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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)

TITLE:&nbsp; Program of Distinction Administrative Assistant&nbsp;
DEPARTMENT: School of Aquaculture and Aquatic Sciences&nbsp;
REPORTS TO: Chair, School of Aquaculture and Aquatic Sciences&nbsp;
EFFECTIVE DATE: Position will remain open until filled&nbsp;
EMPLOYMENT STATUS:&nbsp; Full-time&nbsp;&nbsp;
EMPLOYMENT CLASSIFICATION:&nbsp; Non-Exempt &nbsp;
PRINCIPAL PURPOSE OF JOB: The Program of Distinction (POD) Administrative Assistant serves as the front desk receptionist for the Aquaculture Research Center.&nbsp; The successful candidate provides administrative support for the department/division such as answering telephones, assisting visitors, and resolving and/or referring a range of administrative problems and inquiries.&nbsp;
SCOPE OF RESPONSIBILITY: Under the direction of the Program of Distinction Coordinator, performs a variety of administrative and staff support duties for the School of Aquaculture, which requires a range of skills and knowledge of organizational policies and procedures. Assists and directs visitors, and resolves administrative inquiries; composes, edits, and proofreads correspondence and reports, and prepares a range of administrative documents some of which are of a confidential or sensitive nature.&nbsp;&nbsp;
ESSENTIAL JOB FUNCTIONS:&nbsp;&nbsp;
Serves as the front desk receptionist for the Aquaculture Research Center. Provides administrative/secretarial support for the department/division such as answering telephones, assisting visitors, and resolving and/or referring a range of administrative problems and inquiries.&nbsp;
Operates personal computer to compose and edit correspondence and/or memoranda from dictation, verbal direction, or from knowledge of established department/division policies; may prepare, transcribe, compose, type, edit, and distribute agendas and/or minutes of meetings.&nbsp;
Maintains a calendar of scheduled tours, visits, and/or other similar activities for the Aquaculture Research Center; to include coordinating with other staff to ensure tours, visitor and records are complete and updated. Maintains a sign in log.&nbsp;&nbsp;
Maintains, organizes, and schedules use of conference room.&nbsp;&nbsp;
Assists POD Coordinator in entering requisitions and submitting travel requests and vouchers for faculty, staff, and graduate students.&nbsp;&nbsp;
Establishes, maintains, and updates files, databases, records, and/or other documents; develops and maintains data and performs routine analyses and calculations in the processing of data for recurring internal reports.&nbsp;
Sorts, screens, reviews, and distributes incoming and outgoing mail; composes, prepares, or ensures timely responses to a variety of written inquiries. Maintains standing orders for UPS&nbsp;
Maintains and tracks balance of standing order with Staples. Monitors supplies, assesses needs, and submits orders to POD coordinator for placing.&nbsp;&nbsp;
Performs miscellaneous job-related duties as assigned.&nbsp;
QUALIFICATIONS: High school diploma or GED with 1 to 3 years experience directly related to the duties and responsibilities specified.&nbsp;&nbsp;
KNOWLEDGE, SKILLS, and ABILITIES:&nbsp;&nbsp;
Receptionist skills.&nbsp;
Ability to create, compose, and edit written materials.&nbsp;
Knowledge of supplies, equipment, and/or services ordering and inventory control.&nbsp;
Ability to communicate effectively, both orally and in writing.&nbsp;
Advanced word processing and/or data entry skills.&nbsp;
Ability to gather and analyze statistical data and generate reports.&nbsp;
Database management skills.&nbsp;
Ability to maintain calendars and schedule appointments.&nbsp;
Records maintenance skills.&nbsp;
Ability to record and transcribe meeting minutes.&nbsp;
Ability to gather data, compile information, and prepare reports.&nbsp;
Ability to analyze and solve problems.&nbsp;
PHYSICAL REQUIREMENTS:&nbsp;&nbsp;
Work is normally performed in a typical interior/office work environment.&nbsp;
No or very limited physical effort is required.&nbsp;
No or very limited exposure to physical risk.&nbsp;
Internal candidates are encouraged to apply.
Applicants must be authorized to work for any employer in the United States. At this time, Kentucky State University is unable to sponsor or take over the sponsorship of an employment visa

