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Medical Case Manager (High Risk Pregnancy) CalOptima Join Us in this Amazing Opportunity 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 Medical Case Manager (High Risk Pregnancy) and help shape the future of healthcare where you'll be an integral part of our Case 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. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager, High-Risk Pregnancy, will facilitate communication and coordination among all participants of the health care team and the member to ensure that the services provided promote quality, cost-effective outcomes. You will be a resource for high-risk pregnancy members, delegated plan Case Managers, Personal Care Coordinators (PCCs) and community partners to address medical, behavior and psychosocial concerns. In conjunction with other team members, you will develop and make recommendations for a comprehensive individualized care plan at all levels of care. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Case 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>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>Reviews and analyzes member health risk assessment (HRA) answers and uses clinical judgment to assign a care management level (CML).</li>
<li>Reviews Interdisciplinary Care Team (ICT) summaries and individual care plans (ICP) to ensure compliance with Centers for Medicare and Medicaid Services (CMS) and Model of Care requirements.</li>
<li>Works collaboratively with the PCCs to develop care plans for members, including those who are pregnant, using member HRA data.</li>
<li>Utilizes all other available data to formulate care plans in the absence of an HRA.</li>
<li>Ensures and facilitates communication between PCCs and delegated plan PCCs to achieve favorable member health outcomes.</li>
<li>Responds appropriately to case management triggers generated as part of the HRA or ICT process.</li>
<li>Anticipates needs for those at risk of transitioning of care and proactively support reducing the risk of re-entering a higher level of care.</li>
<li>Acts as an integral part of the team, providing verbal and written support of member needs.</li>
<li>Collaborates and communicates with the member, family, significant other(s), physicians, health network (HN) designee and other health care providers to support and accomplish goals identified on the individualized care plan in all care settings.</li>
<li>Accepts referrals for case management and serves as CalOptima Health's liaison to community agencies, organizations and state personnel.</li>
<li>Provides case management consultation and education to members, their families and the HNs.</li>
<li>Acts as an advocate to assist in the coordination of the client's identified psychosocial needs, utilizing community resources and support when appropriate.</li>
<li>Participates in proactive identification of patients appropriate for care management.</li>
<li>Initiates appropriate follow-up and the development of an individual care plan incorporating assessment, education, resource planning and coordination of services of those patients accepted for case management.</li>
<li>Assists, as requested, to collect and analyze data from initial/annual/updated health risk assessments, stratification tools, outcome measures and internal/external reports to identify trends, individual issues, problems and resources that are most appropriate to meet client's needs.</li>
<li>Develops and maintains a network of current community resources and services where members can be referred for assistance.</li>
<li>Performs regular review of cases and events to identify patterns/trends and to ensure the department's compliance with CMS, Department of Health Care Services (DHCS) and National Committee for Quality Assurance (NCQA) standards.</li>
<li>Maintains documentation of case management plans/interventions and statistics required to demonstrate activities of the ICT and the impact of case management, quality and care settings that best meet the member's needs.</li>
<li>Serves as a liaison and resource between CalOptima Health and the HNs departments, as applicable.</li>
<li>Develops and maintains a good working relationship with all areas. </li>
</ul>
</li>
<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>Associate degree in nursing (ADN) or related field PLUS 3 years of clinical experience working with pregnancy and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Bachelor of Science degree in Nursing (BSN), public health or a related field. </li>
<li>Active and unrestricted Registered Nurse CCM certificate. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). </li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>Current unrestricted Registered Nurse (RN) license to practice in the state of California required.</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 role.
<ul>
<li>Our current hiring range is: Pay Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) NOTE: Training will be held in the office for the first 4 weeks from 8:00am - 5:00pm, on Tuesdays and Thursdays. </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6753575&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 December 8, 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/6753575" target="_blank">https://jobs.caloptima.org/jobs/medical-case-manager-high-risk-pregnancy-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-2aff510fae8fb6448a86895170bc50fc

Medical Case Manager (High Risk Pregnancy)

