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Assistant Director - Special Facilities Management Job ID: 14653 Location: El Paso, TX Full/Part Time: Full Time Regular/Temporary: Regular About UTEP <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/" target="_blank">About the University of Texas at El Paso</a> UTEP is a comprehensive public research university that is increasing access to excellent higher education. We advance discovery of public value and positively impact the health, culture, education, and economy of the community we serve. The University of Texas at El Paso is America's leading Hispanic-serving university. Located at the westernmost tip of Texas, where three states and two countries converge along the Rio Grande, 84% of our 24,000 students are Hispanic, and more than half are the first in their families to go to college. UTEP offers 172 bachelor's, master's and doctoral degree programs at the only open-access, top-tier research university in America. <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/vpba" target="_blank">About VP Business Affairs</a> The Division of Business Affairs oversees many elements of doing business at UTEP, including human resources, the budget office, and accounting and financial services. In addition, the VPBA Office manages business contracts and agreements, institutional memberships, the University's risk management/insurance program, and the open records process. Our goal is to support the University's teaching, research and public service mission by providing superior services to the campus community. <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/sfm/" target="_blank">UTEP Special Facilities Management Department</a> The UTEP Special Facilities Management department, under the Office of Special Events, manages and maintains the Special Use Facilities at the University of Texas at El Paso. These include the Don Haskins Center, Sun Bowl Stadium, and Magoffin Auditorium. These spaces are exceptional rental venues suitable for meetings, conferences, banquets, graduations, athletic events, and more. Available to Registered Student Organizations (RSOs), University departments, Internal Organizations, and External Organizations within the wider El Paso community. Position Information Hiring Department: <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/sfm/" target="_blank">Special Facilities Management Department</a> Posting End Date: Open until filled. Hours: 40 hours per week, standard Monday- Friday 8:00am- 5:00pm, flexibility is required on evenings and weekends FLSA status: Exempt Earliest Start Date: As soon as possible. Salary: Commensurate with experience. Required Application Materials: 
<ul>
<li>Resume</li>
<li>Cover Letter</li>
<li>List of three references</li>
</ul>
 Note: To the extent that this position involves research, work, or access to critical infrastructure as referenced in Executive Order GA-48, being hired for and continuing to be employed in this position requires the ability to maintain the security or integrity of the infrastructure. The primary accountabilities are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or some of the primary accountabilities listed. Specific tasks or responsibilities will be documented in the incumbents' performance objectives as outlined by the incumbents' immediate supervisor or manager. This position is security-sensitive and subject to Texas Education Code §51.215, which authorizes the employer to obtain criminal history record information. A valid driver's license issued by the State where the applicant resides and insurability as defined in UTS 157 may be required to perform the position's essential functions. Purpose of Position Summary: Reports to, and administratively assists, the Director of Special Facility Management in all functions of the Special Events Department. The Assistant Director of Special Facility Management will oversee operations and perform management functions at venues and events in the Office of Special Events. The Assistant Director will be responsible for day-to-day operations to ensure all event needs are met. This position will work closely with staff to provide a high level customer service in order to ensure a friendly, safe environment at all events, and work with operations and technical team on developing policies and procedures, assist with planning and cost estimates. Additionally, the Assistant Director will oversee personnel staffing, job performance, budget, equipment and supplies inventory, and provide input on venue improvements. Note: The primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or some of the primary accountabilities listed below. Specific tasks or responsibilities will be documented in the incumbents' performance objectives as outlined by the incumbents' immediate supervisor or manager. This position is security-sensitive and subject to Texas Education Code §51.215, which authorizes the employer to obtain criminal history record information. A valid driver's license issued by the State where the applicant resides and insurability as defined in UTS 157 may be required to perform the position's essential functions. Statement of Duties and Responsibilities: Coordinate the events calendar and assigns daily work to supervisors. Assist with the scheduling of full time and part time staff for all events. Prioritize posts and determine suitable staffing levels with Supervisors. Assists with event layouts and planning. Assists with event execution from inception to restore. Inspect and assure that final event setup thoroughly matches the Requisition or Production Advance before client arrives. Acts as the liaison with live event production staff regarding security and event operations for ticketed and nonticketed events. Supervises and participates in Athletics Game Day Management; Serves as manager on duty, as required. Oversee the maintenance of the special use facilities grounds and facility equipment. Ensures the quality of services and workmanship by managing, planning, scheduling, supervising engineering and electrical maintenance personnel. Works with Facilities Services on campus