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Risk Adjustment Analyst - Remote REQ-2025-170 Portland, ME Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015. Position Summary The Risk Adjustment Analyst provides analytic, technical, and decision support to the Risk Adjustment Team utilizing third party software as well as the data warehouse as key sources of data. The Analyst works closely with our internal customers related to their department-specific action plans by providing accurate, timely, and consistent information enabling informed decisions related to risk adjustment activities. The Analyst provides subject matter expertise based on content knowledge and analytical capabilities to guide and educate customers on risk adjustment from a range of operational lenses and levels of analysis. This individual also participates in team projects and special analytical assignments in their area of expertise. Job Description Key Outcomes: 
<ul>
<li>Conducts analyses to inform business decisions and activities related to risk adjustment</li>
<li>Develops monitoring and tracking reports and dashboards and conducts analyses to inform business decisions and activities related to risk adjustment</li>
<li>Provides analytic mentorship and guidance to operational departments related to risk adjustment</li>
<li>Liaison with key supporting departments, IT and Informatics, on risk &amp; revenue optimization</li>
<li>Tracks progress and activities within their assigned key initiatives</li>
<li>Provides standardized reports and processes for analyzing data from multiple sources</li>
<li>Works directly with vendors to coordinate needs, resolves issues, and implements data transmission processes</li>
<li>Participates in vendor research, software installation, configuration support, and interface development applications as needed</li>
<li>Supports CMS HCC Risk Adjustment modeling</li>
<li>Maintains and is a proficient user of third-party analytical tools and reporting platforms related to risk profile analysis and HCC coding</li>
<li>Recommends tools and methodologies that can be deployed at the organizational level, to the departments, and with external partners</li>
</ul>
 Education/Experience: 
<ul>
<li>Bachelor's degree or equivalent experience required</li>
<li>Minimum of 3 years' experience related to reporting and analysis of health care data ideally in the areas of managed care, health care delivery, code sets, and/or reimbursement</li>
<li>Experience in developing cost-benefit and ROI analyses</li>
</ul>
 Skills/Knowledge/Competencies (Behaviors): 
<ul>
<li>Strong interpersonal and communication skills, both verbal &amp; written</li>
<li>Solid skills in providing analytic results using a variety of quantitative, qualitative, and visualization mediums</li>
<li>Strong analytical abilities with attention to detail</li>
<li>Ability to manage multiple priorities and deadlines</li>
<li>Familiarity with healthcare applications and business management software applications</li>
<li>Proven ability to pull data from multiple sources and provide complex analyses presented to a wide range of audiences</li>
<li>Proven strength in data management practices</li>
<li>Demonstrated knowledge of Microsoft Office products, especially Transact-SQL and data visualization tools (Cognos,Tableau)</li>
<li>Capable of determining when issues need escalation or prioritization with self-starter reliability and follow-through</li>
<li>Capable of utilizing a variety of analytical techniques to solve problems.</li>
</ul>
 This position is not eligible for immigration sponsorship. We are an equal opportunity/affirmative action employer. Do you have a question about careers at Martin's Point Health Care? Contact us at: <a href="https://apptrkr.com/get_redirect.php?id=6379345&amp;targetURL=mailto:jobinquiries@martinspoint.org" target="_blank">jobinquiries@martinspoint.org</a> To apply, visit <a href="https://apptrkr.com/6379345" target="_blank">https://martin.wd1.myworkdayjobs.com/en-US/MPHC/job/Portland-ME/Risk-Adjustment-Analyst_REQ-2025-170</a>. Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> $GUIDad-logos/L5013353.gif