Medical Case Manager (LVN) (High Risk Pregnancy) CalOptima Join Us in this Amazing Opportunity 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 Medical Case Manager (LVN) (High Risk Pregnancy) and help shape the future of healthcare where you'll be an integral part of our Case 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. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager (LVN), High-Risk Pregnancy, will facilitate communication and coordination among all participants of the health care team and the member to ensure that the services provided promote quality, cost-effective outcomes. You will be a resource for high-risk pregnancy members, delegated plan Case Managers, Personal Care Coordinators (PCCs) and community partners to address medical, behavior and psychosocial concerns. In conjunction with other team members, you will develop and make recommendations for a comprehensive individualized care plan at all levels of care. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Case 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>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>Reviews and analyzes member health risk assessment (HRA) answers and uses clinical judgment to assign a care management level (CML).</li>
<li>Reviews Interdisciplinary Care Team (ICT) summaries and individual care plans (ICP) to ensure compliance with Centers for Medicare and Medicaid Services (CMS) and Model of Care requirements.</li>
<li>Works collaboratively with the PCCs to develop care plans for members, including those who are pregnant, using member HRA data.</li>
<li>Utilizes all other available data to formulate care plans in the absence of an HRA.</li>
<li>Ensures and facilitates communication between PCCs and delegated plan PCCs to achieve favorable member health outcomes.</li>
<li>Responds appropriately to case management triggers generated as part of the HRA or ICT process.</li>
<li>Anticipates needs for those at risk of transitioning of care and proactively support reducing the risk of re-entering a higher level of care.</li>
<li>Acts as an integral part of the team, providing verbal and written support of member needs.</li>
<li>Collaborates and communicates with the member, family, significant other(s), physicians, health network (HN) designee and other health care providers to support and accomplish goals identified on the individualized care plan in all care settings.</li>
<li>Accepts referrals for case management and serves as CalOptima Health's liaison to community agencies, organizations and state personnel.</li>
<li>Provides case management consultation and education to members, their families and the HNs.</li>
<li>Acts as an advocate to assist in the coordination of the client's identified psychosocial needs, utilizing community resources and support when appropriate.</li>
<li>Participates in proactive identification of patients appropriate for care management.</li>
<li>Initiates appropriate follow-up and the development of an individual care plan incorporating assessment, education, resource planning and coordination of services of those patients accepted for case management.</li>
<li>Assists, as requested, to collect and analyze data from initial/annual/updated health risk assessments, stratification tools, outcome measures and internal/external reports to identify trends, individual issues, problems and resources that are most appropriate to meet client's needs.</li>
<li>Develops and maintains a network of current community resources and services where members can be referred for assistance.</li>
<li>Performs regular review of cases and events to identify patterns/trends and to ensure the department's compliance with CMS, Department of Health Care Services (DHCS) and National Committee for Quality Assurance (NCQA) standards.</li>
<li>Maintains documentation of case management plans/interventions and statistics required to demonstrate activities of the ICT and the impact of case management, quality and care settings that best meet the member's needs.</li>
<li>Serves as a liaison and resource between CalOptima Health and the HNs departments, as applicable.</li>
<li>Develops and maintains a good working relationship with all areas. </li>
</ul>
</li>
<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>High school diploma or equivalent PLUS 1 year of clinical experience working with pregnancy and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate degree in nursing (ADN), public health or a related field. </li>
<li>Active and unrestricted Registered Nurse CCM certificate. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>Current unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required.</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 role.
<ul>
<li>Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) ***Training will be held in the office for the first 4 weeks from 8:00am - 5:00pm, on Tuesdays and Thursdays. </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6753587&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 December 8, 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/6753587" target="_blank">https://jobs.caloptima.org/jobs/medical-case-manager-lvn-high-risk-pregnancy-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-6f46a4a5bd072343aa775a9395f14428

Medical Case Manager (LVN) (High Risk Pregnancy)

Personal Care Coordinator Sr CalOptima Join Us in this Amazing Opportunity 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 Personal Care Coordinator Sr and help shape the future of healthcare where you'll be an integral part of our Case 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. The Personal Care Coordinator Sr will perform a wide variety of advanced support activities for plan members. You will ensure regular communication of the member's annual Health Needs Assessment (HNA) or Health Risk Assessment (HRA) and care plan with the member, primary care provider (PCP) and health care team. You will regularly assess the quality of service given to the member's care by identifying barriers and assisting in improving these barriers for all levels of care. You will maintain strong working relationships with the PCP and health care team to ensure member access to timely services and coordination of care. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Maintains strong working relationships when collaborating with the PCP and health care team to ensure timely communication of member's clinical information and ensures appropriate documentation of all interventions. Also, notifies member's care team of key event triggers.</li>
<li>Collaborates with licensed professionals in development of a care plan for each member, incorporating the HNA or HRA all assessment findings. Facilitates communication of care plan to the PCP and member, as necessary.</li>
<li>Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.</li>
<li>Facilitates and participates in interdisciplinary team meetings as applicable.</li>
<li>Processes and maintains complex or sensitive documentation of member's case and care plan within CalOptima Health's medical management system.</li>
<li>Facilitates referrals to Behavioral Health Services and identifies the need for referrals to Long-Term Support Services and community resources.</li>
<li>Facilitates transfers to member's assigned case manager in accordance with member needs, when appropriate.</li>
<li>Anticipates longer-term and more unique member needs by providing guidance in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, as appropriate.</li>
<li>Maintains compliance with established departmental productivity guidelines; compiles and conducts basic analyses and reporting of productivity metrics to management as required.</li>
<li>Coordinates and maintains cases in current case load in accordance with case management standards. Assists with collection of health risk or health needs assessments as well as gathers medical records as needed.</li>
<li>Provides regular outreach to assigned members and evaluates quality of service given to members according to department contact standards.</li>
<li>Serves as the main point of contact for assigned members to anticipate longer term member needs.</li>
<li>Works with Case Management staff to expedite the resolution of member concerns. </li>
</ul>
</li>
<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>High School diploma or equivalent required PLUS 2 years of experience working with the needs of members, such as but not limited to pediatric members, seniors or persons with disabilities (SPD) and/or special populations (e.g., homeless or at risk of homelessness) in a customer/member service capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Bachelor's degree in healthcare management, social work, human services or related field. </li>
<li>2 years of experience with health maintenance organization (HMO), Medi-Cal and health services. </li>
<li>Experience working with individuals with behavior health conditions or substance use disorders. </li>
<li>Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). </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 role.
<ul>
<li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6757445&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 December 9, 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/6757445" target="_blank">https://jobs.caloptima.org/jobs/personal-care-coordinator-sr-505-city-parkway-west-california-united-states-2d201e5c-584f-4826-bd77-999a1a3af3d3</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-08c2a3f2190e1348bf04fb69d1b86160

Personal Care Coordinator Sr

Member Liaison Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity 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 Member Liaison Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our CS - Member Liaison 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. You 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. You will also 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. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<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>
 Do You Have What the Role Requires? 
<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>
</ul>
 You'll Stand Out More If You Possess the Following: 
<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>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</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 role.
<ul>
<li>Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6757493&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 December 9, 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/6757493" target="_blank">https://jobs.caloptima.org/jobs/member-liaison-specialist-customer-service-505-city-parkway-west-california-united-states-33e8b0be-b4dd-42d0-9530-e2df2d63a939</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-537ce69475a85e4fb5e079ee955c18f2

Member Liaison Specialist (Customer Service)