to implement the most efficient and cost effective means for operation of mechanical systems, HVAC systems and lighting systems. Manages resources to ensure compliance with budget objectives, and standards of facility and equipment repair, equipment inventory and cost control. Responsible for ensuring that outside work performed by other departments, contractors, and/or vendors for the facilites are coordinated through the office to insure the work is conducted within prescribed industry standards and norms. Assists in seeking outside clients and events to create additional revenues for the Don Haskins Center, Sun Bowl Stadium, Magoffin Auditorium for the department. Monitors the formulation and coordination of account specifications, requirements for monetary transactions, and associated documents; reviews and approves negotiated agreements for area(s) of assigned responsibility. Reviews cost factors and estimates used in planning, organizing, and scheduling work, preparing bids, selecting vendors or subcontractors, and determining cost effectiveness. Assists in timekeeping software and payroll procedures for part time staff working in the Auxiliary Services Shared Pool. Conducts overall management of a full time supervisors, student work-studies, and internship/volunteer programs. Interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; coaching and counseling subordinates; rewarding and disciplining employees; addressing complaints and resolving problem. Understands department's role in accomplishing the University's mission. Acts as liaison between University Departments and External Clients. Participates in various committees, professional trainings, industry conferences, and conventions. knowledge of all Microsoft Office software, Autodesk CAD software, and able to learn and use institutional software systems. Promotes organization policies and procedures in compliance with local, state, and federal rules and regulations; advises University personnel regarding the development and implementation of regulatory strategy, potential areas of regulatory concern, and new government/regulatory developments. Provides training policies, standards, guidelines, and security monitoring processes in relation to general control, privacy regulations, and development and operation of the University's infrastructure. Knowledge of all Microsoft Office software and able to learn and use institutional software systems. Complies with all State and University policies. Other duties may be assigned. Supervisory Responsibilities Carries out supervisory responsibilities in accordance with the organization's objectives, policies and applicable laws. Qualifications Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required Qualifications: Education: Bachelor's Degree and Experience: Three to 5 years years of experience, and/or training to the essential duties and responsibilities; or equivalent combination of education and experience. Occasional traveling required. Preferred Qualifications: 5+ years related experience (Venue Management, Facility Management, Event Management and/or production, Event Promotion); and a minimum of (2) years of supervisory experience. Strong communicator with proven ability to drive projects assigned to completion. Excellent organizational skills and attention to detail. Ability to foster and develop good working relationships with the University's internal clients as well as clients in the entertainment sectors. Strong written and verbal communication skills. Strong customer service skills. Ability to coordinate multiple projects. Creativity and proven problem solving skills. Ability to work non-traditional hours to include evenings and weekends. Proven ability and knowledge to work with professionals in the live entertainment business. Ability to work well with faculty, staff, students, and the general public. Additional Information Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; sit; stoop, kneel and crouch. The employee is frequently required to use hands to feel; reach with hands and arms; and talk or hear. The employee is occasionally required to lift and move up to 25 pounds. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment ranges from moderate to very loud. In keeping with its access, excellence and impact mission, The University of Texas at El Paso is committed to an open, diverse, and inclusive learning and working environment that honors the talents, respects the differences, and nurtures the growth and development of all. We seek to attract faculty and staff who share our commitment. The University of Texas at El Paso is an Equal Opportunity/Affirmative Action employer. The University does not discriminate on the basis of race, color, national origin, sex, religion, age, disability, genetic information, veteran status, sexual orientation, or gender identity in employment or the provision of services in accordance with state and federal law. Discrimination on the basis of sex includes an employee's or prospective employee's right to be free from sexual harassment under Title IX of the Higher Education Amendments of 1972. Inquiries—including the filing of a Formal Complaint or reporting an incident—about the application of Title IX may be referred to the Title IX Coordinator, who can be reached by phone at (915) 747-8358, by email at <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=mailto:titleix@utep.edu" target="_blank">titleix@utep.edu</a>, or by mail at 500 W. University Ave., El Paso, TX, Kelly Hall, Room 312. For accommodation information for employees and applicants with disabilities, please contact UTEP's Equal Opportunity Office at <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=mailto:eoaa@utep.edu" target="_blank">eoaa@utep.edu</a>. To apply, visit <a href="https://apptrkr.com/6827549" target="_blank">https://zahr-prd-candidate-ada.utshare.utsystem.edu/psp/ZAHRPRDADA/EMPLOYEE/HRMS/c/HRS_HRAM_FL.HRS_CG_SEARCH_FL.GBL?Page=HRS_APP_JBPST_FL&amp;Action=U&amp;FOCUS=Applicant&amp;SiteId=2&amp;JobOpeningId=14653&amp;PostingSeq=1</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-4f7eb2d7005acd4fa18567836297b25c

