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Director, Information Technology Clinical, (Utilization Management, Care Management, and Grievance &amp; Appeals) (Director IV) CalOptima Director, Information Technology - Clinical, (Utilization Management, Care Management, and Grievance &amp; Appeals) Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Director, Information Technology - Clinical, (Utilization Management, Care Management, and Grievance &amp; Appeals) (Director IV) and help shape the future of healthcare where you'll be an integral part of our IT - Applications Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>50% - 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>Leads the development of IT strategy and technical roadmap and ensures its integration with overall IT and CalOptima Health strategies.</li>
<li>Works with the department's leadership team on the project portfolio and governance required to prioritize resources, including budget.</li>
<li>Acts as a trusted advisor and builds and maintains relationships with other internal and external IT and business leaders to develop a clear understanding of business needs. Ensures cost-effective delivery of IT services to meet those needs and can respond with the agility required to address changing business priorities.</li>
<li>Develops and adheres to the annual operating and capital budgets and expenditures for infrastructure to ensure consistency with the departmental and organizational strategic objectives and remain within budget. Manages labor forecasting in support of project cost accounting.</li>
<li>Champions innovative efforts in experimenting with new solutions to take advantage of business opportunities.</li>
<li>Stays abreast of leading-edge and innovative solutions to the recruitment, development and retention of the IT workforce. </li>
<li>Drives the adoption and commitment to continual service improvement. </li>
</ul>
</li>
</ul>
<ul>
<li>45% - Program Oversight
<ul>
<li>Provides strategic direction and oversight for the design, development, operation and support of systems that fulfill the needs of the business, including a deep understanding of the marketplace and technology's role in supporting the assigned systems.</li>
<li>Defines, develops, and manages a comprehensive and integrated architecture for assigned systems based on best-practice processes, disciplines and toolsets.</li>
<li>Operates within the established governance process to ensure that services can continue to be delivered in line with the agreed-upon business outcomes and timelines.</li>
<li>Delivers effective service management through the definition and adoption of a governance practice that uses key performance indicators (KPIs) and metrics to track and measure the quality of service. Continually monitors metrics and the integration of them with key accountabilities to ensure consistency of approach and continual service improvement.</li>
<li>Participates in the assessment of external and internal technology capabilities required to achieve desired competitive positioning.</li>
<li>Maintains knowledge of new technologies and platforms and provides direction on what emerging technologies should be assimilated, integrated, and introduced, ensuring that technology capabilities respond to and support the needs of the business.</li>
<li>Negotiates with vendor and supplier partners to enable cost-effective and innovative contracts and solutions to achieve business goals and ensure receipt of full support in line with service agreements.</li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in computer science, information systems or other related field PLUS 7 years of experience within information technology leadership 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>7 years of experience in an IT leader role at multiple health plans required. </li>
<li>7 years of experience influencing clinical business management and key stakeholders effectively across the organization required. </li>
<li>Experience with technology and business processes required to support Utilization Management, Care Management, EMR, and other clinical tools are required. </li>
<li>Experience in leading IT transformational initiatives in dynamic environments required. </li>
<li>Experience managing staff of 20+ required. </li>
<li>Experience managing large-scale consulting/contracting engagements required. </li>
<li>Experience managing operational and project budgets (including project cost accounting) required. </li>
<li>Experience with the technology implications of a delegated provider model required. </li>
<li>Experience leading the implementation of Utilization and Care Management vendor systems and an extensive knowledge of best-in-class integrations required and optimal reporting/analytics. </li>
<li>Comprehensive knowledge of the Utilization and Care Management technology vendor marketplace and the ability to compare and contrast vendors and benefits delivered. </li>
<li>Experience crafting business cases including meticulous cost estimates and quantifiable benefits.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Experience leading a team responsible for ZeOmega's Jiva (Utilization Management and Care Management). </li>
<li>Clinical credentials.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<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>
 Your 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>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this particular role:
<ul>
<li>Pay Grade: 323 - $204,199 - $326,717 ($98.17 - $157.0756) </li>
</ul>
</li>
<li>This position is approved for Partial Telework. (If the position is listed as Telework, it is eligible within California)</li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6562103&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our 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>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is September 25, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. 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/6562103" target="_blank">https://jobs.caloptima.org/jobs/director-information-technology-clinical-utilization-management-care-management-and-grievance-appeals-director-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-86e01f9ab796ba4dbed8c542ae8adcbd