Sr Director, Pharmacy Management CalOptima Join Us in this Amazing Opportunity 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 Sr Director, Pharmacy Management and help shape the future of healthcare where you'll be an integral part of our Pharmacy 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. Under the direction of the CMO, you will be responsible for strategic planning and leadership, regulatory compliance, and management as well as operational oversight for all aspects of pharmacy services within a managed care organization, including Medi-Cal, Medicare Advantage Part D (HMO D-SNP), and Covered California. You will also be responsible for designing, implementing, and evaluating pharmacy benefit programs that align with clinical goals, financial sustainability, regulatory compliance, and member outcomes. You will develop and direct formulary strategy, utilization management, quality initiatives, and vendor performance-including Pharmacy Benefit Manager (PBM) oversight-and serves as the organization's principal pharmacy advisor to executive leadership and the Board of Directors. You will ensure compliance with Centers for Medicare &amp; Medicaid Services (CMS), state Medicaid, Covered California, Department of Managed Health Care (DMHC), and National Committee for Quality Assurance (NCQA) standards while advancing initiatives to improve population health, medication adherence, and cost-effective drug use. You will be accountable for pharmacy-related quality programs and will contribute to the improvement of CalOptima Health's quality performance including but not limited to Star ratings. This position will require a dynamic, data-driven leader with extensive experience in managed care pharmacy, cross-functional collaboration, and a strong understanding of the regulatory environment governing Medicare, Medicaid, and commercial health plans. You will ensure alignment with CalOptima Health's mission to serve member health with excellence and dignity, respecting the value and needs of each person 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>60% - Leadership Responsibilities
<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 oversees the Pharmacy department in carrying out all department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals and priorities.</li>
<li>Leads, develops, and implements pharmacy business plan and strategic initiatives in alignment with CalOptima Health's objectives and community mission, while taking ownership of both short- and long-term direction of the department.</li>
<li>Supports CalOptima Health's quality goals by driving improvements in Covered California Quality Transformation Initiative, Star Ratings, Pharmacy Quality Alliance (PQA) adherence measures, Healthcare Effectiveness Data and Information Set (HEDIS) outcomes, and other not yet identified quality programs.</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>Oversees and ensures pharmacy management operational compliance with organizational standards, policies and procedures, and regulatory requirements while maintaining knowledge of related changes and developing effective communication plans as needed.</li>
<li>Serves as pharmacy subject matter expert to the executive team and CalOptima Health's Board of Directors.</li>
<li>Directs all aspects of running an efficient Pharmacy team, including hiring, supervising, coaching, developing, disciplining, motivating as well as attracting and retaining a high-performing team that achieves department goals that are in alignment with the CalOptima Health Strategic Plan.</li>
<li>Develops, implements, and upholds departmental policies and procedures.</li>
<li>Collaborates with CMO to develop and monitor annual budgets and corresponding business cases to ensure utilization meets strategic, operational, and budgetary goals.</li>
<li>Collaborates with CMO to manage staffing model and succession planning, and monitors related resource allocation for the department.</li>
<li>Collaborates with CMO and other senior leaders to develop projections for future year utilization and cost trends.</li>
<li>Supports senior leadership within CalOptima Health to drive and lead changes by communicating goals clearly and developing relationships with key stakeholders.</li>
<li>Serves in a Pharmacy and Therapeutics (P&amp;T) Committee Leadership role.</li>
<li>Collaborates with leadership and staff across internal departments to share information, support organization goals, and promote positive and collaborative business relationships with vendors and providers. </li>
</ul>
</li>
<li>35% - Program Operations Oversight
<ul>
<li>Leads and manages all pharmacy-related operational and clinical functions, including but not limited to formulary development, prior authorization protocols, and utilization management for Medi-Cal, Medicare, and Covered California lines of business as appropriate.</li>
<li>Directs the Pharmacy team, including clinical pharmacists, pharmacy operations, and analytic staff, fostering a culture of continuous improvement, excellence and innovation, and promotes collaboration between the Pharmacy team and other internal departments and external providers.</li>
<li>Oversees new program development related to pharmacy, including overseeing new program design and implementation for the Covered California line of business.</li>
<li>Collaborates with internal departments (Medical Management, Quality, Compliance, Finance, line-of business leaders, etc.) to optimize member outcomes and drug cost-effectiveness.</li>
<li>Ensures compliance with state and federal regulations, including CMS, DMHC, Covered California, and Medi-Cal Rx.</li>
<li>Leads Pharmacy Benefit Manager (PBM) procurement, contracting, implementation, oversight and vendor management, including contract negotiation, performance evaluation, and rebate management. PBM oversight is a critical requirement of this role including real time oversight of PBM Point of Service prescription fulfillment.</li>
<li>Collaborates with CMO to provide financial oversight, budget planning, and reporting for pharmacy benefit expenditures, ensuring transparency and fiscal responsibility.</li>
<li>Develops and oversees pharmacy-related internal statistical and performance reports and satisfies reporting requirements to external regulators.</li>
<li>Develops, implements, and monitors department's performance standards.</li>
<li>Manages audit preparation and corrective action plans in response to CMS, DHCS, and other regulatory bodies. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Doctor of Pharmacy (PharmD) PLUS 7 years of health plan experience in Medicare Part D and Medicaid required. </li>
<li>5 years of pharmacy management experience with implementation of commercial managed care products, such as products sold on state-based exchanges/Covered California required. </li>
<li>3 years of progressive pharmacy leadership experience within a managed care, health plan, or PBM environment required. </li>
<li>Demonstrated success in directing and overseeing pharmacy benefit strategy, regulatory compliance, and PBM/vendor contracts required. </li>
<li>Experience with CMS audits, DHCS guidelines, and California Medicaid programs required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>15 years of health plan and pharmacy experience in Medicare Part D and Medi-Cal. </li>
<li>Pharmacy Residency in Managed Care or Pharmacy Practice.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>A current, valid and unrestricted California State Pharmacy License and PharmD.</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 role.
<ul>
<li>Our current hiring range is: Pay Grade: 324 - $216,737 - $346,778 ($104.20 - $166.7201). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6749750&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 December 7, 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/6749750" target="_blank">https://jobs.caloptima.org/jobs/sr-director-pharmacy-management-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-b834097b3b6e134b8064c5e23883c40a

