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Auditor (GARS) 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 Auditor (GARS) and help shape the future of healthcare where you'll be an integral part of our Grievance &amp; Appeals 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. This position has been approved to be Full Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 The Auditor for Grievance and Resolution Services (GARS) will be responsible for auditing provider disputes, grievance and appeal activities performed within the GARS department to ensure compliance with CalOptima Health policies and federal and state regulatory requirements. You will support compliance across Medicare, Medi-Cal and Covered California lines of business. You will review quality assurance results, identify trends, evaluate operational risks and provide actionable recommendations to leadership. Additionally, you will audit letters for all lines of business, which involves specialized knowledge and background regarding grievance, appeals, provider dispute resolution, authorization rules, claim processing, division of financial responsibility and regulatory guidelines relevant to provider disputes, grievance and appeals. You will work independently, exercise judgment and support enterprise audit readiness efforts. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Auditing Functions
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Conducts risk-based and targeted audits of grievances, appeals and provider disputes using CalOptima Health's approved tools consistent with all regulatory, contractual and accrediting standards and requirements.</li>
<li>Assists with the development, revision and maintenance of all audit tools and score cards as necessary, to comply with state and federal regulatory requirements and internal department processes.</li>
<li>Serves as a subject matter expert in the audit and review of provider disputes, appeals and grievances.</li>
<li>Evaluates case classification accuracy, regulatory timeliness, documentation completeness and correct case closures.</li>
<li>Compiles, summarizes and presents audit findings to department leadership, including recommendations for improvement.</li>
<li>Develops and maintains reporting and trend analyses for leadership.</li>
<li>Evaluates and audits case files to ensure cases were resolved within required regulatory timeframes and determines whether the correct case classification was applied appropriately in compliance with CalOptima Health policies, procedures, and regulatory requirements.</li>
<li>Reviews grievance and appeal resolution letters to ensure member and provider concerns are accurately identified, addressed and resolved. Verifies language is appropriate for each line of business, and that complaint categories and codes are correctly applied.</li>
<li>Audits appeals and provider dispute overturn decisions and validates that they are effectuated correctly, promptly and in accordance with all requirements.</li>
<li>Collaborates with Training Program Coordinators and management to identify opportunities for training, system enhancements or workflow improvements related to grievances, appeals and provider disputes.</li>
<li>Assists in the development, review and implementation of departmental policies and procedures. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree PLUS 2 years of experience in auditing, claims, grievances and appeals or provider disputes in a health care setting required, preferably in a managed care environment; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>HMO, Medicare, Medi-Cal/Medicaid, Covered California and health services experience required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>3 years of experience auditing or reviewing provider dispute resolutions, appeals and grievances within a managed care or health plan environment. </li>
<li>Experience with both Medicare and Medi-Cal billing and claims adjudication.</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: 309 - $68,015 - $108,824 ($32.70 - $52.3192). 
<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=6842116&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 January 21, 2026 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/6842116" target="_blank">https://jobs.caloptima.org/jobs/auditor-gars-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-f5968b46f3f65748bcbd716b5b4c8f52

Auditor (GARS)