Program of Distinction Administrative Assistant

The Department of Public Administration, in the School of Public and International Affairs (SPIA) at North Carolina State University (NC State), invites applications from highly-qualified candidates for two (2) tenure-track positions at the Assistant Professor level, beginning August 2024. We seek applicants from a variety of fields within Public Administration, Public Policy, Public Affairs, or related social science disciplines whose research and teaching interests represent expertise in Nonprofits, State and Local Government, or Science and Technology Policy, with a preference for candidates who demonstrate some degree of overlap among areas and applicants engaging in rigorous and innovative research methodologies. &nbsp; Teaching responsibilities for both tenure-track positions will include graduate-level courses related to core offerings in the program and electives related to the areas of particular expertise of the selected candidate. The expected teaching load is two courses per semester (2-2 load), with the option of summer teaching. The successful candidate will also advise and mentor graduate students, which includes service on doctoral student committees. The MPA program’s mission serves pre- and in-service students, with most courses offered face-to-face in the evenings, although hybrid and online courses are also available. Ph.D. seminars are cohort-based and delivered on campus. A successful candidate will be prepared to engage students in active learning, as well as adapt their teaching styles to match the needs of our student body. &nbsp; Applicants must have a PhD in Public Administration, Public Policy, Public Affairs, or a related field by the time of appointment and must demonstrate: evidence of or strong potential for teaching excellence; strong research skills, including a record of and clear agenda for scholarly publication; and an orientation towards service to the university and broader academic and practitioner communities. &nbsp; NC State is located in Raleigh, the state capital and heart of the Research Triangle, and is ranked regularly as one of the nation’s best places to live and work. The university is consistently ranked among the top 50 public universities in the country. The Department of Public Administration also enjoys a strong national reputation, with an active faculty and strong program rankings. SPIA, in the College of Humanities and Social Sciences at NC State, also houses the Department of Political Science, the Master of International Studies Program, the Public Safety Leadership Initiative, and the Leadership in the Public Sector degree completion program. &nbsp; To apply, please visit <a href="http://jobs.ncsu.edu" target="_blank">http://jobs.ncsu.edu</a> and search for posting# PG192618EP or go directly to the posting by visiting <a href="https://jobs.ncsu.edu/postings/184407" target="_blank">https://jobs.ncsu.edu/postings/184407</a>. &nbsp; Applicants should submit:
<ol>
<li>a cover letter discussing their research accomplishments and agenda;</li>
<li>a teaching statement describing teaching interests and philosophy;</li>
<li>a current curriculum vitae;</li>
<li>at least one example of scholarly writing;</li>
<li>sample syllabi;</li>
<li>teaching evaluations (if available); and</li>
<li>the names of three references with contact information.&nbsp;</li>
</ol>
Screening will begin on 10-2-2023 and will continue until the position is filled. You may contact the search committee for this position at <a href="mailto:pubadmin_search@ncsu.edu" target="_blank">pubadmin_search@ncsu.edu</a>. NC State University is an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, gender identity, age, sexual orientation, genetic information, status as an individual with a disability, or status as a protected veteran. NC State promotes an integrated approach to problem solving that transforms lives and provides leadership for social, economic, and technological development across North Carolina and around the world. NC State’s land grant mission of teaching, research and service is dedicated to the service of North Carolina and its people. Applicants are encouraged to review the institution’s mission, vision and strategic plan, and consider how their background, interest and experience would enable them to support the university. If you have general questions about the application process, you may contact Human Resources at (919) 515-2135 or <a href="mailto:workatncstate@ncsu.edu" target="_blank">workatncstate@ncsu.edu</a>. &nbsp; Individuals with disabilities requiring disability-related accommodations in the application and interview process, please call 919-515-3148. Final candidates are subject to criminal &amp; sex offender background checks. Some vacancies also require credit or motor vehicle checks. If highest degree is from an institution outside of the U.S., final candidates are required to have their degree equivalency verified at <a href="http://www.wes.org" target="_blank">www.wes.org</a> or equivalent service. Degree(s) must be obtained prior to start date in order to meet qualifications and receive credit. NC State University participates in E-Verify. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States.