Sr Director, Pharmacy Management

The Juilliard School is seeking a full-time Executive Legal Administrator in the Office of the General Counsel. The Executive Legal Administrator will report to the Vice President and General Counsel.&nbsp;
The salary for this role is $58,500-$60,000.
Working at Juilliard
Founded in 1905, The Juilliard School is a world leader in performing arts education. The school’s mission is to provide the highest caliber of artistic education for gifted musicians, dancers, and actors from around the world so that they may achieve their fullest potential as artists, leaders, and global citizens.
Excellence and professionalism are important guides in how we go about our work, but we also connect to the mission as individuals in the workplace. We thrive because of our variety of backgrounds and our ability to be open and honest, and we also thrive because we enjoy each other’s company. We believe that each employee has the responsibility to help shape the Juilliard organizational culture, and we provide opportunities to participate in team-building throughout the year. Our organizational values focus on excellence, creative enterprise, and equity, diversity, inclusion, and belonging.
We encourage you to read more about how we achieve our mission on our website, juilliard.edu.&nbsp;
Role Responsibilities:
Provide executive support to the Vice President and General Counsel and the Associate General Counsel on matters relating to the chief obligations and mandates of the Office of Legal Counsel.&nbsp;Such duties include:&nbsp;
<ul>
<li>Assisting with the prioritization of tasks and strategies&nbsp;</li>
<li>Identifying and providing recommendations on legal and compliance operations</li>
<li>Managing the contracts process including submitting contracts for the General Counsel’s review, ensuring final execution by the proper signatories, obtaining proper certificates of insurance from vendors, issuing new vendor packages and tax exemption certificates, tracking the opening and expiration dates of contracts, and managing the integration of the contracts in the school’s operations&nbsp;</li>
<li>Managing special projects related to business operations</li>
<li>Interfacing with clientele, outside counsel, courts, and government agencies</li>
<li>Building and maintaining databases and files; organize and track cases and other matters; arrange for service of process; prepare, edit, and disseminate written communication to handle applications, agreements, licenses, and permits&nbsp;</li>
<li>Carrying out major assignments related to legal and factual research; prepare written reports as requested; prepare correspondence and court documents for filing</li>
<li>Managing office operations including daily management of workflow; streamlining work, and&nbsp;identifying and resolving workflow problems; using technology to improve office functions</li>
<li>Coordinating and prioritizing schedules and internal and outside obligations; arranging meetings and conferences, handling communication and travel arrangements, and processing related documentation</li>
<li>Responding to inquiries on behalf of the General Counsel and following up on communications originating from the executives’ offices or department</li>
<li>Performing other functions as assigned&nbsp;</li>
</ul>
Minimum Requirements:
<ul>
<li>Bachelor’s Degree&nbsp;</li>
<li>2-4 years of relevant experience in a university, government agency, nonprofit,&nbsp;or law office, or equivalent combination of education and experience.&nbsp;</li>
<li>Experience working independently and exercising discretion in carrying out duties.&nbsp;</li>
<li>Ability to establish and develop relationships with clientele, outside counsel, government agencies, and other entities.&nbsp;</li>
<li>Experience in handling confidential information. Highly proficient communication, writing, editing, research, and analysis skills necessary.&nbsp;</li>
<li>Ability to organize, prioritize, and carry out detailed procedures in a fast-paced work environment with shifting priorities.&nbsp;</li>
<li>Knowledge and experience in managing an office.&nbsp;</li>
<li>Relevant computer knowledge and experience, including proficiency with Microsoft Word, Excel, and Power Point software.&nbsp;Must be willing to learn and work with new computer programs and electronic technology.&nbsp;</li>
</ul>
Why Work for Juilliard?
<ul>
<li>All Juilliard performances are free to Juilliard employees</li>
<li>We’re part of the Lincoln Center campus, with significant discounts on day-of tickets to many of our partner organizations</li>
<li>Contribution to your 403(b) after 2 years of eligible employment</li>
<li>Generous days-off policy, plus winter break and summer Fridays</li>
<li>A culture of excellence, best practice, and employee engagement with like-minded colleagues</li>
</ul>
Nondiscrimination Policy:
The Juilliard School is committed to a policy of equal treatment and opportunity in every aspect of its relations with its faculty, staff, students, and other members of the Juilliard community, and does not discriminate on the basis of actual or perceived race, color, religion, creed, age, sex, national origin, alienage, ancestry, citizenship, sexual orientation or preference, gender identity, physical or mental disability, medical condition, predisposing genetic characteristics, marital status, partnership status, or any other basis prohibited by applicable local, state, or federal law. This nondiscrimination policy covers, but is not limited to, recruitment, hiring, training, benefits, rates of pay and other forms of compensation as well as student admission, access, and treatment in school programs and activities.

