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Member Liaison Specialist (Customer Service) - Bilingual CalOptima CalOptima Health is seeking a highly motivated Member Liaison Specialist (Customer Service) - Bilingual to join our team. The Member Liaison Specialist (Customer Service) will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program. The incumbent will serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues. Position Information: 
<ul>
<li>Department: CS - Member Liaison </li>
<li>Salary Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>85% - Member 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>Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.</li>
<li>Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.</li>
<li>Coordinates members' health care and social service needs within and outside the health network and CalOptima Health during the original interaction.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program.</li>
<li>Guides members in understanding and accessing the benefits under the Whole-Child Model program.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Initiates referrals to internal and external care management departments and government agencies.</li>
<li>Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes, helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Collaborates with interdepartmental staff in call resolution as needed.</li>
<li>Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.</li>
<li>Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health. </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 2 years of experience as a call center agent or customer/member services representative in health care 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>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese) required. </li>
</ul>
 Preferred Qualifications: 
<ul>
<li>2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity. </li>
<li>Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience. </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=6544028&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 September 16, 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/6544028" target="_blank">https://jobs.caloptima.org/jobs/member-liaison-specialist-customer-service-bilingual-505-city-parkway-west-california-united-states-9f95a945-0116-4567-930e-6074edfaa122</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-09a2096a660c754c9d2f61883f649344

Member Liaison Specialist (Customer Service) - Bilingual

Social Worker (PACE) CalOptima CalOptima Health is seeking a highly motivated Social Worker (PACE) to join our team. The Social Worker for the Program for All-Inclusive Care for the Elderly (PACE) will be responsible for direct social work care management services, such as participant screening, case management, counseling and referrals of participants to PACE. Position Information: 
<ul>
<li>Department: PACEC - Social Work </li>
<li>Salary Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>70% - Care Management
<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>Participates in the Interdisciplinary Team's (IDT) initial, six (6) month and annual assessments, as well as care planning of the participant's case in accordance with industry and departmental standards.</li>
<li>Documents participant changes appropriately in the medical record in accordance with industry and departmental standards.</li>
<li>Communicates effectively and openly with other IDT members on participant status and needs.</li>
<li>Assesses patients for high-risk situations such as suicidal/homicidal ideation and abuse. Reports appropriately in accordance with legal and ethical standards of practice and engages in safety planning with participants and/or family.</li>
<li>Develops and leads group counseling and participant support group activities.</li>
<li>Refers participants and families to appropriate community agencies or facilities, serves as a liaison with such organizations and as an advocate for participants.</li>
<li>Assists in the completion of advance directives, mortuary arrangements, funeral planning and/or facility placement.</li>
<li>Aids patients/representatives in ascertaining third-party and financial resources and planning for financial coverage for services as necessary.</li>
<li>Addresses any psychosocial needs that may require social work support and intervention (e.g., anxiety, depression and other behaviors), both at the center and at home.</li>
<li>Works with PACE participants and the IDT to develop an appropriate discharge plan for disenrolling from PACE services.</li>
<li>May be required to perform home visits to private homes of CalOptima Health's PACE participants; frequent travel in Orange County.</li>
<li>Support PACE participants with care coordination needs, such as transportation, family communication, scheduling visits to the center, supporting with warm handoff process to our community partners.</li>
<li>Represents and supports the participant's care management needs by being an advocate for their care, supporting clinical needs such as supportive counseling, developing care plans to manage all psychosocial needs (i.e., establishing support systems, coping mechanisms, assessing depression, anxiety, cognition) and developing interventions. </li>
</ul>
</li>
</ul>
<ul>
<li>25% - Support Services
<ul>
<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>Consults with and advises staff members regarding the relationship of social, emotional and cultural factors to health and medical care and the availability of social services in the community.</li>
<li>Attends and participates in in-services, staff meetings and case conferences.</li>
<li>Helps support the new enrollee process of enrollment into the PACE program (e.g., communicates to IDT and ensures all service gaps are covered prior to enrollment).</li>
<li>Participates in program improvement for the Social Work department.</li>
<li>Works with the Quality Improvement (QI) department to support grievances, appeals and advocacy consistent with participant's rights.</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>Master's degree in social work from an accredited college or university PLUS 2 years of experience in a health-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>
<li>1 year of experience working with the elderly population with relevant experience within the last 3 years required. </li>
<li>CPR and First-Aid Certification required or must be obtained within six (6) months of the date of hire. </li>
<li>Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 30% of the time or more.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>1 year of case management experience with the elderly population. </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>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=6518121&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 September 10, 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/6518121" target="_blank">https://jobs.caloptima.org/jobs/social-worker-pace-pace-garden-grove-california-united-states-e1367690-5446-4259-84c8-9edc2f709dda</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-05b31905a2fec84589cddeb280728f00