Social Worker (PACE) (Bilingual in Spanish) 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 Social Worker Bilingual in Spanish and help shape the future of healthcare where you'll be an integral part of our PACEC - Social Work 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. This position has been approved to be Full Office. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 You, as the Social Worker for the Program for All-Inclusive Care for the Elderly (PACE) will be responsible for direct social work care management services, such as participant screening, case management, counseling and referrals of participants to PACE. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>70% - Care Management
<ul>
<li>Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. </li>
<li>Participates in the Interdisciplinary Team's (IDT) initial, six (6) month and annual assessments, as well as care planning of the participant's case in accordance with industry and departmental standards. </li>
<li>Documents participant changes appropriately in the medical record in accordance with industry and departmental standards. </li>
<li>Communicates effectively and openly with other IDT members on participant status and needs.</li>
<li>Assesses patients for high-risk situations such as suicidal/homicidal ideation and abuse. Reports appropriately in accordance with legal and ethical standards of practice and engages in safety planning with participants and/or family. </li>
<li>Develops and leads group counseling and participant support group activities. </li>
<li>Refers participants and families to appropriate community agencies or facilities, serves as a liaison with such organizations and as an advocate for participants.</li>
<li>Assists in the completion of advance directives, mortuary arrangements, funeral planning and/or facility placement. </li>
<li>Aids patients/representatives in ascertaining third-party and financial resources and planning for financial coverage for services as necessary. </li>
<li>Addresses any psychosocial needs that may require social work support and intervention (e.g., anxiety, depression and other behaviors), both at the center and at home. </li>
<li>Works with PACE participants and the IDT to develop an appropriate discharge plan for disenrolling from PACE services.</li>
<li>May be required to perform home visits to private homes of CalOptima Health's PACE participants; frequent travel in Orange County. </li>
<li>Support PACE participants with care coordination needs, such as transportation, family communication, scheduling visits to the center, supporting with warm handoff process to our community partners. </li>
<li>Represents and supports the participant's care management needs by being an advocate for their care, supporting clinical needs such as supportive counseling, developing care plans to manage all psychosocial needs (i.e., establishing support systems, coping mechanisms, assessing depression, anxiety, cognition) and developing interventions. </li>
</ul>
</li>
</ul>
<ul>
<li>25% - Support Services
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department. </li>
<li>Consults with and advises staff members regarding the relationship of social, emotional and cultural factors to health and medical care and the availability of social services in the community. </li>
<li>Attends and participates in in-services, staff meetings and case conferences. Helps support the new enrollee process of enrollment into the PACE program (e.g., communicates to IDT and ensures all service gaps are covered prior to enrollment). </li>
<li>Participates in program improvement for the Social Work department. </li>
<li>Works with the Quality Improvement (QI) department to support grievances, appeals and advocacy consistent with participant's rights. </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Master's degree in social work from an accredited college or university PLUS 2 years of experience in a health-related field required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>1 year of experience working with the elderly population with relevant experience within the last 3 years required. </li>
<li>CPR and First-Aid Certification required or must be obtained within six (6) months of the date of hire. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Spanish). </li>
<li>Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 30% of the time or more.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>1 year of case management experience with the elderly population. </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: 309 - $68,015 - $108,824 ($32.70 - $52.3192). 
<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=6838638&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 January 20, 2026 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/6838638" target="_blank">https://jobs.caloptima.org/jobs/social-worker-pace-bilingual-in-spanish-pace-garden-grove-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-28aaeb01aa820543b42b01ac90c5fe90

Social Worker (PACE) (Bilingual in Spanish)

Grievance &amp; Appeals Nurse Specialist 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 Grievance &amp; Appeals Nurse Specialist and help shape the future of healthcare where you'll be an integral part of our Grievance &amp; Appeals 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. This position has been approved to be Full Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 You will participate in managing CalOptima Health's medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests. You will ensure appeals and state hearing requests are processed in accordance with regulations, compliance standards and policies and procedures. You will investigate and prepare case narratives and statements of position based on clinical information, benefits and applicable regulations related to member or provider disputes of decisions. You will clearly articulate the facts and CalOptima Health's position regarding disputes to the Administrative Law Judge hearing the case. You will be responsible for creating and reviewing resolution letters for appropriateness of clinical criteria and regulatory requirements. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - 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>Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions.</li>
<li>Ensures all cases are completed in accordance with state and federal regulatory requirements including timelines.</li>
<li>Presents recommendations based on clinical review, criteria and organizational policies to CalOptima Health's physician reviewers for final determination.</li>
<li>Resolves complex and sensitive member issues within established timelines.</li>
<li>Maintains departmental database and the integrity of records by accurately entering case actions to assigned cases.</li>
<li>Analyzes and reports cases through GARS' subcommittee.</li>
<li>Oversees state hearing cases.</li>
<li>Assists with the notification process to members or providers on the clinical decision issued.</li>
<li>Discusses appeal process, medical decisions and hearing rights with members.</li>
<li>Assists members in coordinating their services with providers and communicates the status and outcome to members.</li>
<li>Assigns position statements and represents CalOptima Health at state hearings. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Participates in departmental meetings, trainings and audits as requested. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma required PLUS 5 years of health care/managed care experience required, preferably in the following related areas of responsibility: grievances and appeals, utilization management and/or quality management; 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>Current unrestricted Registered Nurse (RN) license to practice in the state of California. </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.</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**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6827312&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 January 13, 2026 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/6827312" target="_blank">https://jobs.caloptima.org/jobs/grievance-appeals-nurse-specialist-505-city-parkway-west-california-united-states-15e815c2-3fcd-4db0-a51e-8078f72ffc27</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-6b482c6ee7f7164a8ac6b7e408651c04