Director, Information Technology  Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV)

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)

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

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=6581261&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/6581261" 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-db1ce4f6b297cc42b37b4c6342de152b

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

<h3>Job Description</h3>
Job Description
About US: Tryfacta is a leading, nationally renowned Workforce Management Solution provider for private &amp;public sector firms across the US. We specialize in Healthcare, IT, Business Support, and Professional &amp; Craft/Light Industrial ecosystems. Founded in March 1996, we have a presence in all 50 States. Tryfacta has Ranked number 1 as one of the fastest-growing companies by Inc. Magazine (Inc. 5000)! Tryfacta is certified by the Joint Commission for Healthcare Staffing Services &amp; has numerous ISO Certifications that capture our commitment to continuous improvement.
Job Summary:
Tryfacta is seeking a&nbsp;Employee Relations Specialist&nbsp;for our client in&nbsp;Los Angeles, CA 90012. This is a&nbsp;temporary contract&nbsp;assignment. If you meet the qualifications listed below and are interested, please Apply Now! Position Title:&nbsp;Employee Relations Specialist Location:&nbsp;Los Angeles, CA 90012 Duration:&nbsp;Upto 6 months Work Schedule:&nbsp;44/36 with every other Friday off. Office hours begin at 7:00 am – 4:30 pm Experienced and use excellent judgment in interpreting and adapting guidelines such as policies, regulations, precedents, and work directions for specific cases or problems based on analysis of the subject and course of action selected from various alternatives. The&nbsp;ER Specialist&nbsp;will conduct their daily business in a professional manner with internal and external Legal counsel teams. Additional responsibilities includes researching assigned aspects of law and arbitral precedent related to contract proposals, grievance cases matters and may presents case information in administrative forums or related hearings. Prepares graphs, charts, tables, and summarizes the economic implications of management and labor contract proposals.
Responsibilities for this position include, but are not limited to:
<ul>
<li>Gathers documents for Legal or outside counsel in preparation of grievance appeals.</li>
<li>Interprets and advises management on routine and complex contract administration questions to ensure they are administered consistently.</li>
<li>Researches assigned aspects of law and arbitral precedent related to contract proposals and grievance matters, to ensure consistency with laws, Client precedent in the areas of law and arbitration and to support employer positions on contract language in negotiations and arbitrations.</li>
<li>Prepares graphs, charts, tables, and summarizes the economic implications of management and labor contract proposals.</li>
<li>Provides recommendations for language, cost, and impact on operating requirements for labor contract proposals.</li>
<li>Assists in preparing curriculum for administration of the terms and conditions of the labor agreement and on general and specific knowledge areas of Employee Relations, to ensure that the existing contract is consistently administered and that employee grievances are minimized, resolved, or processed correctly to arbitration, by selecting concepts, materials and training activities.</li>
<li>Reviews grievance records, researches grievance arbitration decisions, and identifies and summarizes areas of existing contracts which have caused operating difficulties over the term of the contract.</li>
<li>Researches, and presents case information in administrative forums for bargaining unit clarifications and related hearings.</li>
<li>Assists in the analysis and collection of data pertaining to investigations of complaints and charges of discrimination, unlawful workplace harassment and retaliation to prevent the violations of policy and federal and state laws.</li>