Social Worker (PACE)

TITLE: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;ChiefTalent Officer
LOCATION: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp;New York, NY (Lower EastSide)
DEPARTMENT: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;Administration/Human Resources
REPORTS TO:&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; Chief Executive Officer (CEO)
SALARY RANGE: &nbsp; &nbsp; &nbsp;&nbsp;&nbsp;$175,000 to $200,000 annually depending onexperience, plus excellent benefits
DATE POSTED: &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;July 2024

OUR CULTURE:&nbsp; At Grand St. we believeleaders are made, not born. &nbsp;We operate on auto trust,expecting staff will do their jobs well and continue to growprofessionally. &nbsp; We assume the best intentions and give gracewhenever needed. &nbsp; Diversity, equity, and inclusion areintegral parts of our culture and personified by our leadership.Grand St. is a community and we strive to make everyone –colleagues and constituents – feel supported and seen. &nbsp;
JOB SUMMARY:&nbsp; The Chief Talent Officer(CTO) provides executive-level leadership and guidance to theorganization’s HR strategies and operations for 600+ Union andManagement staff. The CTO is responsible not only for setting,enforcing, and evaluating legally compliant human resourcespolicies, procedures, and best practices, but also identifying andimplementing long-range strategic talent management goals. You willwork closely with the Executive Team performing all facets ofHR-related duties partnering with the Chief Financial Officer(CFO), Chief Program Officer of Youth &amp; Community Development,Chief Operating Officer (COO), Chief Development &amp;Communications Officer (CDCO), as well as senior management staff.&nbsp;This position carries out responsibilities in the followingfunctional and strategic areas: benefits administration, employeerelations, labor relations, training, performance management,onboarding, policy implementation, recruitment/employment,affirmative action and employment law compliance.&nbsp;
EDUCATION, EXPERIENCE AND SKILLREQUIREMENTS:
<ul>
<li>Masters preferred</li>
<li>Minimum of 10 years of Human Resource Management experiencerequired&nbsp;</li>
<li>HR Certification preferred</li>
<li>Strategic, Talent Management and/or Business Developmentexperience preferred</li>
<li>Knowledge of proven and emerging techniques in all aspects ofpersonnel management</li>
<li>Strong communication skills (both verbal and written)</li>
</ul>
<ul>
<li>Excellent supervisory, leadership, interpersonal and conflictresolution skills</li>
<li>Excellent organizational skills</li>
<li>Strong analytical and problem-solving skills</li>
<li>Thorough knowledge of employment-related laws andregulations</li>
<li>Experience with development and implementation of humanresource information and payroll systems</li>
<li>&nbsp;Experience with labor relations in a unionizedenvironment</li>
</ul>
Supervisory Responsibilities:
<ul>
<li>Supervises Management-level HR and Payroll staff</li>
<li>Oversees the daily workflow of the HR department and theadministration of human resource programs including, but notlimited to, compensation, benefits and leaves, disciplinarymatters, disputes and investigations, performance &amp; talentmanagement, evaluations, recognition, morale, occupational healthand safety, and training and development</li>
</ul>
ESSENTIAL DUTIES AND RESPONSIBILITIES:
<ul>
