City of Fremont, CA
Fremont, California, United States
Description The City of Fremont's Human Resources Department is recruiting for Human Resources Analyst I/II (Payroll/HRIS). VIEW OUR RECRUITMENT BROCHURE THE DEPARTMENT The mission of the Human Resources Department is to support and develop our employees, so they can support the community. We achieve this through bringing stability to an ever-changing and evolving environment, while creating and maintaining equity. THE OPPORTUNITY The City of Fremont is looking for a skilled Analyst to support Payroll and HRIS functions . This position will extract and analyze payroll data; complete reconciliations and audits ; and act as a technical payroll and HRIS Analyst to identify, troubleshoot, and resolve HRIS system and reporting issues. The ideal candidate for this opportunity possesses the following: Public sector payroll experience. Certified Payroll Professional (CPP) designation and/or Fundamental Payroll Certification (FPC). Experience using robust Human Resources systems: PeopleSoft and CalPERS. Knowledge of the principles and practices of human resources, including human resources work experience in a public sector agency performing payroll and/or benefits administrative responsibilities. Knowledge of applicable state and federal payroll and related tax regulations, legislation and guidelines. Ability to balance assigned HRIS projects in partnership with the Information Technology Services Department. Ability to manage multiple tasks and meet deadlines in a high volume, fast-paced work environment. First Review of Applications The first review of applications is April 10 , 2024, at 12:00 p.m. (PST) . This recruitment may close without notice after this date so interested applicants are encouraged to apply immediately. A resume and supplemental questionnaire (part of the online application) must be submitted with the completed City application. To be considered for this outstanding employment opportunity, please complete an application online by clicking "Apply" just above this box. SELECTION PROCESS The process may include a panel interview, in-basket or written exercise, professional reference checks, fingerprint check for criminal history, and other related components. Only those candidates who have the best combination of qualifications in relation to the requirements and duties of the position will continue in the selection process. Meeting the minimum qualifications does not guarantee an invitation to participate in the process. If you are interested in employment in this job classification, you should apply to ensure you are considered for future opportunities that may utilize the candidates from this recruitment. Reasonable Accommodation Human Resources will make reasonable efforts in the examination process to accommodate persons with disabilities. Please advise Human Resources of any special needs a minimum of 5 days in advance of the selection process by calling (510) 494-4660 or emailing humanresources@fremont.gov . Contact Us For additional information, please contact Human Resources Department at: humanresources@fremont.gov The information contained herein is subject to change and does not constitute either an expressed or implied contract. ________________________________________________________________________________ Human Resources Analyst I/II Class Specification Human Resources Analyst is a flexibly staffed position. Level and salary range placement is dependent upon an incumbent’s experience and qualifications. Definition Under direction of a Human Resources Manager, performs a variety of research and detail-oriented project work and professional activities in support of human resources functions including classification and compensation plan administration, job analysis, recruitment and selection, labor relations program and related work as assigned. While this class may be flexibly staffed based on department needs, the Human Resources Analyst III class is reserved for the most significantly responsible assignments requiring complex analysis, independent judgment, and formulation of important recommendations. Class Characteristics Human Resources Analyst I: This is the entry-level class in the professional Human Resources Analyst series. Initially under close supervision, incumbents may perform the more routine classification and salary survey projects, some recruitment and selection activities, and have some exposure to routine labor relations assignments. The Human Resources Analyst I receives direct supervision from higher-level professional or management staff. Frequent contacts are made with members of the Human Resources Department management team, other Human Resources staff, mid-managers, employee organization representatives, other employees of the City of Fremont, and Human Resources staff. This class is distinguished from the Human Resources Analyst II in that incumbents in the latter class are expected to perform the full scope of journey level professional assignments under general, rather than direct, supervision. Human Resources Analyst II: This is the full journey-level class in the professional Human Resources Analyst series. Employees within this class are distinguished by the performance of the full range of duties as assigned, including conducting classification and salary studies, performing job analyses, administering Citywide classification plans and programs, developing compensation recommendations and designing and administering recruitment and selection activities. The Human Resources Analyst II may