<li>Performs other related duties as required.</li>
</ul>
 To be considered for this position, you should have: [Skills, Education, or Experience]
<ul>
<li>Bachelor's degree from an accredited college or university in a related field and four years relevant experience.</li>
<li>Required Knowledge of: Labor relations and Human Resources Principles</li>
<li>Maintains confidentiality</li>
<li>Lead investigations</li>
<li>Advance MSOffice and Ad Administrative duties</li>
<li>Know and understand CBA laws, Rules, and regulations</li>
<li>Experience working in a union environment</li>
<li>Personable, Flexible and handle pressure zones well.</li>
<li>Detail orient, organized, multi task, strong written and verbal communication skills a must.</li>
<li>Valid California Class C Driver License that allows you to drive in the course of your employment.</li>
<li>Non active CalPERS members</li>
</ul>
Required Knowledge of:&nbsp;Labor relations and Human Resources principles, practices, and procedures; research methods and techniques; methods and equipment including multi-line phones, copiers, facsimile machines, and computers. Required Skills and Abilities to:&nbsp;Organize ideas, conceptualize problems, categorize relevant and irrelevant data; prepare reports; communicate clearly and concisely both verbally and in writing; establish and maintain effective working relationships with those contacted in the course of work; operate office equipment including computers and supporting applications. Physical Demands/Work Environment/Vision Requirements The physical demands and work environment characteristics described here are representative of those that must be met or may be encountered by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical Demands:&nbsp;The work is sedentary. Typically, the employee may sit comfortably to do the work. However, there may be some walking; standing; bending; carrying of light items such as paper, books, or small parts; driving an automobile, etc. No special physical demands are required to perform the work. Work Environment:&nbsp;The work environment involves everyday risks or discomforts that require normal safety precautions typical of such places as offices, meeting and training rooms, libraries, and residences or commercial vehicles, e.g., use of safe work practices with office equipment, avoidance of trips and falls, observance of fire regulations and traffic signals, etc. The work area is adequately lighted, heated, and ventilated. Vision Requirements:&nbsp;No special vision requirements Tryfacta is an Equal Opportunity-Affirmative Action Employer. We do not discriminate based on Minority / Female / Disability / Veteran / Gender Identity / Sexual Orientation / Age
Company DescriptionAbout US: Tryfacta is a leading, nationally renowned Workforce Management Solution provider for private &amp;public sector firms across the US. We specialize in Healthcare, IT, Business Support, and Professional &amp; Craft/Light Industrial ecosystems. Founded in March 1996, we have a presence in all 50 States. Tryfacta has Ranked number 1 as one of the fastest-growing companies by Inc. Magazine (Inc. 5000)! Tryfacta is certified by the Joint Commission for Healthcare Staffing Services &amp; has numerous ISO Certifications that capture our commitment to continuous improvement. 
<h3>Company Description</h3>
About US:\r\nTryfacta is a leading, nationally renowned Workforce Management Solution provider for private &amp;public sector firms across the US. We specialize in Healthcare, IT, Business Support, and Professional &amp; Craft/Light Industrial ecosystems.\r\n\r\nFounded in March 1996, we have a presence in all 50 States. Tryfacta has Ranked number 1 as one of the fastest-growing companies by Inc. Magazine (Inc. 5000)!\r\n\r\nTryfacta is certified by the Joint Commission for Healthcare Staffing Services &amp; has numerous ISO Certifications that capture our commitment to continuous improvement.