Executive Legal Administrator

Job Title:&nbsp; VP of MissionAdvancement&nbsp;&nbsp;
Department:&nbsp; Fundraising andDevelopment
Classification:&nbsp; Full time, Exempt
Job Grade:&nbsp; 15
Reports to: CEO &nbsp; 
APPLICATION INSTRUCTIONS:&nbsp; Apply on the <a href="https://www.eugeneymca.org/jobs" target="_blank">Eugene Family YMCA Jobs page</a>,and include a cover letter and resume.
Our Culture&nbsp;&nbsp;
Our mission and core values are brought to life by our culture.In the Y, we strive to live our cause of strengthening communitieswith purpose and intentionality every day.&nbsp; We are welcoming:we are open to all. We are a place where you can belong andbecome.&nbsp;We are genuine: we value you and embrace yourindividuality.&nbsp;We are hopeful: we believe in you and yourpotential to become a catalyst in the world.&nbsp;We are nurturing:we support you in your journey to develop your fullpotential.&nbsp;We are determined: above all else, we are on arelentless quest to make our community stronger beginning withyou.&nbsp;&nbsp;
Position Summary&nbsp;&nbsp;
This position supports the work of the Y, a leading nonprofit,charitable organization committed to strengthening communitythrough youth development, healthy living and socialresponsibility. The VP of Mission Advancement at the Eugene FamilyYMCA intentionally fosters a cause-centered culture that iswelcoming, genuine, hopeful, nurturing, and determined while alsoproviding daily engagement, advancement, and progression of the Y’sstrategic philanthropic goals.&nbsp;
Essential Functions&nbsp;&nbsp;
<ul>
<li>
Work with the CEO and Y leaders to drive the continuousimprovement process in the association using data, analysis, andkey performance indicators.&nbsp;
</li>
</ul>
<ul>
<li>
Supervise the Philanthropy department to ensure soundoperations.&nbsp; Address the root cause of systemic issues ratherthan symptoms.&nbsp;
</li>
</ul>
<ul>
<li>
Work closely with the CEO to build upon YUSA and industry bestpractices in ways that expand the Y’s relationships and engagementwith donors and funders.&nbsp;
</li>
</ul>
<ul>
<li>
Models relationship-building skills in all interactions withstaff, volunteers, donors, partners, members, and thecommunity.&nbsp;
</li>
</ul>
<ul>
<li>
Directs and administers the total operation of the Philanthropydepartment including the interpretation and execution ofestablished policies, the development of procedures and methods,staffing, evaluation of the effectiveness of the programs andoperation.&nbsp;
</li>
</ul>
<ul>
<li>
Regularly, and frequently, is working out of the office tocultivate and steward relationships with major donors.&nbsp;
</li>
</ul>
<ul>
<li>
Ensures that major donors are connected with the Y’s cause,impact, Board volunteers, and CEO.&nbsp;
</li>
</ul>
<ul>
<li>
Supports the CEO in their direct fundraising goals associatedwith donor cultivation and stewardship.&nbsp;
</li>
</ul>
<ul>
<li>
Develops and maintains key long-term relationships with donorsand prospects&nbsp;
</li>
</ul>
<ul>
<li>
Develops organizational goals and strategic plans forfundraising, balancing long-term direction and short-termrequirements; develops systems and manages resources, including thefinancial development budget, needed to carry out the fundraisingplans; develops appropriate fundraising policies and procedures forthe association.&nbsp;
</li>
</ul>
<ul>
<li>
Develops processes and is actively involved in identifying,cultivating and soliciting major gift prospects; maintains databaseresource file on top community leaders.&nbsp;
</li>
</ul>
<ul>
<li>
Directs and coordinates association capital development, annualcampaign, sponsorship and endowment programs.&nbsp;
</li>
</ul>
<ul>
<li>
Prepares and coordinates proposals for grants from governmentsources and private foundations.&nbsp;
</li>
</ul>
<ul>
<li>
Accountable for grant monitoring, compliance, andreporting.&nbsp;
</li>
</ul>
<ul>
<li>
Actively engages the board in challenging conversations anddecision making to advance the Y's impact; develops strategies toincrease volunteer involvement at all levels of financialdevelopment.&nbsp;
</li>
</ul>
<ul>
<li>
Tracks all gifts and pledges by source and purpose and providesreports as needed; ensures that gifts are used for theirdonor-intended purpose.&nbsp;
</li>
</ul>
<ul>
<li>
Provides training in fundraising; educates, motivates andprovides feedback to individuals related to best practices in thefundraising process.&nbsp;
</li>
</ul>
<ul>
<li>
Creates and implements effective communication strategies withcompelling messages that inspire others to accomplish the missionand cause with maximum impact; develops communication plans toensure members, participants, and the community understand the casefor support.&nbsp;
</li>
</ul>
<ul>
<li>
Develops systems and manages resources needed to carry out thefundraising plans; establishes and monitors the financialdevelopment department budget for the YMCA.&nbsp;
</li>
</ul>
<ul>
<li>
Develops communication plans to insure members, participants andthe community understand the case for support; works closely withthe marketing and communication team.&nbsp;
</li>
</ul>
<ul>
<li>
Works closely with the CEO and Accounting Director to developbudgets and key financial goals.&nbsp;
</li>
</ul>
<ul>
<li>
Works closely with the CEO to track key performance indicatorsand budget outcomes in ways that support the Y’s financial strengthand stability.&nbsp;
</li>
</ul>
<ul>
<li>
Vigilantly stewards the Y’s resources and financial goals bymonitoring budgets, striving to identify operationalinefficiencies, and providing recommendations to the CEO on areasto allocate resources.&nbsp;
</li>
</ul>
<ul>
<li>
Closely monitors key performance indicators and financialoutcomes and provides recommendations to the CEO when variancesversus expectations are identified.&nbsp;
</li>
</ul>
<ul>
<li>
Helps create organizational best practices and systems thatremove barriers and foster equity and inclusion for all.&nbsp;
</li>
</ul>
<ul>
<li>
Handles and resolves concerns or questions in an empathetic andprofessional manner; informs supervisor of unusual situations orunresolved issues.&nbsp;
</li>
</ul>
<ul>
<li>
Participates in various standing committees and temporary taskforces as needed.&nbsp;&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
Within 90 days of hire, completion of the following mandatorytrainings): First Aid, CPR/AED, Blood Borne Pathogen, WorkplaceDiscrimination and Harassment Prevention, and Child AbusePrevention.&nbsp;&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
Must maintain a current, valid Oregon driver’s license, a DMVdriving record that meets YMCA standards, and evidence ofinsurability throughout entire term ofemployment.&nbsp;&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
Protects organization's value by keeping informationconfidential always.&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
Performs other duties as assigned by the CEO.&nbsp;
</li>
</ul>
Minimum Qualifications&nbsp;&nbsp;
<ul>
<li>
Requires four years of training in relevant areas and relatedfields beyond high school&nbsp;
</li>
</ul>
<ul>
<li>
At least 4.5 years of directly relevant experience&nbsp;
</li>
</ul>
Preferred Qualifications&nbsp;&nbsp;
<ul>
<li>
YMCA Multi-Team Leader certification preferred for hire andrequired within 3 years of acceptance in the position if notachieved prior to hire&nbsp;
</li>
</ul>
<ul>
<li>
Experience leading annual campaigns in excess of$500,000&nbsp;
</li>
</ul>
<ul>
<li>
Experience leading capital campaigns in excess of$10,000,000&nbsp;
</li>
</ul>
<ul>
<li>
Verbal and written fluency in Spanish&nbsp;
</li>
</ul>
Work Environment &amp; PhysicalDemands&nbsp;&nbsp;
The physical demands described here are representative of thosethat must be met by an employee to successfully perform theessential functions of this job. Reasonable accommodations may bemade to enable individuals with disabilities to perform theessential functions.&nbsp;
<ul>
<li>
The physical demands described here are representative of thosethat must be met by an employee to successfully perform theessential functions of this job.&nbsp; Reasonable accommodationsmay be made to enable individuals with disabilities to perform theessential functions.&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
While performing the duties of this job, the employee isregularly required to use a computer for extended periods of timeand be able to communicate using a computer and phone/smartdevice.&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
The employee must pay frequent, and precise, attention topressing deadlines and details.&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
The employee frequently is required to sit and reach, and mustbe able to move around the work environment.&nbsp;&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
The employee must intermittently lift and/or move up to 25pounds.&nbsp;&nbsp;&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
Specific vision abilities required by this job include closevision, distance vision, and the ability to adjust.&nbsp;&nbsp;
</li>
</ul>
<ul>
<li>
The noise level in the work environment is usuallymoderate.&nbsp;&nbsp;&nbsp;&nbsp;
</li>
</ul>
Full-time Employee Benefits &amp;Discounts&nbsp;&nbsp;
<ul>
<li>
<a href="https://www.eugeneymca.org/careers" target="_blank">Careers |Eugene Family YMCA (eugeneymca.org)</a>&nbsp;&nbsp;
</li>
</ul>
The Eugene Family YMCA is an Equal EmploymentOpportunity Employer.&nbsp;&nbsp;&nbsp;
The Eugene Family YMCA is committed to creating an environmentof mutual recognition where equal employment opportunities areavailable to all applicants and teammates without regard to race,color, religion, sex, pregnancy (including childbirth, lactationand related medical conditions), national origin, age, physical andmental disability, marital status, sexual orientation, genderidentity, gender expression, genetic information (includingcharacteristics and testing), military and veteran status, and anyother characteristic protected by applicable law. The Y believesthat diversity, inclusion, and a sense of purpose and belonging inthe workplace are critical to the achievement of our mission. Weseek to recruit, develop, and retain the most talented people froma diverse candidate pool.&nbsp;&nbsp;
If you need assistance or an accommodation due to a disability,you may complete the <a>ADA Accommodation Request Form</a>; or contact us at <a href="mailto:hr@eugeneymca.org" target="_blank">hr@eugeneymca.org</a> or 541-686-9622,ext. 246.&nbsp;&nbsp;
The Y: We're for youth development, healthy living, andsocial responsibility.&nbsp;