Risk Adjustment Analyst - Remote

Therapy Aide (Recreational) CalOptima CalOptima Health is seeking a highly motivated Therapy Aide (Recreational) to join our team. Under the direct supervision of the Supervisor Day Center (PACE) and working under the guidance of the Activity Coordinator, the Therapy Aide (Recreational) will provide therapeutic and recreational support services to CalOptima Health's Program for All-Inclusive Care for the Elderly (PACE) participants in the day health center. Additionally, the incumbent will perform other activities and tasks as assigned. Position Information: 
<ul>
<li>Department: PACE- Clinic </li>
<li>Salary Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077) </li>
<li>Work Arrangement: Full Office **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists in the coordination of the day center's social programming and activities, communicates current events and PACE organizational issues to participants in a culturally and linguistically appropriate manner.</li>
<li>Facilitates recreational programming in accordance with individual treatment plans and participates in social and recreational activities with participants.</li>
<li>Supports with coordinating and facilitating participant outings, special events and activity ideas and collaborates with other departments.</li>
<li>Supports supervision of the participant's level of engagement and involvement and provides feedback to the Activity Coordinator; documents activity services provided (e.g., charge tickets). </li>
<li>Reports observed changes in the participant's conditions to the supervisor and other Interdisciplinary Team (IDT) members as appropriate. </li>
<li>Maintains and ensures activity supplies are consistently available for participant use.</li>
<li>Demonstrates safe practices with participants utilizing proper body mechanics as needed and complies with universal precautions.</li>
<li>Assists with care plan assessments as needed. </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 1 year of experience with the frail or elderly population within the last 3 years required, preferably in a social or recreational program setting; 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.</li>
<li>1 year of experience with people with dementia required.</li>
<li>CPR and First-Aid Certification required or must be obtained within six (6) months of the date of hire.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Bachelor's degree in recreational therapy or related field.</li>
<li>Experience in event planning or activity coordination.</li>
<li>Experience designing engaging activities for diverse groups with different interests and abilities</li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment more than 50 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6374968&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 23, 2025 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: <a href="https://apptrkr.com/6374968" target="_blank">https://jobs.caloptima.org/jobs/therapy-aide-recreational-pace-garden-grove-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-1fbc4d516e4c304185ac2788c30c1b4c

Therapy Aide (Recreational)

Financial Analyst I (Budgeting) CalOptima CalOptima Health is seeking a highly motivated Financial Analyst I (Budgeting) to join our team. The Financial Analyst I (Budgeting) will be responsible for supporting the Budget department's annual preparation and ongoing maintenance of CalOptima Health's administrative, medical and capital budgets. The incumbent will possess strong analytical and problem-solving skills, have excellent attention to detail and the ability to work independently and as part of the team. Position Information: 
<ul>
<li>Department: Budget </li>
<li>Salary Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>80% - Program Support
<ul>
<li>Supports the preparation and development of annual operating and capital budgets by collaborating with department business owners.</li>
<li>Assists with department inquiries on budget related issues and conducts research to provide recommendations.</li>
<li>Gathers, analyzes and reconciles financial data from various sources, including financial statements.</li>
<li>Prepares and maintains monthly and quarterly financial reports using financial reporting and accounting software.</li>
<li>Maintains capital project reconciliation report and monitors capital expenditures.</li>
<li>Reviews purchase requisitions and travel and training requests to ensure compliance with Board approved budget and policies. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists with the development and implementation of financial policies and procedures. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, finance, accounting or related field 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.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Experience in budgeting, forecasting and financial modeling.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6374978&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 23, 2025 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: <a href="https://apptrkr.com/6374978" target="_blank">https://jobs.caloptima.org/jobs/financial-analyst-i-budgeting-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-b0409e78f19d554488b6272cf1b3aa62

Financial Analyst I (Budgeting)