Assistant Professor of Public Administration

OUR STATEMENT The San José State University Research Foundation (SJSURF) is committed to building a work environment where everyone can show up as their own self and have an opportunity to contribute, develop, and advance in their career. Diversity, Equity, and Inclusion (DEI) are core values of the organization. We strive to attract, retain, and develop employees who reflect the community and society where we work and live. The Research Foundation aims to develop a culture where everyone feels welcome, shares their views, and where differences in backgrounds and perspectives are seen as adding value. GENERAL NATURE OF POSITION
The administrative assistant delivers support services to selected San José State University students. Responsible for recordkeeping, database, and budget management, as well as other administrative support duties as needed. &nbsp;Additionally, this person will report directly to the ASPIRE/McNair Scholars program director. &nbsp;
ESSENTIAL DUTIES &amp; RESPONSIBILITIES
<ol>
<li>Establishes and maintains a complex computerized system of files and records involving participant eligibility, demographic data, results of outcome objectives, and project contracts. Prepares written and statistical reports on student progress and outcomes as requested by the program director.</li>
<li>Maintains expenditure records by specific budget category. Creates and maintains computerized spreadsheets for budget monitoring and control. Reviews and verifies all computer printouts on program budget status prepared by SJSU Research Foundation accounting office.</li>
<li>Prepares quarterly budget reports and projected budget reports for the program director to monitor spending and the effective use of funds.</li>
<li>Assists the director in managing the program budgets and ensuring compliance with TRiO legislation and regulations as stated by the Department of Education.</li>
<li>Assists the director to ensure compliance in accordance with the grant contract with the U.S. Department of Education and SJSU Research Foundation policies and procedures.&nbsp;</li>
<li>Onboarding student staff and monitoring their daily tasks.</li>
<li>Clerical duties as assigned.</li>
<li>Coordinates office workflow and maintenance of files and records between ASPIRE and the McNair Scholars Programs.</li>
<li>Advises the director of any problem areas in handling office workflow, questions about program priorities, and suggestions for improving the efficient operation of the program office.</li>
<li>Arrange and coordinate travel and travel reimbursement for staff and participants of ASPIRE and McNair Programs.</li>
<li>Other duties as assigned.</li>
</ol>
INTERPERSONAL CONTACTS
<ol>
<li>Reports to the director ASPIRE/McNair</li>
</ol>
SUPERVISORY RESPONSIBILITIES
Minimal. Provides training to student aids that work for ASPIRE and the McNair Scholars Programs. Assists with student’s time management and schedules. &nbsp;
QUALIFICATIONS Education and Experience
<ul>
<li>Requires a minimum of an A.A. degree or equivalent. BA/S preferred.</li>
<li>Minimum of 4-6 years related experience.</li>
<li>Preferably with an accounting background or strong knowledge of handling various budgets.</li>
<li>TRIO experience preferred.</li>
</ul>
 Knowledge, Skills, and Abilities Required
<ul>
<li>Excellent written and verbal communication skills.</li>
<li>Ability to work independently in a culturally diverse setting.</li>
<li>PC experience including working knowledge of word processing, excel, and proficiency in interpreting database reporting and database management, bookkeeping and accounting.</li>
<li>Knowledge of office methods and procedures, particularly the handling of confidential student and personnel records.</li>
<li>Ability to maintain an efficient front operation with a strong service orientation to students.</li>
</ul>
 Physical Requirements
<ul>
<li>Works in standard office environment with desk, telephone, computer, bookshelves and file cabinets provided. Maintains office copier and fax machine.</li>
</ul>
 Complexity of Duties
<ul>
<li>Works with minimal direction on all assigned projects.</li>
<li>Exercises independent judgment in developing effective and productive office workflow.</li>
<li>Works independently in maintaining both electronic and hard copy records on participants.</li>
</ul>