<li>Partners with the Executive Team to develop, implement andcommunicate human resource policies, procedures, laws, standardsand government regulations</li>
<li>Maintains the Employee Handbook</li>
</ul>
<ul>
<li>Collaborates with executive leadership to definethe&nbsp;organization's&nbsp;long-term mission and goals;identifies ways to support this mission through talentmanagement</li>
<li>Identifies key performance indicators (KPI’s) forthe&nbsp;organization's&nbsp;human resource and talent managementfunctions and assesses the&nbsp;organization's&nbsp;success andmarket competitiveness based on those metrics</li>
<li>Researches, develops, and implements competitive compensation,benefits, performance appraisal, and employee incentiveprograms</li>
<li>Oversees benefits administration including claims resolution,change reporting, approval of invoice payment, and communicatingbenefit&nbsp;information to employees</li>
<li>Ensures compliance with employment benefits, insurance, safety,401K, EEOC and other labor laws, regulations, and requirements</li>
</ul>
<ul>
<li>Administers and manages the 401K Plan</li>
</ul>
<ul>
<li>Maintains knowledge of laws, regulations, and best practices inemployment law, human resources, compensation and talentmanagement</li>
<li>Drafts and implements the&nbsp;organization's&nbsp;staffingbudget for the department.</li>
<li>Participates in professional development and networkingconferences and events.</li>
</ul>
<ul>
<li>Oversees department’s recruitment efforts including the postingof positions, recruitment advertising and other outreachpartnerships</li>
</ul>
<ul>
<li>Handles labor relations matters and coordination of thegrievance process</li>
</ul>
<ul>
<li>Monitors unemployment claims and assists with appeals onworkers’ compensation claims and coordinates between the employeeand insurance carrier</li>
<li>Responsible for Workers Compensation and 401k Audits</li>
<li>Performs other duties as required and assigned.</li>
</ul>
&nbsp;Your Skills &amp;Knowledge&nbsp;
<ul>
<li>Build a strong organizational culture that aligns with GrandStreet Settlement mission and implements all of those values onevery level of the organization</li>
<li>You take ownership of your work, think strategically, and takethoughtful action with very little direction</li>
<li>Excellent verbal and written communication skills</li>
<li>Excellent analytical and organizational skills</li>
<li>Extremely proficient with Microsoft Office Suite, Google Suiteor related software</li>
<li>People-centric and contributes to Grand St. Settlement’slegacy</li>
</ul>
BENEFITS:
<ul>
<li>Full medical insurance coverage</li>
<li>9% employer contribution to our 401k plan after 1 year</li>
<li>24 vacation days annually, 4 discretionary days, 12 sick daysannually</li>
<li>Guaranteed life Insurance and long-term disabilityinsurance</li>
<li>Flexible spending accounts</li>
<li>Travel/ commute reimbursement</li>
</ul>
HOW TO APPLY:
Please submit a resume and thoughtful cover letter outlining howyour skills &amp; experience meet the job descriptionto&nbsp;<a href="mailto:ctosearch@grandsettlement.org" target="_blank">ctosearch@grandsettlement.org</a>.Please include three professional references that we can contact;at least one should be a former supervisor.&nbsp;
If selected for this position, must obtain NYC Dept.of Health fingerprint clearance and State Central Registry (SCR)clearance (fees may apply); ability to maintain State CentralRegistry (SCR) clearance and fingerprint clearance throughout theduration of employment.
Employment Opportunity Employer (EOE)&nbsp;