Sr Manager, Infrastructure Engineering (Sr Manager IV) CalOptima CalOptima Health is seeking a highly motivated Sr Manager, Infrastructure Engineering (Sr Manager IV) to join our team. The Sr Manager IV (Infrastructure Engineering) will provide critical technical leadership along with management oversight of the technical solutions, support, enhancements, planning and delivery of infrastructure services. The incumbent will provide day-to-day leadership to a diverse staff of infrastructure engineers and administrators while managing the overall performance of the infrastructure systems, solutions and processes. The incumbent will report to and provide updates on team progress, project health and status, and overall challenges, to the Sr. Director of Information Technology. The incumbent is an extension of the Information Technology (IT) leadership team. Working closely with the support, architecture, applications, and platform engineering teams, the incumbent will ensure collaboration and clear communication of technical system status, incidents, risks, changes, projects, planning and overall accomplishments. Additionally, the incumbent will work closely with vendors and technology partners to support all IT services and application services for the organization. The incumbent is accountable for the overall stability and technical services for their teams and provides the necessary key performance indicators (KPI)'s to support their performance, and to measure the capabilities of these services. The incumbent will support the development of the overall strategic direction, technical architecture, and roadmap for their areas of responsibility. Position Information: 
<ul>
<li>Department: ITS- Infrastructure </li>
<li>Salary Grade: 319 - $160,893 - $257,458 ($77.35 - $123.7635) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>50% - Leadership
<ul>
<li>Cultivates and promote a mission-driven culture with a member focus on customer service, consistency, dignity and accountability.</li>
<li>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.</li>
<li>Manages and provides direction and leadership to a team of diverse and highly skilled engineers and administrators.</li>
<li>Sets goals, objectives, KPI's that demonstrate teams' performance and lead to operational excellence and ongoing continuous improvements.</li>
<li>Collaborates and leads the efforts of internal stakeholders and third-party vendors, as well as assures that integrated solutions are provided to meet the organization's needs.</li>
<li>Provides general oversight and management of individual tasks or projects as assigned and specific direction, as needed. </li>
</ul>
</li>
</ul>
<ul>
<li>45% - Program Oversight
<ul>
<li>Manages all components and aspects of the infrastructure, including networks, voice and data, storage and compute. </li>
<li>Designs and implements short- and long-term plans and solution to maintain existing infrastructure operational readiness and scale for future needs.</li>
<li>Responsible for the planning, execution, and ongoing support of all infrastructure projects and initiatives.</li>
<li>Ensures high-availability and continuity of organizational infrastructure and tertiary solutions.</li>
<li>Develops and implements disaster recovery plans that align with business continuity requirement and goals.</li>
<li>Establishes and implements best-practices for installing, configuring, managing, operating and supporting technology solutions.</li>
<li>Works with the change control team to develop, solidify and adhere to the ITIL framework of best practices. </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in computer science, information systems or related field PLUS 9 years of progressive, applicable, technical experience in infrastructure information technology required, specifically with databases, networking, support, storage 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.</li>
<li>5 years of IT leadership experience required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>10 years in an infrastructure leadership role.</li>
<li>Managed care/healthcare experience is a plus.</li>
<li>Large-scale, enterprise-IT experience. </li>
<li>Strong vendor management experience.</li>
<li>Certifications (ITIL, CCISP, MSFT Azure, AWS or GCP).</li>
<li>Experience managing cloud-based systems (within the Azure platform).</li>
<li>Project management experience.</li>
<li>Extensive experience monitoring and managing workloads (on-premises and cloud-based).</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A.</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6372530&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 22, 2025 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: <a href="https://apptrkr.com/6372530" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-infrastructure-engineering-sr-manager-iv-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-df7f2ecda7ccdf468fbbca7100010ac2

Sr Manager, Infrastructure Engineering (Sr Manager IV)