 A background check (including a criminal records check) must be completed satisfactorily before any candidate can be offered a position with the SJSURF. Failure to satisfactorily complete the background check may affect the application status of applicants or the continued employment of current SJSURF employees who apply for the position. PLEASE NOTE:&nbsp;This position is considered a “sensitive” position by SJSURF and CSU policy. Consequently, the successful candidate must undergo and successfully complete the Live Scan (fingerprinting) background check as a condition of their employment. This background check must be completed before the actual start of employment. NOTE: This position description intends to describe the general nature and level of work being performed by people assigned to this job. It is not intended to include all duties and responsibilities. The order in which duties and responsibilities are listed is not significant. BENEFITS The San José State University Research Foundation (SJSURF) provides an excellent benefits package to benefited employees. The comprehensive benefits package includes:
<ol>
<li>Four company health insurance plans to choose from (employee contributions differ according to plan and level of coverage).</li>
<li>Employer-paid dental and vision for both employee and eligible dependents.</li>
<li>Life, AD&amp;D, LTD with supplemental coverage opportunities.</li>
<li>14 paid federal &amp; state holidays.</li>
<li>Retirement Plan: 403 (b) employee contribution plan component and a 403 (b) employer contribution component, which vests immediately.</li>
<li>Vacation-hour accruals and separate sick-hour accumulations.</li>
<li>Employee discounts.</li>
</ol>
Please visit the&nbsp;<a href="https://www.sjsu.edu/researchfoundation/employees/benefits/index.php" target="_blank">Benefits &amp; Compensation page</a>&nbsp;on the SJSU Research Foundation website for more detailed information.
APPLICATION PROCEDURE To apply for this position, an applicant must submit a formal application for employment. Select "Apply Now" to complete the SJSURF online employment application.
REASONABLE ACCOMMODATION The SJSURF is committed to providing access, equal opportunity, and reasonable accommodation for individuals with&nbsp;physical or mental disabilities in the employment, recruitment, examination, interviewing, and hiring processes. If you are a job seeker with a physical or mental disability, and you require a reasonable accommodation to search, apply, or interview&nbsp;for a job opening&nbsp;or otherwise need a reasonable accommodation during the application and hiring process,&nbsp;please contact us at&nbsp;<a href="mailto:foundation-jobs@sjsu.edu" target="_blank">foundation-jobs@sjsu.edu</a>. In the email message, please indicate your full name, phone number and the type of assistance required. You must not reveal the underlying medical reason for your needed reasonable accommodation or otherwise disclose confidential medical information.
ABOUT THE SJSU RESEARCH FOUNDATION SJSURF employment is separate and distinct from San José State University (SJSU) or state of California employment. SJSURF employees are not employees of SJSU or of the state of California. SJSURF is a non-profit auxiliary of SJSU. SJSURF is totally self-supported. The majority of the organization’s funding comes from the federal government, and other public and private entities. With annual revenues totaling over $65 million, programs managed through SJSURF cover a rich diversity of applied research, public services, and educational-related activities. &nbsp; San José State University Research Foundation is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, gender, religion, marital status, registered domestic partner status, age, national origin, ancestry, physical or mental disability, medical condition, sex, genetic information, sexual orientation, military and veteran status or any other consideration made unlawful by federal, state, or local laws. It 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. It is our policy to provide equal employment opportunities to all employees and applicants for employment. All employment practices such as recruitment, selection, promotions, and other terms and conditions of employment are administered in a manner designed to ensure that employees and applicants for employment or services are not subjected to discrimination. We are committed to providing a work environment free from discrimination and harassment, and where employees are treated with respect and dignity. This policy is in accordance with federal, state and local laws and reaffirms the Research Foundation’s continuing commitment to both the spirit and intent of equal employment opportunity laws and policies. If you have any questions or need assistance or an accommodation in completing this application, please contact Research Foundation HR at (408) 924-5582.