Grievance & Appeals Nurse Specialist

Personal Care Coordinator Sr (Bilingual in Vietnamese) 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 (Bilingual in Vietnamese) 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. This position has been approved to be Full Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 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>
<li>Bilingual in English and Vietnamese.</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>
</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=6824141&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 January 4, 2026 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/6824141" target="_blank">https://jobs.caloptima.org/jobs/personal-care-coordinator-sr-bilingual-in-vietnamese-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-5892a69b81543e44b1cd60984a895f6c

Personal Care Coordinator Sr (Bilingual in Vietnamese)

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.
&nbsp;
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>
&nbsp;
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>
&nbsp;
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>
&nbsp;
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>
Job Description
CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in the Mid-Michigan/West Michigan area.
Work from home, and on the road. Monday – Friday, regular business hours. 
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families. Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others. This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction. 
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source</li>
<li>Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans</li>
<li>Provides assessment, planning, implementation, and evaluation of patient’s progress</li>
<li>Evaluates patient’s treatment plan for appropriateness, medical necessity, and cost effectiveness</li>
<li>Attends doctors, other providers, home and in some cases, attorney’s visits</li>
<li>Attends hospital and/or long-term facility discharge planning conferences, etc. for the purpose of determining appropriateness of care and developing an effective long-term care strategy</li>
<li>Conducts home visit for initial evaluation</li>
<li>Implements care such as negotiating the delivery of durable medical equipment and nursing services</li>
<li>This role requires regular travel, dependent on the injured worker’s injuries and needs. The employee must be available for local travel up to approximately 60% of the work week/month </li>
<li>This role may require overnight travel</li>
<li>Additional duties as required</li>
</ul>
<ul></ul>
<ul></ul>

KNOWLEDGE &amp; SKILLS:
<ul>
<li>Effective communication and multi-tasking skills in a high-volume, fast-paced, team-oriented environment</li>
<li>Ability to meet with the patient, their physicians, other healthcare providers, attorneys, advisors/clients, and coworkers</li>
<li>A cost containment background, such as utilization review or managed care is helpful</li>
<li>Strong interpersonal, time management, and organizational skills</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office, including Excel spreadsheets</li>
<li>Ability to work both independently and within a team environment</li>
</ul>

EDUCATION &amp; EXPERIENCE:
<ul>
<li>Experience as an RN Medical Case Manager is ideal, or a clinical background in orthopedics, neurology, or rehabilitation is preferred</li>
<li>Graduate of accredited school of nursing</li>
<li>Current RN Licensure in state of operation</li>
<li>Certification as a CCM, CIRS, or other Case Management certifications preferred</li>
<li>A valid driver’s license, reliable transportation, and ability to travel to assigned locations is required </li>
</ul>
<ul></ul>

PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $62,306 - $93,123
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL – Medical Case Managers:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). 
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. In addition, Medical Case Managers are eligible for bonus and will be provided state-of-the-art technological devices to ensure ready access to CorVel’s proprietary Case Management application, enabling staff to retrieve documents on the go and log activities as they occur.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote

Medical Case Manager I

<h3>Job Description</h3>
Job Description
CorVel Corporation is hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Colorado. 
Work from home, and on the road. Monday – Friday, regular business hours. 
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and their families. Your responsibilities include working closely with injured workers to facilitate their recovery. You will work collaboratively with the patient, their family, medical providers, members of our team, and others. This is a heavy local travel role responsible for working with a caseload of workers compensation injured workers within a defined jurisdiction.

ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES:
<ul>
<li>Provides in-person and telephonic Medical Case Management to individuals, involving the patient, physician, other health care providers, the employer, and the referral source</li>
<li>Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans</li>
<li>Provides assessment, planning, implementation, and evaluation of patient’s progress</li>
<li>Evaluates patient’s treatment plan for appropriateness, medical necessity, and cost effectiveness</li>
<li>Attends doctors, other providers, home and in some cases, attorney’s visits</li>
<li>Attends hospital and/or long-term facility discharge planning conferences, etc. for the purpose of determining appropriateness of care and developing an effective long-term care strategy</li>
<li>Conducts home visit for initial evaluation</li>
<li>Implements care such as negotiating the delivery of durable medical equipment and nursing services</li>
<li>This role requires regular travel, dependent on the injured worker’s injuries and needs. The employee must be available for local travel up to approximately 60% of the work week/month </li>
<li>This role may require overnight travel</li>
<li>Additional duties as required</li>
</ul>

KNOWLEDGE &amp; SKILLS:
<ul>
<li>Effective communication and multi-tasking skills in a high-volume, fast-paced, team-oriented environment</li>
<li>Ability to meet with the patient, their physicians, other healthcare providers, attorneys, advisors/clients, and coworkers</li>
<li>A cost containment background, such as utilization review or managed care is helpful</li>
<li>Strong interpersonal, time management, and organizational skills</li>
<li>Computer proficiency and technical aptitude with the ability to utilize Microsoft Office, including Excel spreadsheets</li>
<li>Ability to work both independently and within a team environment</li>
</ul>

EDUCATION &amp; EXPERIENCE:
<ul>
<li>Experience as an RN Medical Case Manager is ideal, or a clinical background in orthopedics, neurology, or rehabilitation is preferred</li>
<li>Graduate of accredited school of nursing</li>
<li>Current RN Licensure in state of operation</li>
<li>Certification as a CCM, CIRS, or other Case Management certifications preferred</li>
<li>A valid driver’s license, reliable transportation, and ability to travel to assigned locations is required </li>
</ul>

PAY RANGE:
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $62,306 – $93,123
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL – Medical Case Managers:
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). 
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. In addition, Medical Case Managers are eligible for bonus and will be provided state-of-the-art technological devices to ensure ready access to CorVel’s proprietary Case Management application, enabling staff to retrieve documents on the go and log activities as they occur.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Hybrid

<h3>Job Description</h3>
Job Description
Job Title: Medical Case Manager
Department: Case Management
Work Arrangement: Full Office
Work Schedule: Monday through Friday, 8:00 a.m. – 5:00 p.m.
 