Sr. ServiceNow Analyst (ITS Analyst Sr) CalOptima CalOptima Health is seeking a highly motivated Sr. ServiceNow Analyst (ITS Analyst Sr) to join our team. The ITS Analyst Sr (Corporate Applications (ServiceNow)) will facilitate the coordination and integration of program related activities through vendor-supported corporate applications. The incumbent will define system scope, objectives and business requirements to meet user needs. The incumbent will assist business customers in making informed decisions regarding the development, configuration and functionality of various applications and provide technical consulting to end users on systems projects. The incumbent will provide coordination and services relevant to key functions of software supported by the Information Technology Services (ITS) department, which supports a variety of end users and software, usually provided by a third-party vendor. The incumbent will contribute to the support and maintenance of assigned applications and serve as a technical point-of-contact. Position Information: 
<ul>
<li>Department: ITS - Infrastructure </li>
<li>Salary Grade: 314 - $99,902 - $159,843 ($48.03 - $76.8476) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>70% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Optimizes existing and develops new service catalog offerings and associated flows with a focus on continual improvement and automation.</li>
<li>Leverages Flow Designer to further mature the service catalog and migrates away from workflows.</li>
<li>Identifies inefficiencies to ultimately implement areas of automation.</li>
<li>Supports the design of custom catalog items; works with business partners and the Service Catalog manager and application owner for implementation.</li>
<li>Maintains an ongoing knowledge of the ServiceNow product, version upgrades, enhancements, new features, etc. </li>
</ul>
</li>
</ul>
<ul>
<li>25% - Technical Support
<ul>
<li>Processes core system configuration as well as day-to-day user requests and incidents.</li>
<li>Creates technical design, ServiceNow code and architecture, and works with key business units to build solutions and processes, supporting maintenance, continual service improvement, and new capabilities on the ServiceNow platform.</li>
<li>Provides technical guidance on existing workflows for streamlining and improved efficiency. </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in information services or related field required PLUS 5 years of direct experience as a ServiceNow admin or application owner; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
<li>5 years of ITS technical application support experience required.</li>
<li>5 years of computer hardware and/or software troubleshooting techniques and system support required. </li>
</ul>
 Preferred Qualifications: 
<ul>
<li>ServiceNow Certified Implementation Specialist a plus.</li>
<li>ServiceNow Certified Application Developer a plus.</li>
<li>ITIL Certification is highly desirable. </li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>n/a</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6372541&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 23, 2025 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: <a href="https://apptrkr.com/6372541" target="_blank">https://jobs.caloptima.org/jobs/sr-servicenow-analyst-its-analyst-sr-505-city-parkway-west-california-united-states-0be25507-edbb-4b69-82f3-63ed5d658ae6</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-c7813acbb4eb9e41a5d8518b55927940

Sr. ServiceNow Analyst (ITS Analyst Sr)

Sr Manager, Operation and Business Configuration (Sr Manager I) CalOptima CalOptima Health is seeking a highly motivated Sr Manager, Operation and Business Configuration (Sr Manager I) to join our team. The Sr Manager I for Operation and Business Configuration will function as a primary point of contact for the claims analytical support unit which consists of data analytics, process improvement and claims clearinghouse vendor oversight. The incumbent will collaborate with leadership on the development and implementation of analytical tools to identify department trends and will manage dedicated resources for the day-to-day operations to carry out the strategic and tactical execution of CalOptima Health business operations, ensuring compliance with business rules and government regulations. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>40% - Leadership Functions
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>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.</li>
<li>Hires, manages, trains, reviews and sets goals for the department and staff.</li>
<li>Provides an environment that engages staff to fully participate in the overall department functions and workload balancing strategies.</li>
<li>Develops and implements corrective action plans and trains staff as needed.</li>
<li>Establishes and manages teams to a set of standards and governance to improve performance and support effective development and outputs.</li>
<li>Provides management oversight and direction to Data Analysts Business team and serves as a liaison with internal and external entities such as Clearinghouse and health networks to ensure claims and authorization data load integrity.</li>
<li>Provides management oversight and direction to the Clearinghouse Data Analyst team for intake requirements, analysis, conducting clearinghouse user acceptance testing and identifies impacts to systems and processes.</li>
<li>Tracks and trends teams performances by way of dashboards, monitoring day-to-day activities of each claim operational areas, claims operational vendors and all clearinghouses.</li>
<li>Represents Claims department and participates in regulatory audit presentations and demonstrations and conducts follow up remediation action items from the audit as needed.</li>
<li>Works collaboratively with the Office of Compliance, Information Technology (IT), claims vendors and internal business teams on regulatory changes impacting claims adjudication and data integrity.</li>
<li>Manages all claims vendor contract or scope of work (SOW) renewals and takes the lead for any request for proposal projects.</li>
<li>Participates in CalOptima Health's enterprise projects impacting claims or operational payments and procedures/policies.</li>
<li>Conducts claims presentation to staff, senior level leadership and CalOptima Health network providers.</li>
<li>Maintains quality goals and production level within the department by collaborating with Claims department leadership teams and ensures that performance goals are consistently met and/or exceeded.</li>
<li>Anticipates future demands of initiatives, strategic plans and regulatory updates and design/implement solutions to meet these needs. </li>
</ul>
</li>
<li>35% - Program Oversight
<ul>
<li>Ensures compliance with applicable internal policies and procedures and external state and federal regulations for multiple product lines (Medi-Cal, Medicare, Commercial (Covered California) and Program of All-Inclusive Care for the Elderly (PACE). Ensures overall claims adjudication is in accordance with the California Department of Managed Health Care (DMHC), California Department of Health Care Services (DHCS) and Centers for Medicare &amp; Medicaid Services (CMS) health plan regulatory requirements and guidelines.</li>
<li>Intakes and reviews All Plan Letters (APL), CMS bulletins and regulatory guidance; oversees the development, timely and accurate implementation and publication/posting of claims-related regulatory requirements and reporting.</li>
<li>Serves as the primary point of contact to answer questions related to system configuration business rules, various claim adjudication issues and resolves complex claims or benefit adjudication issues for department staff as well as other internal customers; responsible for the identification and resolution of provider claim issues including support of provider education and customer service staff in communications back to providers.</li>
<li>Reviews and maintains department policies and procedures, recommends changes for more efficient operations, drafts new policies and procedures for director's review, communicates changes and updates to staff when appropriate.</li>
<li>Stays current with regulatory guidelines impacting essential functions and data requirements. </li>
</ul>
</li>
<li>20% - Technical Operations
<ul>
<li>Develops the claims data standards and deploys automation tools to obtain and process claims data from different sources. Constructs datasets to analyze, inform, identify trends and support stakeholder decision-making.</li>
<li>Identifies claims transaction inconsistencies, as well as implementation of controls and changes to systems and policies that support claims adjudication, thereby minimizing incorrect claims payment.</li>
<li>Manages activities/service requests with Facets configuration, IT and EDI teams to scope, prioritize, and implement requirement changes.</li>
<li>Manages and intakes all program implementation impacting Facets and systems supporting the Claims, Grievance and Appeals Resolution Services (GARS)/Provider Dispute Resolution (PDR) and Customer Service operations. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in health information management, business administration, health administration or related field PLUS 5 years of experience in information technology business experience implementing claims adjudication programs and projects in a health plan setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>5 years of management/leadership experience that manages claims operation from intake to output of the claims payment required. </li>
<li>5 years of experience utilizing Microsoft technologies required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6372553&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 22, 2025 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: <a href="https://apptrkr.com/6372553" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-operation-and-business-configuration-sr-manager-i-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-f254b5d52e384f44aad2de542f28a181