participate in labor relations functions such as note taking and research and analysis of proposals presented in bargaining unit negotiations. Employees at this level receive only occasional instruction or assistance as new or unusual situations arise, and are fully knowledgeable of the applicable human resources principles and practices. Essential Functions Payroll Performs analytical support to assist with the interpretation and application of human resources rules, policies, legislation and MOUs with the City’s nine bargaining groups. Extracts and analyzes payroll data from HRIS for payroll processing, data analytics and reporting purposes to ensure accuracy and compliance with policies, procedures and regulatory requirements. Completes payroll, benefit/retirement plan reconciliations, analysis and internal audits. Performs analytical support to assist with the interpretation and application of human resources rules, policies, legislation, and MOUs with the City's nine bargaining groups. Utilizes Human Resources systems and adheres to processes (payroll, leave of absence, workers’ compensation) while ensuring compliance with all federal/state laws and regulations. Ensures that benefits, leaves of absences and workers’ compensation processes are accurately administered within the HRIS system. Responds to internal and external payroll and policy related inquiries. Identifies opportunities for process improvements. Stays informed about changes in tax and HR laws that apply to the payroll process. Prepares and reconciles quarterly payroll tax filings as required by federal and state law. Reconciles and audits employees’ W-2 statements prior to distribution. Provides back-up support to other HR department team members, as needed. Completes special projects, as needed. Data Analysis/Reporting Generates ad-hoc and standard reports from the HRIS for payroll, HR and internal/external customers. Partners with City departments to produce required reports and documentation. Develops and maintains queries and reports to support payroll process and requests from users. HRIS System Enhancements and Upgrades Participates in the implementation of system enhancements, upgrades and integrations. Tests new features and functionalities in the HRIS related to payroll processing. Performs technical payroll and HRIS analytical support to identify, troubleshoot, resolve system and reporting issues. Minimum Qualifications Knowledge, Skills and Abilities Knowledge of: Principles and practices of public personnel administration; methods and techniques related to classification, compensation and benefits analysis; applicable state and federal employment laws and regulations; principles and techniques of recruitment and selection in the public sector. Journey level classes require knowledge of Meyers-Milias-Brown Act, California Public Employees’ Retirement System, Worker's Compensation law, Family and Medical Leave Act, and Fair Labor Standards Act. Skill in: Preparing clear, concise and complete analysis, proposals, reports and other written materials; maintaining accurate records and meeting critical deadlines; researching and analyzing complex problems, evaluating varied information and data, either in statistical or narrative form, and exercising sound judgment within established guidelines; establishing and maintaining effective working relationships, and working collaboratively with diverse individuals and groups contacted in the course of work. Ability to: Interpret the City's personnel programs and policies to employees and department managers; interpret and analyze information; coordinate a variety of tasks and assignments; elicit the cooperation of others; use a variety of computer software programs, including Microsoft Word, Excel, PowerPoint, and Visio; work in an office environment, which may require sitting for extended periods of time; maintain physical and mental condition appropriate to the performance of assigned duties. Incumbents must possess the physical and mental capacity to work under the conditions described in this document and to perform the duties required by their assigned position. Education/Experience Any combination of education and or experience that has provided the knowledge, skills and abilities necessary for satisfactory job performance would be qualifying. A typical way to obtain the required knowledge and skills would be: Human Resources Analyst I: Bachelors degree from an accredited college or university with major course work in human resources management, public or business administration, industrial relations, or a closely related field; OR two (2) years of experience in the field of human resources. Experience in a public agency setting is desirable. Human Resources Analyst II: Bachelors degree from an accredited college or university with major course work in human resources management, public or business administration, industrial relations, or a closely related field; and at least two (2) years of experience performing duties comparable to those of a Human Resources Analyst I. Experience related to the human resources function, which has provided the knowledge and skills outlined above, may be substituted for the college education on a year-for-year basis. Experience in a public agency setting is desirable. Licenses/Certificates/Special Requirements Must be willing to work such hours as are necessary to accomplish the job requirements; This classification requires the ability to travel independently within and outside of City limits. Possession of a valid California Class C driver’s license