Assistant Director - Special Facilities Management

Graham Ricker Air Conditioning &amp; Heating is a family-owned and operated HVAC company based in Cathedral City California that has been in business serving the Coachella Valley since 1988. We are seeking a professional and organized Office Manager to join our team. This is a Part Time position which involves front desk operations, providing exceptional customer service, and supporting office management tasks. The ideal candidate will have strong computer literacy, excellent communication skills, and experience in administrative or clerical roles. Bilingual abilities are a plus to effectively serve diverse clients and team members. This position offers an opportunity to work in a dynamic environment where organizational skills and attention to detail are highly valued.
 Responsibilities Interact with prospective clients and existing clients in a friendly and professional manner as the representative of the company. Manage phone systems, screen calls, and direct inquiries appropriately. Schedule appointments, manage calendars, and coordinate meetings using HubSpot, Google Workspace and Microsoft Office tools. Perform data entry, filing, and maintain accurate records using QuickBooks and HubSpot. Support office management tasks such as supply ordering, filing systems, and general administrative duties. Assist with bookkeeping tasks including basic bookkeeping and invoicing as needed. Provide excellent customer support via phone, email, or in person, demonstrating proper phone etiquette. Skills - Proficiency with Microsoft Office Suite (Word, Excel, Outlook) and Google Workspace applications - Experience with QuickBooks - Strong organizational skills with the ability to prioritize tasks effectively - Good typing accuracy for data entry and document preparation - Exceptional communication skills, both verbal and written; bilingual abilities are advantageous - Office management experience including filing, proofreading, and calendar management - Ability to handle customer service interactions with professionalism and patience - Strong time management skills to balance multiple responsibilities efficiently - Previous experience as a service industry Office Manager is desirable but not required
Compensation: Starting at $17 per hour for 3 to 4 days per week.

Office Manager

Facilities &amp; Support Services Coordinator 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 Facilities &amp; Support Services Coordinator and help shape the future of healthcare where you'll be an integral part of our Facilities 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>
 Under general supervision, the Facilities &amp; Support Services Coordinator will be responsible for assisting in the coordination and completion of all facility maintenance activities and issues assigned by facilities management. The incumbent will also support mailroom operations, including shipping and receiving for CalOptima Health and CalOptima Health's Program of All-Inclusive Care for the Elderly (PACE) Center. You will clean breakrooms and restock breakroom supplies daily as well as monitor physical and perimeter security functions, facility maintenance and employee safety. Also, you will coordinate efforts with other employees, departments, external vendors and contractors regarding storage, office space moves, improvements or maintenance issues at all CalOptima Health locations. 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>Coordinates and assists in the delivery and installation of office furniture and equipment.</li>
<li>Assists in off-site equipment and furniture storage inventory. </li>
<li>Supports facilities management in the coordination of space utilization and office moves with multiple departments simultaneously.</li>
<li>Monitors daily meetings and calendars to ensure sufficient time is scheduled for set-ups and delivery of necessary equipment.</li>
<li>Coordinates temporary workspace arrangements during the completion of office moves and construction projects.</li>
<li>Supports facilities management with CalOptima Health's electronic key card identification/badge system and issues badges as necessary.</li>
<li>Assists in managing employee safety programs, including ergonomic evaluations and employee safety committee.</li>
<li>Keeps mailroom and storage area neat and free from clutter to maximize safety and efficiency while maintaining an aesthetically pleasing appearance. </li>
<li>Ensures postage meter account is adequately funded and initiates a check request to replenish funds when necessary. </li>
<li>Maintains sufficient stock of mailroom supplies to avoid overstock and stock out situations, in accordance with established stock replenishment procedures.</li>
<li>Logs, receives and promptly delivers all UPS, Federal Express, Airborne and other courier delivered packages.</li>
<li>Ensures all shipments received are properly identified upon arrival and items are logged and posted into CalOptima Health's receiving database to enable prompt payment of invoices.</li>
<li>Sorts mail by the appropriate department, including special drop boxes and requests.</li>
<li>Performs regularly scheduled morning and afternoon mail deliveries to multiple departments in a timely and consistent manner.</li>
<li>Schedules and performs tasks associated with hard copy and electronic work requests promptly and efficiently. </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects or 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 in property/facilities maintenance and office support or related experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>Have access to means of transportation for work away from the primary office approximately 10% of the time required. </li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate degree in facilities management, engineering, business administration or related filed. </li>
<li>Certifications in facilities management through the Building Owners and Managers Association (BOMA), International Facility Management Association (IFMA) or similar organizations. </li>
<li>OSHA 30 certification.</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 more than 50 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 Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6827286&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/6827286" target="_blank">https://jobs.caloptima.org/jobs/facilities-support-services-coordinator-505-city-parkway-west-california-united-states-1a896b86-a35c-4ac0-8ec4-8d6d8660f03d</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-c0759de54815ca41a29abd57884b6f41

