Non-Exempt Salary Grade: G - $55,000 - $82,786 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 on Thursday , January 25, 2023 at 11:59 PM. 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. About CalOptima Health CalOptima Health is the single largest health plan in Orange County, serving 880,000 members, or 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. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima Health. About the Position The Community Relations Specialist will function as a representative for CalOptima Health in the community and to community-based organizations. The incumbent will plan and coordinate community outreach activities, including quarterly networking forums, community town hall meetings, stakeholder meetings, educational seminars and health fairs. The incumbent will serve as a knowledgeable resource about CalOptima Health's programs and services. The incumbent will be expected and empowered to be a real-time problem solver for members and stakeholders. Duties & Responsibilities: 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 a CalOptima Health representative for community organizations. Plans, coordinates and evaluates community relations projects, activities and events. Specific activities include developing project work plans and budgets, scheduling and facilitating planning meetings and coordinating logistics. Participates as a representative of CalOptima Health in assigned community meetings, collaborative, committees and coalitions to develop and enhance community partnerships. Attends health and community fairs and health promotion events. Organizes and plans workshops, presentations and supports large/special events. Partners with Strategic Development, Communications, Government Affairs and other internal departments to maintain positive stakeholder relationships. Cultivates support for CalOptima Health's programs and generates leads for outreach and enrollment staff. Communicates major community developments and issues to leadership and other internal departments. Ensures key messages related to CalOptima Health's programs and policy issues are clearly communicated to external stakeholders. Conducts presentations for community-based organizations to increase awareness about CalOptima Health's programs and services. Engenders cultural sensitivity and knowledge regarding the diversity of the populations CalOptima Health serves. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in Community Health, Public Affairs, Communications, Public Health or related field required. 3 years of experience in community health, public relations and/or community-based organizations, including planning and organizing large-scale public events 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. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) required. 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 30% of the time or more. Preferred Qualifications: Master's degree in Public Affairs, Community Health or related field. Physical Demands and Work Environment: The physical demands and work environment characteristics described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization and to travel to offsite locations. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case while traveling, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Occasional travel to off-site locations is required. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. Employee will occasionally work outdoors in varied temperatures. 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 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4504 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-8a45a461946a3149a8dd3e8c077d82cc

Claims Examiner CalOptima CalOptima Health is seeking a highly motivated an experienced Claims Examiner to join our team. The Claims Examiner will be responsible for analyzing and validating claim data elements and claims processing. The incumbent will be responsible for adhering to the regulatory and internal processing guidelines in conjunction with CalOptima Health policies and procedures related to claims adjudication. Position Information: Department: Claims Administration Salary Grade: C - $43,281 - $61,798 ($20.81 - $29.7106) Work Arrangement: Full Telework **This position is eligible for telework in California.** Duties & Responsibilities: 85% - Claims Support Performs thorough review of pended claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services. Processes non-institutional claim types. Corrects system generated errors manually prior to final claims adjudication. Processes claims based upon CalOptima Health contractual agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and CalOptima Health policies and procedures. Analyzes and validates Medi-Cal pricing; researches, adjusts and adjudicates claims; reviews services for accurate charges and utilizes current billing code sets, i.e. International Classification Diseases (ICD10) codes, Current Procedural Terminology (CPT) codes and/or authorization guidelines as reference. Validates eligibility and other possible health insurance coverage on the claim. Alerts manager or supervisor of more complex issues that arise. Processes claim exception reports as assigned. 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 by management. Minimum Qualifications: High School diploma or equivalent required. 1 year of related claims processing 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: Experience processing online claims in a managed care environment. Experience processing Medi-Cal claims. 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 April 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/claims-examiner-505-city-parkway-california-united-states Copyright 2024 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-9daf340b4d064445940a8eff07b82826

Program Specialist, Sr. (Government Affairs) Job Description Department(s): Government Affairs Reports to: Sr Director (Federal and Local Government Affairs) FLSA status: Non-Exempt Salary Grade: I - $61,000 - $99,110 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 on Tuesday, January 23, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Program Specialist Sr, Government Affairs will assist in the development, planning and execution of government affairs strategies, communications and activities to ensure elected officials maintain awareness of CalOptima Health's initiatives. In collaboration with CalOptima Health's Communications and Community Relations departments, the incumbent will help facilitate community meetings, events and media opportunities that include public officials and staff representing all levels of government. The incumbent will also prepare external facing materials and presentations on behalf of CalOptima Health's leadership and staff. Duties & Responsibilities: 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. Proactively identifies opportunities to engage, promote and socialize CalOptima Health initiatives and programs with elected officials through public forums and media events. Facilitates the coordination of communication materials for CalOptima Health's leadership, including but not limited to talking points, presentations and correspondence, to educate government and community officials regarding CalOptima Health's mission, strategic priorities, policy positions, projects, plans and other activities. Collaborates on both the development and dissemination of collateral materials to policymakers and thought leaders. Builds and maintains relationships with elected officials' staff, external organizations and community partners on behalf of the Government Affairs department. Responds to inquiries regarding event scheduling and assists with organizing government affairs content and involvement, as appropriate, including at in-person convenings and presentations. Participates as a representative of CalOptima Health at assigned events to develop and enhance government and community partnerships. Tracks, monitors and updates public affairs matrix and elected official distribution lists on a regular basis. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in political science, public policy, public administration, communications, health care administration or related field required. 3 years of work experience in advocacy communications, public affairs and/or government relations. 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. Have access to means of transportation for work away from the primary office approximately 20% of the time. Preferred Qualifications: 1 year of experience in a health care environment. Experience working for a government entity and/or a large organization. Strategic planning and project management experience. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee is required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse; must also be able to reach with hands and arms. Employee must be able to talk and hear, particularly for regular communication on the phone. Work Environment: Employee will work in an office environment with moderate noise levels and controlled office temperatures. 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4500 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-a8bbdc37f991ae40b951dcaaacdae3aa