is required. Failure to maintain this license will result in discipline up to and including termination. Desirable Qualifications: Public sector payroll experience. Certified Payroll Professional (CPP) designation and/or Fundamental Payroll Certification (FPC). Experience using robust Human Resources systems: PeopleSoft and CalPERS. Knowledge of the principles and practices of human resources, including human resources work experience in a public sector agency performing payroll and/or benefits administrative responsibilities. Knowledge of applicable state and federal payroll and related tax regulations, legislation and guidelines. Ability to balance assigned HRIS projects in partnership with the Information Technology Services Department. Ability to manage multiple tasks and meet deadlines in a high volume, fast-paced work environment. Physical and Environmental Demands Rare = 66% Sitting: Constant Walking: Occasional Standing: Rare Bending (neck): Frequent Bending (waist): Rare Squatting: Rare Climbing: Never Kneeling: Never Crawling: Never Jumping: Never Balancing: Never Twisting (neck): Occasional Twisting (waist): Rare Grasp - light (dominant hand): Occasional Grasp - light (non-dominant): Rare Grasp - firm (dominant hand): Rare Grasp - firm (non-dominant): Rare Fine manipulation (dominant): Frequent Fine manipulation (non-dominant): Frequent Reach - at/below shoulder: Rare Reach - above shoulder level: Never Push/pull: Up to 10 lbs. Rare 11 to 25 lbs. Never 26 to 50 lbs. Never 51 to 75 lbs. Never 76 to 100 lbs. Never Over 100 lbs. Never Lifting: Up to 10 lbs. Occasional 11 to 25 lbs. Never 26 to 50 lbs. Never 51 to 75 lbs. Never 76 to 100 lbs. Never Over 100 lbs. Never Carrying: Up to 10 lbs. Rare 11 to 25 lbs. Never 26 to 50 lbs. Never 51 to 75 lbs. Never 76 to 100 lbs. Never Over 100 lbs. Never Coordination: Eye-hand: Required Eye-hand-foot: Not required Driving: Not required Vision: Acuity, near: Required Acuity, far: Not required Depth perception: Required Accommodation: Required Color vision: Not required Field of vision: Required Talking: Face-to-face contact: Required Verbal contact w/others: Required Public: Required Hearing: Normal conversation: Required Telephone communication: Required Earplugs required: Not required Work environment: Works indoors, using computer monitor, works around others, works alone, works with others. Class Code: Level II: 2025 FLSA: Exempt EEOC Code: 2 Barg. Unit: UME Probation: 12 months Rev.: 04/11 The City of Fremont offers a comprehensive benefit package including general and holiday leave as well as medical, dental, vision, life, and long/short-term disability insurance. To view a summary of the benefits the City offers, please visit: City of Fremont Benefits Summary
Description The City of Fremont's Human Resources Department is recruiting for Human Resources Analyst I/II (Payroll/HRIS). VIEW OUR RECRUITMENT BROCHURE THE DEPARTMENT The mission of the Human Resources Department is to support and develop our employees, so they can support the community. We achieve this through bringing stability to an ever-changing and evolving environment, while creating and maintaining equity. THE OPPORTUNITY The City of Fremont is looking for a skilled Analyst to support Payroll and HRIS functions . This position will extract and analyze payroll data; complete reconciliations and audits ; and act as a technical payroll and HRIS Analyst to identify, troubleshoot, and resolve HRIS system and reporting issues. The ideal candidate for this opportunity possesses the following: Public sector payroll experience. Certified Payroll Professional (CPP) designation and/or Fundamental Payroll Certification (FPC). Experience using robust Human Resources systems: PeopleSoft and CalPERS. Knowledge of the principles and practices of human resources, including human resources work experience in a public sector agency performing payroll and/or benefits administrative responsibilities. Knowledge of applicable state and federal payroll and related tax regulations, legislation and guidelines. Ability to balance assigned HRIS projects in partnership with the Information Technology Services Department. Ability to manage multiple tasks and meet deadlines in a high volume, fast-paced work environment. First Review of Applications The first review of applications is April 10 , 2024, at 12:00 p.m. (PST) . This recruitment may close without notice after this date so interested applicants are encouraged to apply immediately. A resume and supplemental questionnaire (part of the online application) must be submitted with the completed City application. To be considered for this outstanding employment opportunity, please complete an application online by clicking "Apply" just above this box. SELECTION PROCESS The process may include a panel interview, in-basket or written exercise, professional reference checks, fingerprint check for criminal history, and other related components. Only those candidates who have the best combination of qualifications in relation to the requirements and duties of the position will continue in the selection process. Meeting the minimum qualifications does not guarantee an invitation to participate in the process. If you are interested in employment in this job classification, you should apply to ensure you are considered for future opportunities that may utilize the candidates from this recruitment. Reasonable Accommodation Human Resources will make reasonable efforts in the examination process to accommodate persons with disabilities. Please advise Human Resources of any