Employee Relations Specialist

<h3>Job Description</h3>
Job Description
Overview
Are you looking for a career you can feel good about? We hire only those that strive to do their best. By joining our family, you'll receive the honor and recognition that comes with working for the industry's global leader in evidenced based rehabilitation.
Who We Are:
GEO provides complementary, turnkey solutions for numerous government partners worldwide across a spectrum of diversified correctional and community reentry services. From the development of state-of-the-art facilities and the provision of management services and evidence-based rehabilitation to the post-release reintegration and supervision of individuals in the community, GEO offers fully diversified, cost-effective services that deliver enhanced quality and improved outcomes.
Why Work for GEO:
<ul>
<li>We believe that work is more than a place you go to every day. It is about being inspired and motivated to achieve extraordinary things.</li>
<li>Employee benefits play an important role in making The GEO Group a great place to work. At GEO, we believe in the three pillars of employee wellbeing: physical, emotional, and financial. With comprehensive benefits and competitive wages, we trust that you will find all the resources you need here to be successful.</li>
</ul>
 
Responsibilities
Summary
This position focuses on serving the needs, concerns and objectives of both managers and our employees through building effective partnerships and by creating trust and mutual respect. It leads the administration and implementation of Human Resources (HR) policies, programs and practices throughout the facility and acts as the liaison between the facility management and Regional/Corporate HR.
Primary Duties and Responsibilities
<ul>
<li>Serves as an advisor to the Facility Administrator and facility management on Human Resources issues.</li>
<li>Supports local recruiting and outreach efforts in coordination with the centralized recruiting team to meet or exceed monthly and annual recruiting targets in the most efficient and effective manner possible. Ensures a positive candidate and hiring manager experience. Prepares and maintains personnel records and ensures compliance to procedures for controlling personnel transactions and reporting personnel data. Administers and tracks employee developmental training.</li>
<li>Assists, coaches and provides guidance for progressive discipline, standards of employee conduct and employee terminations.</li>
<li>Supports reporting serious staff misconduct to the Office of Professional Responsibility (OPR).</li>
<li>Engages employees and acts as a conduit to provide facility management, Regional HR and Corporate HR insight into employee concerns.</li>
<li>Responsible for employee onboarding to include data entry into the HR Information system and new employee orientation. Ensures that data entered is accurate and employees have a thorough understanding of Company policies and procedures, to include the information included in the employee handbook.</li>
<li>Responsible for maintaining records of insurance coverage, retirement plans, and personnel transactions such as hires, promotions, transfers, performance reviews, terminations, and other related personnel and payroll issues.</li>
<li>Serves as EEO specialist and maintains affirmative action plan.</li>
<li>Serves as subject matter expert for leaves of absences, FMLA and ADA issues.</li>
<li>Ensures compliance with Company policies and procedures and develops a thorough understanding of Corporate HR policies and procedures.</li>
<li>Reviews facility personnel procedures to ensure that they are applicable, effective, and comply with contract requirements, local, state and federal law, and Company policies, procedures.</li>
<li>Resolves employee personnel inquiries and submits necessary inputs, changes, additions and deletions into the HR Information System for correction. Refers unusual or unresolved problems to Regional HR for further action.</li>
<li>May manage an assigned human resources staff and perform the duties typically associated with a management level position including hiring, training, and employee development.</li>
<li>Coordinates grievance and disciplinary hearings and activities.</li>
<li>Coordinates benefit programs, annual enrollment, and employee wellness program at facility..</li>
<li>Monitors unemployment claims, assists with appeals and may attend hearings as the Human Resources representative.</li>
<li>Partners with facility management to ensure the performance appraisal program is compliant and effective.</li>
<li>Provides guidance on compensation, bonuses and other recognition programs.</li>
<li>Monitors and coordinates workers’ compensation claims and may compile information to file workers’ compensation claims for employees and for the insurance carrier.</li>
<li>Provides necessary referral support for the Employee Assistance Program (EAP).</li>
<li>Performs other duties as assigned.</li>
</ul>
 
Qualifications
Minimum Requirements
<ul>
<li>High school diploma with a minimum of seven (7) years of progressive professional experience in Human Resources or a Bachelor’s degree from an accredited college or university in Human Resources or related field with five (5) years of experience working in a Human Resources position.</li>
<li>Three (3) years supervisory experience preferred.</li>
<li>Must exhibit leadership qualities to gain the respect of all employees and be able to display confidence when interacting with people at all levels of management.</li>
<li>Must have the ability and desire to work in a cooperative manner and to make management decisions.</li>
<li>Experience working with an HR Information System required.</li>
<li>Must be able to maintain confidentiality at all times due to the handling of sensitive and confidential information.</li>
<li>Must have the ability to communicate effectively, both verbally and in writing.</li>
<li>Must have proficiency in Microsoft Office suite (Windows, MS Word, Excel, and PowerPoint) and other computer programs and software normally used by HR.</li>
<li>Must possess an active, valid driver's license.</li>
<li>Must be at least twenty-one (21) years of age or older.</li>
<li>Must be a United States Citizen.</li>
<li>Must pass a background check and drug screen.</li>
</ul>
GEO Secured Services