Facilities & Support Services Coordinator

Pharmacy Services Specialist (Clinical Programs - Stars) 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 Pharmacy Services Specialist (Clinical Programs - Stars) 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. 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 utilize specialized pharmacy knowledge and expertise to assist participating pharmacies, members, providers, CalOptima Health departments, health networks and other entities in assuring the efficient, timely and effective provision of pharmaceutical products and services to CalOptima Health members. You will interact with other department staff throughout the organization, as well as external contacts daily. You will be responsible for ongoing public contacts including, but are not limited to, members, individual pharmacies, member advocates, family members, health networks, Public Guardian's Office, Regional Center and other agencies. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>85% - 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>Conducts outbound calls to members, pharmacies, and providers in an effort to improve Star measure performance for medication adherence and other Star programs as needed.</li>
<li>Using a pharmacy computer program, retrieves drug-specific technical data and information necessary for the completion of departmental and interdepartmental pharmacy-related functions and operations.</li>
<li>Assists with resolution of provider and member pharmacy issues requiring specialized technical and professional knowledge and expertise, including pharmacy authorizations.</li>
<li>Supports the department with claims disputes between providing pharmacies, the pharmacy claims administrator, CalOptima Health Claims Department and other entities as necessary.</li>
<li>Interprets and articulates Pharmacy Management program policies and procedures to pharmacy providers, other providers, other CalOptima Health staff, external agencies and others as required.</li>
<li>Assists in the processing of pharmaceutical prior authorization and appeals requests as per the CalOptima Health Prior Authorization Guidelines as needed.</li>
<li>Establishes and maintains key contacts both internally and externally to assure appropriate coordination and provision of pharmacy services to CalOptima Health Members.</li>
<li>Accepts referrals from Member Services and work in conjunction with employees from this department to resolve all pharmacy-related member complaints, including those related to the pharmacy authorization process.</li>
<li>Assists pharmacies and health plans in resolving member-specific pharmacy services access issues, removing barriers to access to pharmaceutical services.</li>
<li>Identifies pharmacy-related resources and recommend new procedures, processes or activities that help assure the efficient provision of pharmacy services to members. </li>
</ul>
</li>
<li>10% - 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>Maintains documentation of the Stars adherence program and other Stars program outreach according to the internal guidelines. </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 or equivalent PLUS 1 year of experience as a pharmacy technician 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 a health-related field. </li>
<li>Pharmacy Technician Certification Board (PTCB). </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>A current, valid, unrestricted California Pharmacy Technician license 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: 301 - $47,840 - $64,584 ($23.00 - $31.0500). 
<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=6827274&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/6827274" target="_blank">https://jobs.caloptima.org/jobs/pharmacy-services-specialist-clinical-programs-stars-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-a4c910d8a384f94e85311a8402a7ab2c

Pharmacy Services Specialist (Clinical Programs - Stars)

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

Customer Service Representative Sr (General) 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 Customer Service Representative Sr (General) and help shape the future of healthcare where you'll be an integral part of our Customer Service 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 serve as the senior point of contact for CalOptima Health members and providers and will assist them with questions and/or complaints related to the Medi-Cal programs for Orange County. You will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers. 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>Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).</li>
<li>Handles and resolves escalated issues (i.e., customer service representative unable to handle/resolve).</li>
<li>Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.</li>
<li>Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed.</li>
<li>Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures. </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>Addresses member and provider inquiries, questions and concerns in all areas, including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.</li>
<li>Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.</li>
<li>Maintains departmental productivity and quality standards. </li>
</ul>
</li>
<li>5% -
<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 in customer/member service, including 1 year call center 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. Typing speed of 35 words per minute (WPM) is required. </li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>1 year of Medi-Cal/Medicaid or health services experience.</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 Partial Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6827321&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 15, 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/6827321" target="_blank">https://jobs.caloptima.org/jobs/customer-service-representative-sr-general-505-city-parkway-west-california-united-states-b07e09d5-c2af-4dd7-b1c2-df82d2d85adb</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-fa711373b232a541b02c666c089d06d2