Position Summary
One of our client is seeking a dedicated and experienced Medical Case Manager to support comprehensive care coordination and case management services. This role is responsible for assessing member needs, developing individualized care plans, coordinating services across the continuum of care, and advocating for optimal health outcomes. The Medical Case Manager will work collaboratively with members, caregivers, providers, and interdisciplinary teams to ensure high-quality, member-centered care.
Duties &amp; Responsibilities
Care Management (85%)
<ul>
<li>Conducts standardized health needs assessments and health risk assessments to identify member needs.</li>
<li>Performs comprehensive, disease-specific clinical assessments, including evaluation of:</li>
<li>Physical, functional, social, and psychological status</li>
<li>Cultural and linguistic needs</li>
<li>Caregiver resources and available benefits</li>
<li>Completes post-discharge assessments following hospital or emergency department stays to identify ongoing care needs, including:</li>
<li>Follow-up provider care and appointment coordination</li>
<li>Durable medical equipment (DME) and medical supplies</li>
<li>Community resources and support services</li>
<li>Develops, implements, and manages individualized care plans using SMART goals (Specific, Measurable, Achievable, Relevant, Time-Bound).</li>
<li>Reviews, updates, and modifies care plans continuously, at minimum annually or upon change in condition.</li>
<li>Schedules and conducts follow-ups to assess progress toward goals and identify barriers to care.</li>
<li>Provides regular outreach to assigned members and members on worklists, ensuring compliance with departmental contact standards.</li>
<li>Coordinates care and services with members, family members or representatives, healthcare providers, community supports, and Long-Term Services and Supports (LTSS).</li>
<li>Communicates effectively with physicians, specialists, community agencies, and vendors to ensure seamless service delivery.</li>
<li>Facilitates referrals to behavioral health and substance use disorder services, LTSS departments, and community resources.</li>
<li>Facilitates and participates in interdisciplinary team meetings as required.</li>
<li>Collaborates with interdepartmental teams to resolve complex cases.</li>
<li>Identifies cases requiring escalation to supervisors, managers, directors, or medical directors and follows appropriate routing and closure procedures.</li>
<li>Advocates for members by securing necessary funding, treatment alternatives, timely services, and ongoing evaluation of outcomes.</li>
</ul>
Administrative Support (10%)
<ul>
<li>Supports a mission-driven culture emphasizing quality performance, customer service, dignity, accountability, and consistency.</li>
<li>Assists the team in achieving departmental short- and long-term goals.</li>
<li>Documents all case management interventions in accordance with organizational protocols.</li>
<li>Prepares and maintains accurate, timely documentation of patient care and progress within care plans.</li>
</ul>
Other Duties (5%)
<ul>
<li>Completes additional projects and responsibilities as assigned.</li>
</ul>
Minimum Qualifications
<ul>
<li>Associate Degree in Nursing (ADN) or related field required, plus three (3) years of clinical and/or managed care experience,</li>
<li>OR an equivalent combination of education and experience sufficient to perform the essential duties.</li>
<li>Bilingual in English and Spanish (required; threshold language).</li>
</ul>
Preferred Qualifications
<ul>
<li>Bachelor of Science in Nursing (BSN) or related field.</li>
<li>Case Management Certification (CCM).</li>
</ul>
Required Licensure / Certifications
<ul>
<li>Current, unrestricted Registered Nurse (RN) license to practice in the state of California.</li>
</ul>
Knowledge, Skills &amp; Abilities
<ul>
<li>Ability to establish and maintain effective working relationships with leadership, staff, and external partners from diverse backgrounds.</li>
<li>Strong independent judgment and decision-making skills.</li>
<li>Excellent verbal and written communication skills.</li>
<li>Ability to work flexible schedules, including evenings and weekends as needed.</li>
<li>Strong organizational, analytical, problem-solving, and project management skills.</li>
<li>Ability to manage multiple priorities in a fast-paced environment.</li>
<li>Demonstrated ability to motivate and lead multi-program teams and external committees.</li>
<li>Proficiency with Microsoft Office applications (Word, Outlook, Excel, PowerPoint) and job-specific systems.</li>
</ul>
Physical Requirements (With or Without Accommodations)
<ul>
<li>Ability to read from computer screens, printed materials, and forms.</li>
<li>Clear verbal communication and adequate hearing for phone and in-person interactions.</li>
<li>Manual dexterity for typing, writing, standing, reaching, bending, crouching, kneeling, walking, and prolonged sitting.</li>
<li>Ability to lift and move objects, patients, or equipment weighing 10–25 pounds.</li>
</ul>
Work Environment
<ul>
<li>Office or Remote Location:</li>
<li>Indoor, sedentary work environment with potential travel as needed.</li>
<li>Moderate noise levels; no harmful environmental conditions.</li>
<li>Clinical indoor setting serving frail and elderly populations.</li>
<li>Potential exposure to hazardous conditions; moderate to loud noise levels.</li>
<li>Community-Based Work:</li>
<li>Combination of indoor sedentary work and occasional outdoor activities in varying temperatures.</li>
<li>Potential exposure to hazardous conditions; moderate to loud noise levels.</li>
</ul>

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