MANAGER, HUMAN RESOURCES

<h3>Job Description</h3>
Job Description
Association Representative/Labor Relations
San Jose, California: San Francisco Bay Area
RNPA (Registered Nurses Professional Association)
RNPA is a small local nurses’ union that represents more than 3,500 Registered Nurses within Santa Clara County. We’ve been independent for more than 42 years, and all our Board of Directors are Registered Nurses who work alongside their membership. We have members spread throughout the Santa Clara Valley Health and Hospital System, which includes St. Louise Regional Hospital, O’Connor Hospital, Clinics, and Custody Health.
This is a full journey level salaried exempt position. This position is responsible for providing the full range of union representation for RNPA members, including but not limited to labor management, contract negotiations and enforcement, grievance handling, member organizing, research, disciplinary representation, dispute resolution, training, and implementation.
DUTIES:
· Works independently and in collaboration with Senior Association Representative to process grievances and appeals
· Assists with member inquiries by phone, email, or in person
· Assists members with the resolution of personnel issues encountered in the workplace
· Serves as support staff to the negotiating team, taskforces, and committees
· Assists in the distribution of newsbreaks, leaflets, bulletins notices, email updates and/or any other pertinent association material to the membership worksite(s)
· Conducts surveys, audits, investigations, and related research to aid in the development of union policies, bargaining positions and future interests
· Attends meetings to represent RNPA members as assigned
· Serves as a liaison to community and labor groups as needed
· Assist with the organizing membership which includes development, planning and implementation of RNPA member activities and events
MINIMUM QUALIFICATIONS
Requirements:
<ul>
<li>Proven ability to organize and plan work</li>
<li>Leadership skills to educate, motivate, and organize members</li>
<li>Ability to manage multiple tasks simultaneously while being flexible</li>
<li>Ability to exercise sound judgment in complex situations</li>
<li>Strong public speaking skills</li>
<li>Knowledge of or ability to acquire computer skills</li>
</ul>
· Driver’s License and auto insurance
· Willingness to work flexible hours if needed including evenings
· Ability to communicate effectively orally, and in writing to a variety of individuals and groups.
· Analytical skills directed toward investigation, planning, and preparation
· Ability to establish and maintain rapport with our diverse membership and multi-cultural community groups
· Ability to work under time guidelines with minimal supervision
· Ability to take direction from the leadership team as needed and strives to meet the mission statement and objectives of the Association.
Preferred Qualifications/Experience
· Salesforce
· Human Resources
<ul>
<li>College degree in labor-related field; or extensive experience and demonstrated ability in labor relations, labor organizing or related work</li>
</ul>
· Contract Negotiations
· Labor Organizing
· Experience and knowledge working with healthcare professionals
· Knowledge about small businesses and local independent unions
SALARY
Competitive salary structure and excellent benefit package, to be determined at the time of employment. Offer is commensurate with education and experience.
To Apply:
 Fax or email cover letter and résumé to <a href="mailto:RNEXEC@rnpa.net" target="_blank">RNEXEC@rnpa.net</a> or contact office at (408) 292-6061
Company DescriptionRegistered Nurse Professional Association (RNPA) was founded in 1978. RNPA is an independent organization representing registered nurses working for the County of Santa Clara. We have 3,500 members working throughout the Santa Clara Valley Health and Hospital System. Our members work at Valley Medical Center, O’Connor Hospital, Saint Louise Regional Hospital, Ambulatory and Community Health Services, Psychiatric Services, and Custody Health Services. We are looking for energetic, hard-working professional staff who is committed to representing registered nurses. 
<h3>Company Description</h3>
Registered Nurse Professional Association (RNPA) was founded in 1978. RNPA is an independent organization representing registered nurses working for the County of Santa Clara. We have 3,500 members working throughout the Santa Clara Valley Health and Hospital System. Our members work at Valley Medical Center, O’Connor Hospital, Saint Louise Regional Hospital, Ambulatory and Community Health Services, Psychiatric Services, and Custody Health Services. We are looking for energetic, hard-working professional staff who is committed to representing registered nurses.