VP of Mission Advancement

<h3>Job Description</h3>
Field Nurse Case Manager – Atlanta, GA
This is a full-time, permanent opportunity with a growing Case Management Company that offers nurses greater autonomy in managing their caseloads while still providing the ability to earn bonuses. We are seeking highly skilled, self-motivated Registered Nurses (RNs) with experience in workers’ compensation nurse case management.
As a Field Case Manager, you will evaluate, coordinate, and manage medical care for injured workers by collaborating with treating providers, therapists, employers, and insurance carriers—delivering results that truly make a difference.
 
Requirements:
<ul>
<li>Active Georgia Registered Nurse (RN) license</li>
<li>CCM (Certified Case Manager)</li>
<li>Georgia Rehabilitation Supplier designation preferred</li>
<li>Minimum 2 years of clinical nursing experience</li>
<li>Previous workers’ compensation case management experience</li>
<li>Valid driver’s license and Georgia auto insurance</li>
<li>Proficiency in Microsoft Office Suite (Outlook, Word, Excel)</li>
</ul>
 
Benefits:
<ul>
<li>Flexible hours</li>
<li>Home office equipment provided</li>
<li>Competitive salary range: $85,000–$95,000</li>
<li>Monthly bonus potential: $500–$2,500 uncapped </li>
<li>Mileage reimbursement</li>
<li>Comprehensive benefits package including health insurance and 401(k)</li>
</ul>
 
Who We Are
Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm specializing in placing healthcare professionals—from staff to leadership—in both clinical and non-clinical roles. Our comprehensive, customer-focused workforce solutions include Right-to-Hire Contract Staffing, Direct Placement, and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationwide.
Pivotal Placement Services is an Equal Opportunity Employer.