special needs a minimum of 5 days in advance of the selection process by calling (510) 494-4660 or emailing humanresources@fremont.gov . Contact Us For additional information, please contact Human Resources Department at: humanresources@fremont.gov The information contained herein is subject to change and does not constitute either an expressed or implied contract. ________________________________________________________________________________ Human Resources Analyst I/II Class Specification Human Resources Analyst is a flexibly staffed position. Level and salary range placement is dependent upon an incumbent’s experience and qualifications. Definition Under direction of a Human Resources Manager, performs a variety of research and detail-oriented project work and professional activities in support of human resources functions including classification and compensation plan administration, job analysis, recruitment and selection, labor relations program and related work as assigned. While this class may be flexibly staffed based on department needs, the Human Resources Analyst III class is reserved for the most significantly responsible assignments requiring complex analysis, independent judgment, and formulation of important recommendations. Class Characteristics Human Resources Analyst I: This is the entry-level class in the professional Human Resources Analyst series. Initially under close supervision, incumbents may perform the more routine classification and salary survey projects, some recruitment and selection activities, and have some exposure to routine labor relations assignments. The Human Resources Analyst I receives direct supervision from higher-level professional or management staff. Frequent contacts are made with members of the Human Resources Department management team, other Human Resources staff, mid-managers, employee organization representatives, other employees of the City of Fremont, and Human Resources staff. This class is distinguished from the Human Resources Analyst II in that incumbents in the latter class are expected to perform the full scope of journey level professional assignments under general, rather than direct, supervision. Human Resources Analyst II: This is the full journey-level class in the professional Human Resources Analyst series. Employees within this class are distinguished by the performance of the full range of duties as assigned, including conducting classification and salary studies, performing job analyses, administering Citywide classification plans and programs, developing compensation recommendations and designing and administering recruitment and selection activities. The Human Resources Analyst II may participate in labor relations functions such as note taking and research and analysis of proposals presented in bargaining unit negotiations. Employees at this level receive only occasional instruction or assistance as new or unusual situations arise, and are fully knowledgeable of the applicable human resources principles and practices. Essential Functions Payroll Performs analytical support to assist with the interpretation and application of human resources rules, policies, legislation and MOUs with the City’s nine bargaining groups. Extracts and analyzes payroll data from HRIS for payroll processing, data analytics and reporting purposes to ensure accuracy and compliance with policies, procedures and regulatory requirements. Completes payroll, benefit/retirement plan reconciliations, analysis and internal audits. Performs analytical support to assist with the interpretation and application of human resources rules, policies, legislation, and MOUs with the City's nine bargaining groups. Utilizes Human Resources systems and adheres to processes (payroll, leave of absence, workers’ compensation) while ensuring compliance with all federal/state laws and regulations. Ensures that benefits, leaves of absences and workers’ compensation processes are accurately administered within the HRIS system. Responds to internal and external payroll and policy related inquiries. Identifies opportunities for process improvements. Stays informed about changes in tax and HR laws that apply to the payroll process. Prepares and reconciles quarterly payroll tax filings as required by federal and state law. Reconciles and audits employees’ W-2 statements prior to distribution. Provides back-up support to other HR department team members, as needed. Completes special projects, as needed. Data Analysis/Reporting Generates ad-hoc and standard reports from the HRIS for payroll, HR and internal/external customers. Partners with City departments to produce required reports and documentation. Develops and maintains queries and reports to support payroll process and requests from users. HRIS System Enhancements and Upgrades Participates in the implementation of system enhancements, upgrades and integrations. Tests new features and functionalities in the HRIS related to payroll processing. Performs technical payroll and HRIS analytical support to identify, troubleshoot, resolve system and reporting issues. Minimum Qualifications Knowledge, Skills and Abilities Knowledge of: Principles and practices of public personnel administration; methods and techniques related to classification, compensation and benefits analysis; applicable state and federal employment laws and regulations; principles and techniques of recruitment and selection in the public sector. Journey level classes require knowledge of Meyers-Milias-Brown Act, California Public Employees’ Retirement System, Worker's