Association Representative/Labor Relations

<h3>Job Description</h3>
Job DescriptionSummary Description:
The Chief Medical Officer (CMO) is responsible for all areas of Medical Management including, but not exclusive to, utilization management, quality management, credentialing, medical policy development, and medical informatics. The CMO will provide leadership, management and direction for all medical management operations, reporting and contracting functions while ensuring that the Board of Directors, Chief Executive Officer (CEO), the President, and other members of the senior leadership team have constant access and timely updates relative to departmental information and analysis necessary to assist in meeting its operational goals and business objectives as set forth in the company’s strategy for growth and annual performance budget. This position carries out responsibilities in the following functional areas: Chair Quality Committee, Chair Appeals Review Meeting, Chair Peer Review Committee, Member Pharmacy Oversight Committee, Utilization Management and Quality Management meetings, ensuring compliance with requirements for confidentiality and conflict of interest, development of staff relationships, and bringing together the coalition of medical groups and integrated delivery systems.
Representative Duties:
• Promote and adhere to WHA’s Privacy and Information Security Programs. Ensure and verify that all department Workforce Members attend and complete mandatory training. Inform department Workforce Members that WHA will take disciplinary action up to and including termination of employment or assignment with WHA for violation of these privacy and security policies, procedures, and regulatory requirements. Also, that strict adherence to the related laws, rules, regulations, policies, and procedures is considered an integral part of their job performance, and monitor compliance.
• Contribute to the strategic direction, goals and vision of the plans offered by Western Health Advantage.
• Provide clinical oversight to the Medical Management staff and remain ultimately responsible for the Utilization Management Program and the oversight of any delegated functions.
• Responsible for the overall quality of care program to include performance review, Credentialing, Clinical Pathway Development, Quality Outcome Studies and Disease State Management.
• Develop and interpret medical policy guidelines from nationally recognized entitles, governmental, or internally developed.
• Develop strategies for the development/implementations of a Medical Informatics Plan utilizing encounter data.
• Responsible for oversight of all clinical aspects of the grievance/appeal system and for continuous review of appeal, complaint, and grievance data to identify emerging patterns of member dissatisfaction.
• Report appeal/complaint/grievance data from Quality Improvement Committee (QIC) to the Board of Directors.
• Participate in the strategic development of Western Health Advantage and accomplishment of set goals.
• Remain key contributor to clinical data system decisions and projects.
• Actively participate in board meetings, providing reports and inputs when directed.
• Assist and oversee clinical regulatory and accreditation audits.
• Monitor network access and recommend actions when appropriate.
• Establish and implement the departmental staffing plans and sound business processes to support the effective execution of the company’s business plans and strategies.
• Work collaboratively with Human Resources and Medical Management Department Team leaders to select, train, supervise, and effectively performance manage the medical management staff.
• Maintain consistently high performance standards for all departmental staff and team members by regularly communicating business updates, coaching, counseling, disciplining and completing timely performance evaluations in accordance with the company’s HR guidelines and standards.
• Establish and execute personal and professional development initiatives for the Medical Management Department team members and their self for the purpose of keeping current and effective in the performance of their various job duties and roles.
• Perform other duties and special projects as assigned.
Skills:
<ul>
<li>
Highly proficient at strategic planning and building effective company business directly linked to the achievement of the company’s business performance objectives.
</li>
<li>
Possess a highly proficient understanding of Federal and State and commercial regulations as dictated by both the Department of Health Services and the Department of Managed Health Care while working closely with the Chief Executive Officer as they interact with the State of California regulatory agencies and other payers.
</li>
<li>
Possess a working knowledge of capitation, medical risk, and HMO contracting, including the role utilization plays in affecting the bottom line of the business.
</li>
<li>
Possess a full understanding of the company’s Business Plan envisioning multiple payers set against a complex web of federal and State regulations and policies.
</li>
<li>
Proficient in business relevant software programs used within the Medical Management Department, including Excel, Word, Outlook, and Salesforce software.
</li>
<li>
Effective public speaking, group presentations and one-on-one interactions, both internal and external to the company with a proven ability to positively influence listeners, which includes use of communications aids (i.e. charts, graphs, overheads, etc.).
</li>
<li>
Proficient with leadership practices and processes with members of their department, including administration and adherence to company policies and procedures.
</li>
<li>
Highly effective at building rapport that encourages trust, inspires confidence and enlists cooperation with all other WHA team members and departments in a variety of work situations.
</li>
<li>
Highly proficient at establishing credibility and maintaining effective work relationships with those contracted in the performance of required duties for the company.
</li>
<li>
Highly proficient with oral and written communication in the primary language(s) used in the workplace, including the ability to prepare reports and business correspondence in a professional and timely manner.
</li>
</ul>
Qualifications:
<ul>
<li>
Doctorate in Medicine or Osteopathy.
</li>
<li>
7 years’ clinical management experience.
</li>
<li>
Current License to practice medicine without restriction in the State of California required.
</li>
<li>
Must be California State Board Certified.
</li>
<li>
Highly competent computer skills, including electronic mail, routine database activity, word processing, spreadsheet, graphics, etc. Specifically, the ability to create formulas and graphs in Excel and import them into Word documents.
</li>
<li>
Must be able to speak, read, write, and understand the primary language(s) used in the workplace.
</li>
</ul>
Salary: $350,000.00 - $380,000.00 Annually
Western Health Advantage is committed to providing equal employment opportunities to employees and applicants for employment on the basis of merit and without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, physical or mental disability, medical condition, genetic information, marital status, ancestry, military or veteran status, or any other basis made unlawful by federal or state law.
Western Health Advantage values and supports the unique talents and strengths that each employee brings to our organization. Collaborating with the best and the brightest means a dynamic, fulfilling work experience for you — and excellent customer service for our members.
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Chief Medical Officer