Medical Case Manager

<h3>Job Description</h3>
Field Nurse Case Manager 
Ready to make a real impact on patients’ lives? Join us as a Field Nurse Case Manager and become the trusted guide who helps injured workers navigate their recovery with confidence and care. In this role, you’ll meet patients face-to-face at physicians’ offices, advocate for their needs, and ensure they receive the best possible outcomes. We offer full-time stability, comprehensive benefits! If you’re passionate about helping people and want a career where every day makes a difference, this is your chance.
 
Requirements:
<ul>
<li>TX Registered Nurse (RN) license</li>
<li>Previous Case Management or Home Health experience</li>
<li>Ability to use Microsoft Office Suite effectively (Outlook, Word, Excel)</li>
</ul>
 
Benefits:
<ul>
<li>Home office equipment provided</li>
<li>Salary, monthly bonus, mileage reimbursement, and excellent comprehensive benefits, including Health Insurance and 401k</li>
<li>Monthly Bonus Averages between approximately $500 and $2,500 (however, they are uncapped)</li>
</ul>
 
Who We Are
Headquartered in Central Florida, Pivotal Placement Services is a full-service national workforce solutions firm specializing in placing healthcare professionals, from staff to leadership, with both clinical and non-clinical employers. Our Comprehensive and Focused Workforce Solutions include Right-to-Hire Contract Staffing, Direct Placement, and Managed Service Provider (MSP) / Vendor Managed Services (VMS) engagements nationally. Pivotal Placement Services is an Equal Opportunity Employer.

<h3>Job Description</h3>
Job Description
 
Hawai’i Health &amp; Harm Reduction Center (HHHRC) provides harm reduction-focused services to marginalized populations in Hawai’i, including people living with and/or affected by HIV, hepatitis, substance use, homelessness, and the transgender, LGBQ, and the Native Hawaiian communities. HHHRC bridges gaps and helps individuals access essential resources such as housing, health care, entitlements, and treatment. We foster health, wellness, and systemic change in Hawai’i and the Pacific through outreach, care services, advocacy, training, prevention, education, and capacity building.
 
SUMMARY OF POSITION
The HIV Medical Case Manager is responsible for providing client-centered medical case management services to clients living with HIV. This position delivers support and advocacy focused in the following areas: (1) medical &amp; dental; (2) medication; (3) financial; (4) emotional &amp; mental; (5) nutrition &amp; food; and (6) housing. The HIV Medical Case Manager must work closely with clients, case management team, patient navigators, clinical staff, partner agencies, advocacy organizations, funders, and other resource providers to support positive client health and wellness outcomes. 
This is a permanent, full-time, exempt, salaried position with HHHRC located in Honolulu, Hawaiʻi. Expected hours of work are generally between 8:30am and 5:00pm, Monday through Friday, with some evening and weekend attendance for required events. Salary is commensurate with experience. 
 
REPORTING RELATIONSHIP:
Reports to: HIV Program Manager 
Supervises: N/A 
 
ESSENTIAL DUTIES &amp; RESPONSIBILITIES:
<ul>
<li>Ensure clients are contacted.
<ul>
<li>Contact clients in accordance with HHHRC standards for acuity level and document in e2 Hawaii and EMR.</li>
<li>Meet with clients in or out of the office to address their needs.</li>
</ul>
</li>
<li>Ensure that all clients have access to medical and dental care.
<ul>
<li>Confirm that all clients have health care coverage via Medicare, Medicaid, or their employer, including COBRA.</li>
<li>Link clients to dental services via Waikiki Health (Makahiki Clinic), Queen’s Medical Center (QMC), or Department of Health (i.e., state dental).</li>
<li>Refer clients to appropriate medical providers and provide medical transportation to appointments if client has no other means of transportation.</li>
<li>Attend medical appointments if the client needs support and advocacy during an appointment.</li>
</ul>
</li>
<li>Link clients to applicable resources for HIV and other medications.
<ul>
<li>Assist eligible clients in applying for HDAP or other drug assistance programs, if needed.</li>
<li>Act as liaison between pharmacies and clients.</li>
</ul>
</li>
<li>Ensure that all clients are linked to medical care.
<ul>
<li>Stay abreast of all current HIV treatment practices and work in conjunction with the community-based nurse.</li>
<li>Conduct hospital visits for medically acute clients on consultative basis as needed.</li>
<li>Establish and maintain relationships with local clinics and hospital facilities (e.g., Clint Spencer Clinic, Waianae Coast Comprehensive Health Center, Waikiki Health Center, Queens Medical Center, Kuakini Medical Center, Straub Medical Center, Castle Hospital, and Kahi Mohala) and HIV specialists.</li>
<li>Monitor clients’ adherence to recommended medical care, including medications and doctor’s visits.</li>
<li>Establish and maintain relationships with local prison facilities (e.g., Halawa, OCCC).</li>
<li>Establish and maintain relationships with Hawaiʻi State Hospital.</li>
</ul>
</li>
<li>Ensure that all clients have access to all applicable financial benefits.
<ul>
<li>Assist eligible clients in applying for Social Security Disability Insurance (SSDI).</li>
<li>Assist eligible clients in applying for Supplemental Security Income (SSI), if needed. </li>
<li>Assist eligible clients in applying for Department of Human Services’ (DHS) monetary benefits and Food Stamps, if needed.</li>
<li>Assist eligible clients in applying for unemployment benefits, if needed.</li>
<li>Assist eligible clients in applying for Ryan White emergency funding, if needed.</li>
<li>Link clients with vocational rehabilitation programs (e.g., Social Security’s “Ticket to Work” program).</li>
<li>Advocate on behalf of clients for Worker’s Compensation benefits, long-term disability, short-term disability, or temporary disability.</li>
</ul>
</li>
<li>Provide ongoing emotional support to all clients.
<ul>
<li>Link eligible clients to psychiatric care services.</li>
<li>Link clients to other mental health resources, if needed.</li>
<li>Refer clients in crisis (e.g., suicidal) to appropriate resources.</li>
<li>Provide counseling to clients considering re-entry into the workforce.</li>
<li>Visit clients who are hospitalized or link them to the community-based nurse for intensive services.</li>
</ul>
</li>
<li>Ensure that all clients have access to nutritious food.
<ul>
<li>Link clients to Food Basket and other meal programs, or other community resources.</li>
<li>Link clients to Waikiki Health Center’s (WHC) nutritionist.</li>
<li>Assist clients in accessing HHHRC food pantry, no more than once per month.</li>
<li>Inform clients about meals served at HHHRC (i.e., Wednesday lunch) and at other community resources.</li>
</ul>
</li>
<li>Ensure that all clients have access to housing.
<ul>
<li>Assist eligible clients to access emergency or temporary shelter.</li>
<li>Assist eligible clients to obtain emergency funding for security deposits, rent, and utilities. </li>
<li>Assist eligible clients to obtain furniture and household items from Laulima, Community Clearinghouse, or other resources.</li>
<li>Advocate for clients during housing eligibility assessments (i.e., Gregory House).</li>
<li>Act as liaison between clients and landlords.</li>
<li>Assist eligible clients in navigating Section 8 application if/when Section 8 opens.</li>
</ul>
</li>
<li>Follow all administrative procedures/requirements.
<ul>
<li>Document progress notes and batch entries/service deliveries for each and every phone and face-to-face and contact with clients in e2 Hawaii and Emed Practice (EMR) within 24 hours.</li>
<li>Complete assessment within thirty (30) days of intake. Review care plan regularly. Revise care plan every six (6) months to determine eligibility.</li>
<li>Initiate discharge procedures as needed.</li>
<li>Recertify clients for HDAP every six (6) months to determine eligibility.</li>
<li>Ensure hours worked are accurately recorded in ADP timekeeping system.</li>
<li>Maintain reliable attendance and adhere to scheduled work hours.</li>
<li>Attend and participate in meetings and supervisions as required and necessary. </li>
</ul>
</li>
<li>Perform other duties as needed and assigned. Duties are subject to change.</li>
</ul>
 