Administrative Assistant

Program Manager, Broker Management CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Program Manager, Broker Management and help shape the future of healthcare where you'll be an integral part of our OneCare Sales &amp; Marketing 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 be responsible for leading the development and implementation of special projects, programs and new initiatives for OneCare Sales &amp; Marketing. You will assist with the implementation of programs with departmental and organizational-wide impact and will interact with all levels of staff, network providers, health networks, field marketing organizations (FMO) and broker agencies. You will be responsible for recruitment, training and servicing of agents and brokers. You will assist in the overall day-to-day activities of the department, including sales events for our certified agents. You will also create reports and a process to ensure compliance with required regulations. 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>Ensures strategic direction of broker and agent strategy is in line with department goals and CalOptima Health's strategic priorities.</li>
<li>Makes moderate to significant improvements of processes to enhance the performance of broker management.</li>
<li>Develops and maintains reports to document broker performance and ensures brokers are meeting sales performance requirements.</li>
<li>Ensures compliance with all company, Center for Medicare &amp; Medicaid Services (CMS) and state Medi-Cal outreach regulations.</li>
<li>Monitors, analyzes and reports on health care marketplace conditions, marketplace competitors and policy developments/changes.</li>
<li>Conducts analysis and assesses information from different sources focused on health care initiatives, new programs or focus areas as assigned.</li>
<li>Develops an initial workplan for assigned projects and activities, and manages the scope, schedule, budget and quality of the project.</li>
<li>Develops workflows, key performance indicator (KPI) dashboards, procedures and/or policies and recommends changes to ensure timely, efficient and effective outputs of assigned agents and FMOs.</li>
<li>Develops specifications and/or scopes of work for requests for community activities and lead generation partnerships with agents and FMOs.</li>
<li>Drafts presentations and provides reports to support broker training and education, and field activities.</li>
<li>Attends and supports agents at community events and lead generation activities.</li>
<li>Supports project workgroup activities. </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>Assists, shares knowledge with and mentors CalOptima Health staff regarding standards, organizational understanding and relationship building to promote successful delivery of projects.</li>
<li>Documents agent activity into CalOptima Health's broker customer relationship management (CRM) system.</li>
<li>Assists management with strategic programs and pilots for the department.</li>
<li>Supports the day-to-day team administrative activities. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in public health, business, health care administration or related field PLUS 3 years of experience working in a sales role within health care programs is 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>Experience in broker management. </li>
<li>Managed care operations experience. </li>
<li>2 years of experience and aptitude for working in a highly matrixed, mission-driven organization.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>California Department of Insurance License.</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Community Worker (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6823893&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 17, 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/6823893" target="_blank">https://jobs.caloptima.org/jobs/program-manager-broker-management-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-233615021ec72e40bd65b3060f783659

Program Manager, Broker Management

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

Grievance Resolution Specialist

Claims Resolution Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Claims Resolution Specialist (Customer Service) 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. You will be the first line of contact for CalOptima Health providers. You will assist providers with questions related to the payment of claims and resolution of claims payment issues. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - Claims Support
<ul>
<li>Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.</li>
<li>Follows up with providers as needed. </li>
</ul>
</li>
<li>15% - Administrative 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>Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets.</li>
<li>Routes escalated calls to the appropriate departments and/or management. </li>
</ul>
</li>
<li>5% - Completes other duties or projects as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience in claims resolution required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>1 year of call center experience with high call volumes or customer service experience required. </li>
<li>1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required. </li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>n/a</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>n/a</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6824042&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/6824042" target="_blank">https://jobs.caloptima.org/jobs/claims-resolution-specialist-customer-service-505-city-parkway-west-california-united-states-4e3fd218-8652-4990-a6d7-d5e994892d39</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-3ee5c0b7e906304183fde18e41900662