<h3>Job Description</h3>
Job DescriptionDescription:
 
Purpose:
The Student Services Advisor is responsible for the overall functioning and performance of the Student Services Department providing day-to-day leadership and direction with respect to policies, practices, systems and community support. The Student Services Advisor oversees the Student Services department with respect to scheduling and work assignments, Title IX compliance, ADA coordination, student complaints, grievances, appeals and performing other duties as required. The Student Services Advisor contributes to the College’s success by providing input into the development of the campus’ strategic and operational plans, and by ensuring that the campus achieves its student engagement, retention, and completion goals in a student centric campus environment. Responsible for taking a leadership role in cultivating and creating Smith Chason College campus spirit and pride.
 
Qualifications:
<ul>
<li>Bachelor’s degree preferred. Acceptable experience includes at minimum, 2-3 years of administrative experience. Recommended competencies include:</li>
<li>Must have strong technical skills including all computer applications, internet research, database management, and analytical skills.</li>
<li>Ability to prioritize, multi-task, perform well under pressure, meet deadlines, and work flexible schedule. </li>
<li>Ability to communicate with high level industry supervisors and management teams. </li>
<li>Strong ability to work independently as well as collaboratively with other team members. </li>
<li>Ability to engage in critical thought and analyze all types of quantitative and qualitative data into reports and presentation for strategic planning and problem-solving.</li>
<li>Ability to provide support and ensure accountability for results.</li>
<li>Strong organizational skills.</li>
<li>Effective time management skills; ability to separate important issues and identify priorities.</li>
<li>Ability to track, monitor, assess and evaluate student progress and registry outcomes.</li>
<li>Possesses strong motivational skills, oral and written communication proficiency.</li>
<li>Provide excellent customer service to all members of the WCUI community.</li>
<li>Must have strong documentation skills.</li>
<li>Demonstrates integrity, credibility, confidentiality, and responsibility in all interactions.</li>
<li>Possesses high ethical standards and an honest, open, and consistent approach to working with peers, employees, employers and staff.</li>
<li>Individuals must be professional in all aspects of the position including appearance, demeanor, communication and attitude.</li>
</ul>
Reports to:
Campus Director/ Director of Education
 
Responsibilities:
<ul>
<li>Lead and represent the Department of Student Services, ensure safety of students, regulatory compliance, consistency of practice and excellent student/customer service </li>
<li>Manage the Department’s work with faculty and staff, colleagues, students and community partners to support, provide and/or facilitate activities that ensure that the campus achieves its student engagement, satisfaction, retention, and completion goals </li>
<li>Provide leadership, analysis and advisement in relation to policies, procedures, and operational plans regarding students and services for students, including risk management. </li>
<li>Monitor, manage and enforce Satisfactory Academic Progress and Attendance Policies </li>
<li>Provide a leadership role with Title IX compliance and is the campus Title IX Coordinator </li>
<li>Work with the ADA Compliance Coordinator to facilitate all communication for requests for accommodations, ensure approved accommodations are communicated and managed and support students with the grievance process </li>
<li>Ensure that the Department’s budget is planned, prepared and monitored </li>
<li>Address complaints and conducts investigations as directed by the Campus Director </li>
<li>Hire, orientate, and supervise the Student Advocate by performing such things as: direct, schedule, provide performance feedback, evaluate, suggest professional development and where necessary discipline direct reports. Manage the performance review process </li>
<li>Ensure that Student Services Department monitors students’ attendance and academic performance on a weekly basis, progress toward program completion, providing or recommending interventions as needed </li>
<li>Ensure the Student Services Department maintains appropriate documentation with regards to advising sessions including meeting overviews, progress notes, referrals, and follow-up activities. </li>
<li>Ensure that the Student Services Department follows all regulatory bodies </li>
<li>Lead in the developing and conducting of student events including but not limited to orientation, community outreach, graduation and student appreciation </li>
<li>Maintain knowledge of Smith Chason College programs, campus resources, information systems, and policies and procedures </li>
<li>Additional job-related duties as required and assigned</li>
</ul>
 