Chief Talent Officer

<h3>Job Description</h3>
Job Description
Grievance &amp; Appeals (G&amp;A) Coordinator II Location: Alameda, CA (Hybrid – mostly WFH with occasional onsite meetings) Pay: $30-$35/hr, paid biweekly Start: 10/06/2025 - 06/26/2026 (This is a W2 contract assignment with opportunity to convert to direct based on attendance, performance, and business needs)
MUST have experience in health services, health insurance, hospital, or similar setting
About the Role
We are seeking a Grievance &amp; Appeals Coordinator II to join our team. In this role, you will review, investigate, and process non-complex grievances across multiple lines of business, while ensuring accuracy, compliance, and excellent member communication. You will work independently within a collaborative team environment and play a key part in ensuring quality service and regulatory compliance.
Key Responsibilities
<ul>
<li>Address and respond to telephonic and written inquiries regarding member non-complex grievances.</li>
<li>Investigate, research, review, and resolve grievances within regulated timeframes.</li>
<li>Interpret and apply policies, clinical guidelines, contracts, and regulatory requirements.</li>
<li>Communicate with members and providers throughout the grievance process.</li>
<li>Draft clear, professional written correspondence that meets regulatory standards.</li>
<li>Maintain accurate case documentation and database records.</li>
<li>Prepare and coordinate grievance documentation for State Fair Hearings, IMRs, and appeals.</li>
<li>Identify and escalate systemic issues impacting member care or service.</li>
<li>Manage a caseload of at least 60 cases per month while meeting quality and compliance standards.</li>
<li>Collaborate with internal departments to resolve member issues.</li>
<li>Participate in special projects as assigned.</li>
</ul>
Qualifications
<ul>
<li>High school diploma or equivalent (required). Associate’s or Bachelor’s degree (preferred).</li>
<li>2+ years of experience in health services, health insurance, hospital, or similar setting (required).</li>
</ul>
Skills &amp; Abilities
<ul>
<li>Knowledge of managed care and medical terminology.</li>
<li>Strong customer service and healthcare coordination background.</li>
<li>Excellent verbal and written communication skills.</li>
<li>Ability to handle sensitive information with confidentiality and accuracy.</li>
</ul>
Corrin Misak, Staffing Manager II A-Line Staffing Solutions <a href="mailto:cmisak@alinestaffing.com" target="_blank">cmisak@alinestaffing.com</a>

Grievance and Appeals Coordinator

<h3>Job Description</h3>
Job Description
BCforward is currently seeking a highly motivated Grievance &amp; Appeals Coordinator for an opportunity in Remote who reside in Georgia
Position Title: Grievance &amp; Appeals Coordinator
Location: Remote in Georgia
Expected Duration: 12 months contract or 3 months convert into FTE
Pay Rate: $22.50/hr on w2
Education level: HIGH School/GED or Associates
Anticipated Start Date: ASAP
Shift : 8:00am – 5:00pm EST Monday – Friday

********Remote to Georgia - Candidates must reside in GA**********

Job Description:
<ul>
<li>Analyze and resolve verbal and written claims and authorization appeals from providers, and pursue resolution of formal grievances from members.</li>
</ul>
Education/Experience:
<ul>
<li>High school diploma or equivalent required; Associate’s degree preferred.</li>
<li>2+ years of grievance or appeals, claims, or related managed care experience.</li>
<li>Strong oral, written, and problem-solving skills.</li>
</ul>

Responsibilities:
<ul>
<li>Gather, analyze, and report verbal and written member and provider complaints, grievances, and appeals.</li>
<li>Prepare response letters for member and provider complaints, grievances, and appeals.</li>
<li>Maintain files on individual appeals and grievances.</li>
<li>Coordinate the Grievance and Appeals Committee as needed.</li>
<li>Support pay-for-performance programs, including data entry, tracking, organizing, and researching information.</li>
<li>Assist with HEDIS production functions, including data entry, provider office calls, and claims research.</li>
<li>Manage large volumes of documents, including copying, faxing, and scanning incoming mail.</li>
</ul>
Benefits:
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.
Company DescriptionAbout BCforward: Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally. BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class places to work. BCforward is an equal opportunity employer. 
<h3>Company Description</h3>
About BCforward:\r\n\r\nFounded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.\r\n\r\nBCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class places to work.\r\n\r\nBCforward is an equal opportunity employer.