Sr Manager, Operation and Business Configuration (Sr Manager I)

Community Partner (Inside Medicare Sales) CalOptima CalOptima Health is seeking a highly motivated Community Partner (Inside Medicare Sales) to join our team. The Community Partner (Inside Medicare Sales) will perform telemarketing and appointment setting tasks associated with obtaining new members in the OneCare program by making outbound calls to prospective members, participating providers, community-based organizations and government agencies. The incumbent will assist in enrolling new members, which will include the explanation of the OneCare benefits and coordination of services regarding Medicare and Medi-Cal services for individuals within these populations. The incumbent will perform outreach activities and attend cultural events and fairs within Orange County in conjunction with the Sales and Marketing departments. The incumbent will facilitate appointment setting and enrollment activities with members and OneCare Community Partners in a timely, professional and courteous manner. Position Information: 
<ul>
<li>Department: OneCare Sales &amp; Marketing </li>
<li>Salary Grade: 306 - $58,205 - $90,217 ($27.98 - $43.3736) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Provides assistance and education to potential members regarding OneCare program for enrollment purposes.</li>
<li>Prepares and conducts telemarketing presentations to potential members and community agencies.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Conducts targeted outreach and training to community-based organizations, health networks, vendors, members and providers.</li>
<li>Performs outreach to potential members and provides them with information about OneCare at cultural events and fairs. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 3 years of experience working with the needs of persons with disabilities in an enrollment capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed below may also be qualifying. </li>
<li>Valid driver's license and vehicle, an acceptable driving record and current auto insurance or other approved means of transportation, will be required for work away from the primary office 50% of the time or more.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>1 year of phone experience in a sales environment. </li>
<li>Experience in Medicare Sales as an agent or broker. </li>
<li>Experience working with people in a customer or member service capacity. </li>
<li>HMO, Medi-Cal/Medicaid and health services experience. </li>
<li>Contact informational systems experience. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>Possession of an active California Department of Insurance (DOI) license required or must be obtained within 60 calendar days from the start date of employment. </li>
<li>DOI license renewal every 2 years is required. </li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6372564&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 22, 2025 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: <a href="https://apptrkr.com/6372564" target="_blank">https://jobs.caloptima.org/jobs/community-partner-inside-medicare-sales-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-a301c61328f60e4ea08d226efa24dee8