PHYSICAL REQUIREMENTS/ WORKING CONDITIONS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
<ul>
<li>Must be able to remain in a stationary position for prolonged periods of time</li>
<li>Can independently move objects up to 25 lbs.</li>
<li>Sufficient hand, arm, and finger dexterity to operate a computer keyboard, other office machinery, and perform repetitive motions</li>
<li>Must have sufficient hearing and speaking ability to communicate in person or on the phone/computer with others</li>
<li>Must be able to occasionally function in activities that include walking, bending, squatting, and reaching</li>
</ul>
 
CULTURE OF CARE
Culture of Care is our commitment to create a supportive environment in which every student can achieve their educational and career goals. Culture of Care encourages one-on-one relationships. Creating a culture that focuses on the student and their wellness. This includes understanding the student's complex lives. It is about creating a school where everyone feels welcomed by: 
· Creating a sense of community in all interactions and communications with students 
· Identifying problem areas and offering assistance 
· Opening up safe conversations for cooperative solutions 
· Holding students to standards and goals that will ultimately make them successful in their careers
 
Requirements:

Student Services Advisor

<h3>Job Description</h3>
Job Description
Overview
Seeking a Sales Account Representative/Executive for our Signature Advantage Plan who will work with senior care partners to assist in enrolling new residents and members. You will actively market our plan to new senior care partners within a plan service area.
We value candidates with direct sales and account management experience, a KY or TN State Insurance Licence (or willingness to quickly get one), and experience working with our elder community. Regional Travel is required.
Our salary of $64,000- 66,000/year includes eligability for an incentive bonus paid monthly!
 
Responsibilities
<ul>
<li>Working with senior care partners to assist with enrolling new resident members and discussing plan benefits with senior care partners, potential plan members and their families.</li>
<li>Responsible for educating members on the plan and providing high quality customer service, providing professional, accurate and timely response to all inquiries regarding eligibility, plan coverage, coordination of benefits and claim payment solutions.</li>
<li>Assisting with resolution to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals.</li>
<li>Actively market plan to new senior care partners within plan Service Area.</li>
<li>Assist with identifying key providers in market area that would enhance plan’s network.</li>
<li>Meet the physical and sensory requirements stated below and be able to work in the described environment.</li>
<li>Responsible for year-round enrollment of eligible individuals into Signature Advantage’s Institutional Special Needs Plan(s).</li>
<li>Manage market territory with plan service area.</li>
<li>Meeting New and existing members to collect information on early interventions for service or health needs and communicate this back to the Care Team.</li>
<li>Deliver approved sales and marketing presentations in accordance with applicable Centers for Medicare &amp; Medicaid Services (CMS) and State guidelines and standards.</li>
<li>Conduct individual meetings, small group presentations and attend scheduled facility rollout meetings as needed.</li>
<li>Must communicate effectively with Medicare beneficiaries, their families, caretakers, nursing facility management and staff.</li>
<li>Must consistently achieve established sales goals and report all sales and field marketing results daily.</li>
<li>Responsible for tracking and maintaining accurate records in compliance with HIPAA / HITECH laws and Signature Advantage policies and procedures.</li>
<li>Other special projects and duties, as assigned.</li>
</ul>
 
Qualifications
<ul>
<li>Two-year associate/technical degree, bachelor’s degree or experience with direct sales and account management preferred.</li>
<li>Tennessee/Kentucky State Health Insurance License required.</li>
<li>Experience working with the senior population preferred.</li>
<li>Ability to organize and manage multiple priorities is necessary.</li>
<li>Must be self-directed, highly motivated and possess excellent interpersonal communication skills.</li>
<li>Ability to prospect, set-up, present, close and utilize time for maximum results.</li>
<li>Problem analysis and problem resolution.</li>
<li>Ability to work independently with minimal direct supervision.</li>
<li>Must have reliable transportation and be able to pass a background check.</li>
<li>Regional travel is expected.</li>
<li>Effective verbal and written English communication skills.</li>
<li>Demonstrated intermediate to advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation.</li>
<li>Highest level of professionalism with the ability to maintain confidentiality.</li>
<li>Ability to communicate at all levels of organization and work well within a team environment in support of company objectives.</li>
<li>Customer service oriented with the ability to work well under pressure.</li>
<li>Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.</li>
<li>Strong analytical and problem-solving skills.</li>
<li>Ability to work with minimal supervision, take initiative and make independent decisions.</li>
<li>Ability to deal with new tasks without the benefit of written procedures.</li>
<li>Approachable, flexible and adaptable to change.</li>
<li>Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.</li>
</ul>

21 grievance-and-appeals-representative Jobs