Customer Service Representative Sr (General)

Program Assistant (Claims Administration) 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 Program Assistant (Claims Administration) and help shape the future of healthcare where you'll be an integral part of our Claims Administration 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 general supervision, the Program Assistant for Claims Administration will assist in the day-to-day activities of the department by providing administrative support to execute all responsibilities of the position. You will exercise discretion and judgment and may assist in coordinating department events. You will perform analytical and/or administrative responsibilities including claims reporting, vendor invoice validation, and data submission to external departments. 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>Coordinates calendar and schedule of the department Directors, including scheduling appointments, meetings and events.</li>
<li>Exercises discretion in committing time, evaluating needs, and making meeting arrangements.</li>
<li>Interacts with other departments, external stakeholders and CalOptima Health's general office system, and coordinates work or processes with other administrative staff within CalOptima Health.</li>
<li>Supports the managers and supervisors with claims audit file assembly and submissions.</li>
<li>Serves as the timekeeper and coordinates records retention for the department, including maintenance and coordination of retrieving files stored at an offsite facility.</li>
<li>Serves as the point of contact for claims provider escalation cases and follows through with the leadership team on deliverables.</li>
<li>Answers telephone calls and assists internal and external callers as necessary.</li>
<li>Prioritizes situations requiring the Directors' attention and either redirects them to the appropriate staff or handles them personally.</li>
<li>Handles all incoming vendor/purchase services invoices and expense reports for management personnel as appropriate which includes reconciliations of transaction records, files and counts.</li>
<li>Coordinates travel arrangements for management personnel.</li>
<li>Prepares/updates routine and ad hoc reports for all lines of business including budget and department statistics.</li>
<li>Develops materials, coordinates and analyzes data and prepares information for reports while providing administrative support for specific and/or ongoing projects.</li>
<li>Provides support to staff, including but not limited to preparing meeting materials, maintaining minutes, routing documents, performing data entry and handling incoming and outgoing correspondence per administrative policy.</li>
<li>Maintains an inventory of supplies, including monitoring needs and ordering.</li>
<li>Maintains confidential and sensitive information and files regarding management projects, policy, and personnel ensuring appropriate follow-up. </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 or equivalent PLUS 1 year of administrative support 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>2 years of administrative support experience.</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 Partial Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6823984&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 23, 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/6823984" target="_blank">https://jobs.caloptima.org/jobs/program-assistant-claims-administration-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-c7242f43b7150f4b8b4dfe64660d5230

Program Assistant (Claims Administration)

Auditor, Provider Data 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, Provider Data and help shape the future of healthcare where you'll be an integral part of our Provider Data Operations 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 be responsible for conducting ongoing data quality auditing of CalOptima Health's provider network data, which includes working with internal departments and health networks to remediate data errors. You will perform within the Provider Data Operations department to ensure that regulatory and internal guidelines are being followed in conjunction with CalOptima Health's policies and procedures. You will provide analytical and administrative support specific to the Provider Data Operations department. You will be responsible for auditing CalOptima Health's provider data, which involves specialized background or knowledge regarding contract setup, provider data requirements, directories requirements and claims processing. You will often work independently and duties include research, analysis, documentation and reporting responsibilities. 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>Assists with audits of the department's data entry activities into CalOptima Health's provider data management systems.</li>
<li>Compiles and summarizes data reports and writes audit results to internal committees and meetings with recommendations for improvement.</li>
<li>Works with health networks, providers and internal departments to obtain audit information and presents findings and recommendations as appropriate.</li>
<li>Audits processes and activities to ensure accuracy and compliance for programs, including the provider directories, onboarding and term processes, health network data for network certification and adequacy and the 274 file.</li>
<li>Works with vendors and leverages internal and external tools to audit and improve provider data accuracy and integrity.</li>
<li>Reviews and break downs regulatory requirements to identify data impact for audit process updates and implementation.</li>
<li>Assists with implementing and monitoring Corrective Action Plans for regulatory compliance and/or operational compliance.</li>
<li>Maintains a well-documented audit trail.</li>
<li>Maintains ongoing reporting formats for use in data auditing and conducts independent analysis of audit results.</li>
<li>Maintains ongoing knowledge of provider data requirements and set up within the organization's provider management systems.</li>
<li>Analyzes regulatory audit requirements, develops workplans and processes.</li>
<li>Conducts data integrity activities to support CalOptima Health's goal of maintaining a high rate of accuracy. </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 in healthcare administration or related field PLUS 2 years of experience working with provider data in a health care or managed care environment required, preferably in a related area of responsibility, such as utilization management, quality management or provider data 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>
<li>Have access to means of transportation for work away from the primary office approximately 15% of the time required. </li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Experience with regulatory compliance and provider data management.</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=6824129&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 6, 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/6824129" target="_blank">https://jobs.caloptima.org/jobs/auditor-provider-data-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-19cd4c506144ba49be9d6189022c91c4