<h3>Job Description</h3>
**OPEN ONLY TO THOSE WHO RESIDE IN ARIZONA**
 
CORE FUNCTIONS:
<ol>
<li>Maintains State Fair Hearing Logs with appropriate information required by HP policy, AHCCCS, HCG, and CMS regulations.</li>
<li>Reviews all State Fair Hearing requests by members and providers, pulls case files, meets with Grievance &amp; Appeals Manager for further review and action, which may include collaboration with others to avoid/reduce grievances, appeals, and/or claim disputes. May attend State Fair Hearings.</li>
<li>Coordinates and assists the Grievance &amp; Appeals Manager in preparing for higher levels of appeals (i.e., Independent Review Entity reviews, hearings, etc.), including telephonic requests.</li>
<li>Assists with project management of departmental improvements. Coordinates with other departments on Grievance &amp; Appeals projects/workgroups.</li>
<li>Assists the Marketing Department with the production of all member letters and notices. Participates actively in meetings, workgroups, and committees relevant to the Grievance &amp; Appeals process. May produce, prepare, quality check, or deliver all reporting requirements in the absence of the Grievance &amp; Appeals Manager.</li>
<li>Produces and analyzes weekly and monthly data to determine trends and provides recommendations for intervention. Assists with internal, external, and self-audits of the department and annual data validation.</li>
<li>Produces a Monthly Operational Dashboard. Produces, analyzes, and reports monthly data to ensure regulatory compliance. Updates Grievance &amp; Appeals data in conjunction with the Marketing department on all HP websites.</li>
<li>Monitors and resolves member and provider expedited appeals and grievances received after hours and/or holidays when assigned to rotational on-call duty. Coordinate appropriate action by supporting clinical staff for processing of member and provider expedited appeals and/or grievances.</li>
<li>This position works under supervision, prioritizing data from multiple sources to provide quality care and support. Incumbents work in a fast-paced, sometimes stressful environment with a strong focus on customer service. Interacts with staff at all levels throughout the organization.</li>
</ol>
 
MINIMUM QUALIFICATIONS:
<ul>
<li>High school diploma/GED or equivalent working knowledge. Two years of work experience in a health care related field or experience managing projects/initiatives, or an equivalent combination of education and experience</li>
<li>Three to four years of grievance and appeal work in a health care environment, or an equivalent combination of education and experience. Maintains knowledge of AHCCCS, HCG, and CMS regulations by participating in training, teleconferences, and services.</li>
</ul>

Senior Grievance and Appeals Coordinator

<h3>Job Description</h3>
Immediate need for a talented Appeals and Grievance Coordinator in California. This is a 06+ months contract opportunity with long-term potential and is located in Los Angeles County, CA (Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID: 25 65809
 
Pay Range: $26 - $30/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:
 
<ul>
<li>Manage and investigate member appeals and grievances received via email and phone.</li>
<li>Review and evaluate claims and medical billing documentation to support appeal decisions.</li>
<li>Ensure all cases are handled in compliance with regulatory standards and internal policies.</li>
<li>Accurately document communications and outcomes within case management systems.</li>
<li>Communicate clearly and empathetically with members to resolve concerns efficiently.</li>
</ul>
 
Key Requirements and Technology Experience: 
 
<ul>
<li>Key Skills- Strong Case management experience with Inpatient acute care (Hospital) Experience within Appeals and Grievance, Utilization and conducting investigations.</li>
</ul>
 
 
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
 
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

Appeals and Grievance Coordinator in California

<h3>Job Description</h3>
Job Description
Grievance &amp; Appeals (G&amp;A) Coordinator II Location:&nbsp;Alameda, CA (Hybrid – mostly WFH with occasional onsite meetings) Pay:&nbsp;$30-$35/hr, paid biweekly Start:&nbsp;09/29/2025 - 06/26/2026 (This is a W2 contract assignment with opportunity to convert to direct based on attendance, performance, and business needs)
MUST have experience in health services, health insurance, hospital, or similar setting
About the Role
We are seeking a&nbsp;Grievance &amp; Appeals Coordinator II&nbsp;to join our team. In this role, you will review, investigate, and process non-complex grievances across multiple lines of business, while ensuring accuracy, compliance, and excellent member communication. You will work independently within a collaborative team environment and play a key part in ensuring quality service and regulatory compliance.
Key Responsibilities
<ul>
<li>Address and respond to telephonic and written inquiries regarding member non-complex grievances.</li>
<li>Investigate, research, review, and resolve grievances within regulated timeframes.</li>
<li>Interpret and apply policies, clinical guidelines, contracts, and regulatory requirements.</li>
<li>Communicate with members and providers throughout the grievance process.</li>
<li>Draft clear, professional written correspondence that meets regulatory standards.</li>
<li>Maintain accurate case documentation and database records.</li>
<li>Prepare and coordinate grievance documentation for State Fair Hearings, IMRs, and appeals.</li>
<li>Identify and escalate systemic issues impacting member care or service.</li>
<li>Manage a caseload of at least 60 cases per month while meeting quality and compliance standards.</li>
<li>Collaborate with internal departments to resolve member issues.</li>
<li>Participate in special projects as assigned.</li>
</ul>
Qualifications
<ul>
<li>High school diploma or equivalent (required). Associate’s or Bachelor’s degree (preferred).</li>
<li>2+ years of experience in health services, health insurance, hospital, or similar setting (required).</li>
</ul>
Skills &amp; Abilities
<ul>
<li>Knowledge of managed care and medical terminology.</li>
<li>Strong customer service and healthcare coordination background.</li>
<li>Excellent verbal and written communication skills.</li>
<li>Ability to handle sensitive information with confidentiality and accuracy.</li>
</ul>
Corrin Misak, Staffing Manager II A-Line Staffing Solutions <a href="mailto:cmisak@alinestaffing.com" target="_blank">cmisak@alinestaffing.com</a>