GENERAL RESPONSIBILITIES:
<ul>
<li>Contribute to a safe, creative, enthusiastic, and cooperative working environment for all.</li>
<li>Work as a team with other staff and support team members.</li>
<li>Maintain appropriate professional and ethical standards while serving as a representative of HHHRC.</li>
<li>Observe and comply with all rules and regulations – such as HHHRC Code of Conduct, Drug-Free Workplace – and other administrative policies of HHHRC.</li>
<li>Abide by all policies and procedures of the HHHRC Health &amp; Safety Program and the Quality Management Program. </li>
<li>Comply with HHHRC confidentiality policy, HIPAA requirements, cultural competencies, and rights to persons served, as well as CARF standards.</li>
<li>Demonstrate steadfast understanding of, and commitment to, the Mission, Vision, and Values of HHHRC. </li>
</ul>
 
WORKING CONDITIONS/PHYSICAL DEMANDS:
<ul>
<li>Office environment: indoors, air conditioned.</li>
<li>Fieldwork: outdoors or indoors, may be subjected to unpredictable environments with extremes in temperature, noise, odors, weather conditions, etc.</li>
<li>Regular use of computer keyboards, telephone, and operating office equipment, requiring eye-hand coordination and finger dexterity.</li>
<li>Occasional lifting and carrying of supplies, equipment, files, documents, records, etc.</li>
<li>Long periods of time sitting using office equipment and computers.</li>
<li>Periods of standing and walking.</li>
<li>Requires possession of a reliable insured vehicle for traveling to off-site locations and for transporting participants.</li>
<li>Requires closed-toe shoes during working hours and comfortable and appropriate business-casual attire (walking shorts, and pertinent tee-shirt for scheduled activities/events of the day).</li>
</ul>
 
REQUIRED QUALIFICATIONS:
Knowledge/Skills/Abilities:
<ul>
<li>Willingness and ability to do outreach and engagement within communities of underserved populations, including but not limited to people living with and/or are affected by HIV, hepatitis, substance use, houselessness, and mental health challenges. </li>
<li>Excellent interpersonal, written, and verbal communication skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.</li>
<li>Demonstrated ability to function as a team member, accept constructive criticism, and provide feedback and support.</li>
<li>Ability to work well and thrive professionally in an atmosphere of significant diversity, working with marginalized populations.</li>
<li>Good listening skills, non-judgmental, flexible, and able to handle complex situations/clients.</li>
<li>Capability to self-regulate when experiencing triggers, trauma responses, or stressors to stay engaged, remain productive, and meet the needs of the team and clients.</li>
<li>Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, SharePoint, etc.).</li>
</ul>
Education/Experience:
<ul>
<li>Bachelor’s degree in Social Work (or comparable degree), or equivalent work experience. </li>
</ul>
 
PREFERRED QUALIFICATIONS:
<ul>
<li>Master’s Degree in Social Work, and/or human services background.</li>
<li>Familiarity with principles of harm reduction and the application of motivational interviewing techniques to support patient chronic disease case management. </li>
</ul>
 
REQUIRED WORK CARDS/CERTIFICATIONS:
<ul>
<li>Valid Hawaii Driver's License and clean three-year (3-year) Driver's Abstract.</li>
<li>COVID-19 Vaccination (Recommended) </li>
<li>TB Clearance</li>
<li>Hep B Clearance and/or Vaccination</li>
<li>Must pass Center for Medicare/Medicaid Services eligibility screening.</li>
</ul>
Hawaiʻi Health &amp; Harm Reduction Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

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