Compensation law, Family and Medical Leave Act, and Fair Labor Standards Act. Skill in: Preparing clear, concise and complete analysis, proposals, reports and other written materials; maintaining accurate records and meeting critical deadlines; researching and analyzing complex problems, evaluating varied information and data, either in statistical or narrative form, and exercising sound judgment within established guidelines; establishing and maintaining effective working relationships, and working collaboratively with diverse individuals and groups contacted in the course of work. Ability to: Interpret the City's personnel programs and policies to employees and department managers; interpret and analyze information; coordinate a variety of tasks and assignments; elicit the cooperation of others; use a variety of computer software programs, including Microsoft Word, Excel, PowerPoint, and Visio; work in an office environment, which may require sitting for extended periods of time; maintain physical and mental condition appropriate to the performance of assigned duties. Incumbents must possess the physical and mental capacity to work under the conditions described in this document and to perform the duties required by their assigned position. Education/Experience Any combination of education and or experience that has provided the knowledge, skills and abilities necessary for satisfactory job performance would be qualifying. A typical way to obtain the required knowledge and skills would be: Human Resources Analyst I: Bachelors degree from an accredited college or university with major course work in human resources management, public or business administration, industrial relations, or a closely related field; OR two (2) years of experience in the field of human resources. Experience in a public agency setting is desirable. Human Resources Analyst II: Bachelors degree from an accredited college or university with major course work in human resources management, public or business administration, industrial relations, or a closely related field; and at least two (2) years of experience performing duties comparable to those of a Human Resources Analyst I. Experience related to the human resources function, which has provided the knowledge and skills outlined above, may be substituted for the college education on a year-for-year basis. Experience in a public agency setting is desirable. Licenses/Certificates/Special Requirements Must be willing to work such hours as are necessary to accomplish the job requirements; This classification requires the ability to travel independently within and outside of City limits. Possession of a valid California Class C driver’s license is required. Failure to maintain this license will result in discipline up to and including termination. Desirable Qualifications: Public sector payroll experience. Certified Payroll Professional (CPP) designation and/or Fundamental Payroll Certification (FPC). Experience using robust Human Resources systems: PeopleSoft and CalPERS. Knowledge of the principles and practices of human resources, including human resources work experience in a public sector agency performing payroll and/or benefits administrative responsibilities. Knowledge of applicable state and federal payroll and related tax regulations, legislation and guidelines. Ability to balance assigned HRIS projects in partnership with the Information Technology Services Department. Ability to manage multiple tasks and meet deadlines in a high volume, fast-paced work environment. Physical and Environmental Demands Rare = 66% Sitting: Constant Walking: Occasional Standing: Rare Bending (neck): Frequent Bending (waist): Rare Squatting: Rare Climbing: Never Kneeling: Never Crawling: Never Jumping: Never Balancing: Never Twisting (neck): Occasional Twisting (waist): Rare Grasp - light (dominant hand): Occasional Grasp - light (non-dominant): Rare Grasp - firm (dominant hand): Rare Grasp - firm (non-dominant): Rare Fine manipulation (dominant): Frequent Fine manipulation (non-dominant): Frequent Reach - at/below shoulder: Rare Reach - above shoulder level: Never Push/pull: Up to 10 lbs. Rare 11 to 25 lbs. Never 26 to 50 lbs. Never 51 to 75 lbs. Never 76 to 100 lbs. Never Over 100 lbs. Never Lifting: Up to 10 lbs. Occasional 11 to 25 lbs. Never 26 to 50 lbs. Never 51 to 75 lbs. Never 76 to 100 lbs. Never Over 100 lbs. Never Carrying: Up to 10 lbs. Rare 11 to 25 lbs. Never 26 to 50 lbs. Never 51 to 75 lbs. Never 76 to 100 lbs. Never Over 100 lbs. Never Coordination: Eye-hand: Required Eye-hand-foot: Not required Driving: Not required Vision: Acuity, near: Required Acuity, far: Not required Depth perception: Required Accommodation: Required Color vision: Not required Field of vision: Required Talking: Face-to-face contact: Required Verbal contact w/others: Required Public: Required Hearing: Normal conversation: Required Telephone communication: Required Earplugs required: Not required Work environment: Works indoors, using computer monitor, works around others, works alone, works with others. Class Code: Level II: 2025 FLSA: Exempt EEOC Code: 2 Barg. Unit: UME Probation: 12 months Rev.: 04/11 The City of Fremont offers a comprehensive benefit package including general and holiday leave as well as medical, dental, vision, life, and long/short-term disability insurance. To view a summary of the benefits the City offers, please visit: City of Fremont Benefits Summary
CalOptima
Orange, CA, USA
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
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