Auditor, Provider Data

Intern (Privacy Operations) - Spring 2026 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. The submission of ALL items are required for consideration for Spring 2026: 
<ul>
<li>Completion of application </li>
<li>Resume</li>
<li>A statement of interest on why you are interested in this internship position (2 pages maximum).</li>
<li>Two (2) letters of recommendation (one academic, one professional) will be required upon confirmation of minimum qualifications.</li>
</ul>
 More About the Opportunity We are hoping you will join us as a Intern (Privacy Operations) - Spring 2026 and help shape the future of healthcare where you'll be an integral part of our OOC - Privacy 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 overall purpose and objective of the Intern (Privacy Operations) is to gain work experience in the field prior to graduating. This is an opportunity to utilize and apply the skills and knowledge learned in the classroom setting and apply it in the workforce. You will be primarily responsible for handling department assigned projects, given a moderate degree of independence. You will frequently meet with supervisors to go over the status and progress of assignments. Under general supervision, you will assist and support privacy operations, including but not limited to data analysis, release of information, policy development and regulatory compliance activities. You will participate in special projects and will develop a capstone deliverable that strengthens the Privacy department's processes. This internship will provide hands-on experience in health care privacy. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Department Support
<ul>
<li>Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists with department assigned projects.</li>
<li>Meets deadlines and completes sub-tasks of assigned projects.</li>
<li>Participates in meetings with the supervisor to go over status and progress of work. </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 or equivalent PLUS enrollment in a college or university two- or four-year degree program, an accredited vocational institution or a graduate program required, preferably with a focus in health information management.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Pursuing a law degree. </li>
<li>Pursuing a Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) certification.</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: 301 - $47,840 - $64,584 ($23.00 - $31.0500). 
<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=6824032&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 22, 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/6824032" target="_blank">https://jobs.caloptima.org/jobs/intern-privacy-operations-spring-2026-505-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-b0cf864258f75a4aaa56a0c37a2daa77

Intern (Privacy Operations) - Spring 2026

Grievance Resolution 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 Resolution 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 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 will be responsible for coordinating the grievance and appeal resolution process. You will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions and pharmacy and vision decisions. You will have frequent external contact with members and families, health care providers, health networks, third party administrators and regulators. You will collaborate with internal departments such as Customer Service, Provider Relations, Pharmacy and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals. 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>Maintains adequate information in CalOptima Health's systems; ensures data collection, summarization, integration and reporting, including case creation and management and events/activity tracking.</li>
<li>Gathers pertinent information regarding the grievances and appeals received, including member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.</li>
<li>Coordinates and participates in case discussions with operational experts to result in a final case disposition as needed.</li>
<li>Evaluates case details, proposes recommendations, or makes decisions as applicable, ensures the organization's decision is implemented according to the Grievance and Appeals policies and case resolution.</li>
<li>Develops resolution letters and correspondence to members and providers.</li>
<li>Communicates with internal and external customers to ensure timely review and resolution of grievances or appeals.</li>
<li>Initiates referrals to the Quality Improvement department as applicable and facilitates responses to members according to CalOptima Health policy. </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>Assists with health networks' compliance process.</li>
<li>Meets performance measurement goals for Grievance and Appeals Resolution Services (GARS).</li>
<li>Identifies trends and root cause of issues, proposes solutions, or escalates ongoing issues to management. </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 or equivalent PLUS 1 year of experience in grievances and appeals, claims, regulatory compliance, customer service or related field required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate degree in business, health care administration or related field. </li>
<li>Experience in health care practice standards for both government and commercial plans. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, 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 Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6824005&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 31, 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/6824005" target="_blank">https://jobs.caloptima.org/jobs/grievance-resolution-specialist-505-city-parkway-west-california-united-states-132a29ad-c6dc-41d4-83e2-463f783089a5</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-b91eeef896b1c44e908896c55c9a9cbb

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