Claims Resolution Specialist (Customer Service)

Program Manager - Quality Initiatives 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 Manager - Quality Initiatives and help shape the future of healthcare where you'll be an integral part of our Quality Analytics 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 Partial 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>
 Under the general direction of the Manager Quality Analytics, the Program Manager (Quality Initiatives) will collaborate and coordinate with leadership to design, implement and evaluate quality programs. You will coordinate, monitor and complete tasks supporting the development of quality programs and initiatives. You will monitor cross-functional projects and other assignments, including those related to department efficiency, to ensure department strategic objectives and initiatives are met. You will interact with CalOptima Health's executives and management, legal counsel and state and federal regulatory agencies. Additionally, you will support CalOptima Health staff on related projects as needed. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - Program Management
<ul>
<li>Supports with program design, development and implementation of quality programs impacting, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS), Managed Care Accountability Sets (MCAS) and Centers for Medicare &amp; Medicaid Services (CMS) STARs quality measures, consistent with the quality program and workplan.</li>
<li>Leads performance and quality improvement projects, Plan Do Study Act or other formats.</li>
<li>Supports National Committee for Quality Assurance (NCQA) accreditation standard initiatives or projects and provides analysis and evaluation of related activities as needed.</li>
<li>Assists with monitoring strategic program development, root cause analysis and impact analysis and coordinates collaborative and quality innovation pilots.</li>
<li>Reviews evidence based literature for best practices to incorporate into strategy.</li>
<li>Produces slide decks, documentation, summaries and other reports for leadership as needed.</li>
<li>Develops and oversees the process of written tools for programmatic use, including program plans, surveys and evaluation instruments.</li>
<li>Establishes key performance indicators (KPIs) and metrics to monitor project progress and performance, providing regular updates to senior management as needed.</li>
<li>Collaborates with other departments in the development of program measures of success and outcome reports for programs.</li>
<li>Maintains current knowledge of applicable regulations or clinical guidelines related to program development.</li>
<li>Stays current on the local, state and federal health care environment and identifies issues that may impact CalOptima Health's quality program and work plan. </li>
</ul>
</li>
<li>15% - Administration 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>Reviews and assists in updating policies and procedures to ensure knowledge related to assigned programs and projects is kept up to date.</li>
<li>Works with all CalOptima Health's departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in health care or a related field PLUS 3 years of related work experience in program development, program/project management or quality metrics analysis and improvement 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>Master's degree in public health, health administration or related field. </li>
<li>1 year of experience working in a highly matrixed, mission-driven organization.</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: 311 - $77,863 - $124,581 ($37.43 - $59.8947). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for 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=6824109&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, 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/6824109" target="_blank">https://jobs.caloptima.org/jobs/program-manager-quality-initiatives-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-d05cf41a9295e94082519dffd5f609d3