Community Partner (Inside Medicare Sales)

Business Analyst (Claims) CalOptima CalOptima Health is seeking a highly motivated Business Analyst (Claims) to join our team. Under general supervision, the Business Analyst (Claims) will identify and design solutions within Claims Administration processes. The incumbent will interpret regulatory letters and memos to identify the impact on claims processes. The incumbent will be responsible for implementation of changes through project management, system configuration and User Acceptance Testing (UAT). The incumbent will work independently and perform more complex analytical and administrative responsibilities. The incumbent will exercise discretion and judgment and may coordinate a function and the work of others within the program or representing the program/project. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Works in conjunction with the Claims Administration team, Contracting, Provider Relations, Coding Initiatives and/or Information Technology to implement benefit or process changes that impact system configuration due to federal and state notices.</li>
<li>Performs system research and testing to ensure regulatory, coding, contract updates and configuration changes produce expected results; ensures that all documentation accurately reflects the current status of changes and outstanding issues identified during testing.</li>
<li>Creates business user test scenarios and testing schedules, including time estimates and deadlines, monitors milestone completion, tracks all phases of testing and provides timely reporting of issues that impact the testing progress.</li>
<li>Communicates to the Claims Administration management team, training and staff regarding any system enhancements or changes, including any process deficiencies identified from claims look-back analysis and UAT.</li>
<li>Assists the Claims Administration management team in identifying training and development of desktop procedures and policies for the Medi-Cal and Medicare lines of business impacted by system and/or regulatory changes.</li>
<li>Provides analytical support and technical expertise on requests for information from executives, directors and other staff regarding claims.</li>
<li>Remains updated on state, federal and commercial health care environments, identifying impacts to CalOptima Health programs and claims processes utilizing MedLearn, Centers for Medicare &amp; Medicaid Services (CMS) Updates, Medi-Cal Provider Bulletins, Medi-Cal manuals and Industry Collaboration Effort (ICE).</li>
<li>Reviews ad-hoc analysis and generates reports as requested.</li>
<li>Collaborates with Claims Administration management process improvement, project management and Training Program Coordinator to identify process improvement opportunities.</li>
<li>Partners with trainer and Claims Administration management team to create or update document processes and procedures.</li>
<li>Serves as subject matter expert with end-to-end claims adjudication/processing.</li>
<li>Facilitates communication on claims related topics. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, management or related field PLUS 2 years of both Medicare and Medi-Cal claims adjudication experience required, including experience with Current Procedural Terminology (CPT-4), Healthcare Common Procedure Coding System (HCPC) coding or International Classification of Diseases (ICD-10); 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.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6372575&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 22, 2025 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: <a href="https://apptrkr.com/6372575" target="_blank">https://jobs.caloptima.org/jobs/business-analyst-claims-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-e67e1e573a7a6948a011a0304b064368

Business Analyst (Claims)