Grievance and Appeals Case Manager

<h3>Job Description</h3>
Job Description
Job Title: RN Clinical Quality Coordinator – Managed Long-Term Care (MLTC) Location: Bronx, NY (Remote after possible onsite training) Job Type: Full Time/Permanent
Join a dedicated healthcare team focused on improving quality of care for older adults in a managed long-term care setting. This role offers an immediate opportunity to make a meaningful impact by supporting quality assurance and performance improvement activities.
Responsibilities:
<ul>
<li>Analyze clinical data to identify trends, opportunities, and recommend improvements</li>
<li>Serve as a subject matter expert for clinical quality within the organization</li>
<li>Process all Appeals within regulatory timelines, including verbal and written notifications</li>
<li>Investigate clinical grievances and quality of care concerns across product lines</li>
<li>Coordinate with staff to ensure timely completion and submission of grievance, appeal, incident, and quality improvement documentation</li>
<li>Collaborate with Quality Assurance and IT teams for clinical data analysis</li>
</ul>
Qualifications:
<ul>
<li>Bachelor’s degree in nursing required</li>
<li>Current valid Registered Professional Nurse license in New York State</li>
<li>Minimum of 2 years’ experience in managed care, including Care Management, Quality, Utilization Management, or Grievance and Appeals</li>
<li>Strong knowledge of Medicare and Medicaid regulations</li>
<li>Excellent analytical, organizational, and communication skills</li>
<li>Proficiency with Microsoft Word, PowerPoint, and Excel</li>
<li>Ability to work independently and solve problems effectively</li>
</ul>
Important Details: Compensation: $113,000 - $118,000 per year (based on experience) Benefits: Health insurance, Retirement plans, Paid time off, Professional development opportunities
Company DescriptionPride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life &amp; disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts. 
<h3>Company Description</h3>
Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life &amp; disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts.

Clinical Quality Coordinator RN

<h3>Job Description</h3>
Immediate need for a talented Grievance &amp; Appeals Coordinator . This is a 06+ months contract opportunity with long-term potential and is located in US(Remote). Please review the job description below and contact me ASAP if you are interested.
 
Job ID: 25-83333
 
Pay Range: $21 - $22/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:
 
<ul>
<li>Shifts: M-F 8-4:30 PT</li>
<li>Gather, analyze and report verbal and written member and provider complaints, grievances and appeals</li>
<li>Prepare response letters for member and provider complaints, grievances and appeals</li>
<li>Maintain files on individual appeals and grievances</li>
<li>May coordinate the Grievance and Appeals Committee</li>
<li>Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information</li>
<li>Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.</li>
<li>Manage large volumes of documents including copying, faxing and scanning incoming mail.</li>
</ul>
 
Key Requirements and Technology Experience: 
 
<ul>
<li>Key skills; 2+ years grievance or appeals, claims, or related managed care experience</li>
<li>Oral/written communication/organizational/time management/technical proficiency</li>
<li>Healthcare call center, customer service, admin/doctor’s office experience</li>
<li>HS Diploma &amp; Certification</li>
</ul>
 
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
 
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

21 grievance-and-appeals-coordinator Jobs