Program Manager - Quality Initiatives

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

Sr Manager, Member Retention &amp; Outreach (Sr Manager I) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Sr Manager, Member Retention &amp; Outreach (Sr Manager I) and help shape the future of healthcare where you'll be an integral part of our Operations 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 Partial Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 The Sr Manager for Member Retention &amp; Outreach will lead the design of and operationalize member retention and outreach programs for CalOptima's Medicare Advantage line of business. You will be responsible for developing a proactive, data-driven strategy to reduce voluntary disenrollment, improve member satisfaction and experience, and close retention gaps across the lifecycle-ensuring each interaction builds trust, supports continuity of care, and reinforces plan value. Also, you will collaborate closely with departments including Customer Service, Provider Network, Quality, Operations, and Marketing to identify and address root causes of member dissatisfaction and strengthen communication and service recovery processes. You will oversee a blended team of phone-based Retention Specialists and field-based Outreach and Engagement staff focused on reducing voluntary disenrollment, improving experience measures, and supporting member engagement. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>50% - Leadership Functions
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department. </li>
<li>Develops a comprehensive, annual Retention &amp; Outreach Strategy Plan focused on reducing controllable disenrollments, improving Stars and CAHPS performance, and strengthening overall membership stability. </li>
<li>Launches and scales member outreach and support programs - including onboarding, re-engagement, ambassador and repeat-caller initiatives- to improve retention and reduce grievances.</li>
<li>Uses data and analytics to identify predictive risk indicators, inform proactive retention efforts and guide program improvements.</li>
<li>Defines key performance indicators (KPIs) and develops dashboards and scorecards to monitor program effectiveness. </li>
<li>Utilizes matrix management and directs and/or coordinates staff throughout the organization in the implementation of strategic growth and retention plans.</li>
<li>Hires, manages, trains, reviews and sets goals for staff, including assisting in team engagement and management.</li>
<li>Manages and coaches teams through activities such as building strong relationships, documenting initiatives and discussions, identifying gaps/issues/solutions, standardizing tools/templates, implementing quality departmental initiatives and reporting to stakeholders and management team.</li>
<li>Manages and coordinates the day-to-day assignment of resources and shifts in work and priorities based on departmental needs.</li>
<li>Develops, establishes and updates department processes to maintain operational excellence.</li>
<li>Fosters ongoing relationships and mutually beneficial partnerships with internal CalOptima Health departments and external organizations.</li>
</ul>
</li>
</ul>
<ul>
<li>45% - Program Oversight
<ul>
<li>Conducts regular analysis of member disenrollment trends and collaborates with cross-functional partners as well as external provider networks to resolve systemic issues contributing to attrition.</li>
<li>Partners with Quality and Customer Service teams to align outreach with CAHPS and HOS drivers, improving key member experience domains such as access, communication, and coordination of care.</li>
<li>Collaborates with internal departments to ensure analysis and feedback informs operational, services and process improvements.</li>
<li>Establishes and leads a Community Engagement and Partnerships function that strengthens local presence and member connection by enhancing CalOptima OneCare's presence in the community through community events, educational outreach and relationship building efforts that reinforce retention goals.</li>
<li>Collaborates with CalOptima Health departments to plan and execute community outreach activities including member and provider outreach events, and to enhance visibility, trust and engagement.</li>
<li>Develops and oversees multi-touch onboarding campaigns for new members and year-round engagement campaigns (e.g., benefit education, preventive care reminders) to close gaps in care and improve experience. </li>
<li>Partners with internal teams to identify and coach lower performing medical groups and providers on strategies to improve CAHPS-related experience measures, ensuring alignment between provider performance, member satisfaction, and overall retention goals.</li>
<li>Collaborates and supports organizational member experience initiatives including but not limited to: CMS Star Program operational initiatives and Hierarchical Condition Category (HCC) maintenance and improvement activities. </li>
<li>Ensures implementation of OneCare member retention initiatives comply with CMS regulatory requirements and communicates with stakeholders regarding implementation of initiatives. </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in business administration or related field PLUS 5 years of experience in a management position of a health insurance plan, managed care organization or public agency serving Medicare and Medicaid (Medi-Cal) populations 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>4 years of progressive leadership experience, including direct supervision of staff required. </li>
<li>Valid driver's license and vehicle, an acceptable driving record and current auto insurance or other approved means of transportation, will be required for work away from the primary office 25% of the time or more.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Master's degree in business administration, marketing, gerontology, health administration or related field. </li>
<li>Medicare Advantage health plan marketing/outreach and operations, Medicare Advantage health maintenance organization (HMO) special needs plans (SNP), and Medicaid/Medi-Cal experience. </li>
<li>Project management 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: 316 - $120,881 - $193,410 ($58.12 - $92.9856). 
<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=6824074&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, 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/6824074" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-member-retention-outreach-sr-manager-i-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-8b78ae2d5d2fc74c8b365db038b0e604

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