Auditor Sr (Non-Clinical) CalOptima CalOptima Health is seeking a highly motivated Auditor Sr (Non-Clinical) to join our team. The Claims Administration Department is responsible for managing and processing all medical claims in accordance with industry standards and regulations, ensuring accuracy and timely reimbursement to health care providers. The Auditor Sr (Non-Clinical) will be responsible for conducting routine oversight monitoring and auditing of all business functions within CalOptima Health to ensure compliance with federal, state, regulatory and internal guidelines. The incumbent will ensure the Claims Administration department adheres to regulatory and internal guidelines in conjunction with CalOptima Health policies and procedures as they apply to claims processing. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Conducts routine audits of claims processed to ensure continued adherence to CalOptima Health's policies and procedures and compliance with regulatory requirements.</li>
<li>Monitors and plans multiple concurrent audits and related projects, makes decisions around object, scope and ensures effective and efficient audit execution.</li>
<li>Serves as a knowledge expert for assigned functional areas.</li>
<li>Reports and tracks audit findings, identifies areas of concern and validates remediation efforts, including identifying potential solutions (immediate and long-term controls).</li>
<li>Provides written and oral summaries of audit analyses as needed.</li>
<li>Supports the facilitation of mock audits of departmental functions using designated audit tools and develops Corrective Action Plans (CAPs) to address deficiencies.</li>
<li>Conducts audits of department functions using designated audit tools and develops CAPs to address identified deficiencies.</li>
<li>Participates in workgroups that address non-clinical internal activities for which CalOptima Health must demonstrate improvement to meet its contractual requirements with the Centers for Medicare &amp; Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and any other applicable entity.</li>
<li>Interprets and applies guidance from industry standards and audit protocols.</li>
<li>Collects and summarizes performance data, identifies improvement opportunities and presents findings to management.</li>
<li>Informs the department of any changes to regulatory requirements.</li>
<li>Performs audit validation of monthly claim submissions.</li>
<li>Serves as a liaison with other areas and business units. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, health care administration or related field PLUS 4 years of medical health 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. </li>
<li>3 years of experience in a managed care environment and interacting with governmental requirements and regulations (e.g., Medi-Cal/Medicaid, Medicare) required. </li>
<li>2 years of audit experience in audit and oversight, claims, customer service or related area required. </li>
<li>Experience with DHCS and CMS rules and regulations governing claims adjudication practices and procedures required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6372586&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 22, 2025 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: <a href="https://apptrkr.com/6372586" target="_blank">https://jobs.caloptima.org/jobs/auditor-sr-non-clinical-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-06e544b287e00c4d9616015c6ae39f61

Auditor Sr (Non-Clinical)

Intern (Community Relations) CalOptima CalOptima Health is seeking a highly motivated Intern (Community Relations) to join our team. The overall purpose and objective of the Intern (Community Relations) is to gain work experience in the field prior to graduating. This is an opportunity to utilize and apply the skills and knowledge learned in the classroom setting and apply it in the workforce. The incumbent will have the primary responsibility of handling department assigned projects, given a moderate degree of independence. The incumbent will frequently meet with supervisors to go over the status and progress of assignments. Under general supervision, the incumbent will assist the department's management team in a wide variety of duties. The incumbent works closely with the department manager to assist in community engagement with key stakeholders and program development and implementation of special projects, large scale events and meetings with key stakeholders to support CalOptima Health initiatives. The incumbent may assist with coordinating administrative support for special events, projects, and meetings, led by CalOptima Health and our key community stakeholders. The integrity and the ability to maintain confidentiality is essential. Position Information: 
<ul>
<li>Department: Community Relations </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Office </li>
<li> The submission of ALL items are required for consideration for Fall 2025: 
<ul>
<li>Completion of application </li>
<li>Resume</li>
<li>A statement of interest on why you are interested in this internship position (2 pages maximum). </li>
<li>Two (2) letters of recommendation (one academic, one professional) will be required upon confirmation of minimum qualifications.</li>
</ul>
</li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Department Support
<ul>
<li>Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists with department related projects as assigned.</li>
<li>Meets deadlines and completes sub-tasks of projects assigned.</li>
<li>Participates in meetings with the supervisor to go over status and progress of work assigned.</li>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent required PLUS enrollment in a college or university two- or four-year degree program, an accredited vocational institution or a graduate program.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>n/a</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>n/a</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>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. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 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 &amp; 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, 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 <a href="https://apptrkr.com/get_redirect.php?id=6372597&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> 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 July 22, 2025 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: <a href="https://apptrkr.com/6372597" target="_blank">https://jobs.caloptima.org/jobs/intern-community-relations-505-city-parkway-west-california-united-states-17213b2e-7e7b-48ea-8d15-7e271d33688f</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-051f37c273b22f4188a91f30a762adc1

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