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Assistant Director - Special Facilities Management Job ID: 14653 Location: El Paso, TX Full/Part Time: Full Time Regular/Temporary: Regular About UTEP <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/" target="_blank">About the University of Texas at El Paso</a> UTEP is a comprehensive public research university that is increasing access to excellent higher education. We advance discovery of public value and positively impact the health, culture, education, and economy of the community we serve. The University of Texas at El Paso is America's leading Hispanic-serving university. Located at the westernmost tip of Texas, where three states and two countries converge along the Rio Grande, 84% of our 24,000 students are Hispanic, and more than half are the first in their families to go to college. UTEP offers 172 bachelor's, master's and doctoral degree programs at the only open-access, top-tier research university in America. <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/vpba" target="_blank">About VP Business Affairs</a> The Division of Business Affairs oversees many elements of doing business at UTEP, including human resources, the budget office, and accounting and financial services. In addition, the VPBA Office manages business contracts and agreements, institutional memberships, the University's risk management/insurance program, and the open records process. Our goal is to support the University's teaching, research and public service mission by providing superior services to the campus community. <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/sfm/" target="_blank">UTEP Special Facilities Management Department</a> The UTEP Special Facilities Management department, under the Office of Special Events, manages and maintains the Special Use Facilities at the University of Texas at El Paso. These include the Don Haskins Center, Sun Bowl Stadium, and Magoffin Auditorium. These spaces are exceptional rental venues suitable for meetings, conferences, banquets, graduations, athletic events, and more. Available to Registered Student Organizations (RSOs), University departments, Internal Organizations, and External Organizations within the wider El Paso community. Position Information Hiring Department: <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=https://www.utep.edu/sfm/" target="_blank">Special Facilities Management Department</a> Posting End Date: Open until filled. Hours: 40 hours per week, standard Monday- Friday 8:00am- 5:00pm, flexibility is required on evenings and weekends FLSA status: Exempt Earliest Start Date: As soon as possible. Salary: Commensurate with experience. Required Application Materials: 
<ul>
<li>Resume</li>
<li>Cover Letter</li>
<li>List of three references</li>
</ul>
 Note: To the extent that this position involves research, work, or access to critical infrastructure as referenced in Executive Order GA-48, being hired for and continuing to be employed in this position requires the ability to maintain the security or integrity of the infrastructure. The primary accountabilities are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or some of the primary accountabilities listed. Specific tasks or responsibilities will be documented in the incumbents' performance objectives as outlined by the incumbents' immediate supervisor or manager. This position is security-sensitive and subject to Texas Education Code §51.215, which authorizes the employer to obtain criminal history record information. A valid driver's license issued by the State where the applicant resides and insurability as defined in UTS 157 may be required to perform the position's essential functions. Purpose of Position Summary: Reports to, and administratively assists, the Director of Special Facility Management in all functions of the Special Events Department. The Assistant Director of Special Facility Management will oversee operations and perform management functions at venues and events in the Office of Special Events. The Assistant Director will be responsible for day-to-day operations to ensure all event needs are met. This position will work closely with staff to provide a high level customer service in order to ensure a friendly, safe environment at all events, and work with operations and technical team on developing policies and procedures, assist with planning and cost estimates. Additionally, the Assistant Director will oversee personnel staffing, job performance, budget, equipment and supplies inventory, and provide input on venue improvements. Note: The primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or some of the primary accountabilities listed below. Specific tasks or responsibilities will be documented in the incumbents' performance objectives as outlined by the incumbents' immediate supervisor or manager. This position is security-sensitive and subject to Texas Education Code §51.215, which authorizes the employer to obtain criminal history record information. A valid driver's license issued by the State where the applicant resides and insurability as defined in UTS 157 may be required to perform the position's essential functions. Statement of Duties and Responsibilities: Coordinate the events calendar and assigns daily work to supervisors. Assist with the scheduling of full time and part time staff for all events. Prioritize posts and determine suitable staffing levels with Supervisors. Assists with event layouts and planning. Assists with event execution from inception to restore. Inspect and assure that final event setup thoroughly matches the Requisition or Production Advance before client arrives. Acts as the liaison with live event production staff regarding security and event operations for ticketed and nonticketed events. Supervises and participates in Athletics Game Day Management; Serves as manager on duty, as required. Oversee the maintenance of the special use facilities grounds and facility equipment. Ensures the quality of services and workmanship by managing, planning, scheduling, supervising engineering and electrical maintenance personnel. Works with Facilities Services on campus to implement the most efficient and cost effective means for operation of mechanical systems, HVAC systems and lighting systems. Manages resources to ensure compliance with budget objectives, and standards of facility and equipment repair, equipment inventory and cost control. Responsible for ensuring that outside work performed by other departments, contractors, and/or vendors for the facilites are coordinated through the office to insure the work is conducted within prescribed industry standards and norms. Assists in seeking outside clients and events to create additional revenues for the Don Haskins Center, Sun Bowl Stadium, Magoffin Auditorium for the department. Monitors the formulation and coordination of account specifications, requirements for monetary transactions, and associated documents; reviews and approves negotiated agreements for area(s) of assigned responsibility. Reviews cost factors and estimates used in planning, organizing, and scheduling work, preparing bids, selecting vendors or subcontractors, and determining cost effectiveness. Assists in timekeeping software and payroll procedures for part time staff working in the Auxiliary Services Shared Pool. Conducts overall management of a full time supervisors, student work-studies, and internship/volunteer programs. Interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; coaching and counseling subordinates; rewarding and disciplining employees; addressing complaints and resolving problem. Understands department's role in accomplishing the University's mission. Acts as liaison between University Departments and External Clients. Participates in various committees, professional trainings, industry conferences, and conventions. knowledge of all Microsoft Office software, Autodesk CAD software, and able to learn and use institutional software systems. Promotes organization policies and procedures in compliance with local, state, and federal rules and regulations; advises University personnel regarding the development and implementation of regulatory strategy, potential areas of regulatory concern, and new government/regulatory developments. Provides training policies, standards, guidelines, and security monitoring processes in relation to general control, privacy regulations, and development and operation of the University's infrastructure. Knowledge of all Microsoft Office software and able to learn and use institutional software systems. Complies with all State and University policies. Other duties may be assigned. Supervisory Responsibilities Carries out supervisory responsibilities in accordance with the organization's objectives, policies and applicable laws. Qualifications Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required Qualifications: Education: Bachelor's Degree and Experience: Three to 5 years years of experience, and/or training to the essential duties and responsibilities; or equivalent combination of education and experience. Occasional traveling required. Preferred Qualifications: 5+ years related experience (Venue Management, Facility Management, Event Management and/or production, Event Promotion); and a minimum of (2) years of supervisory experience. Strong communicator with proven ability to drive projects assigned to completion. Excellent organizational skills and attention to detail. Ability to foster and develop good working relationships with the University's internal clients as well as clients in the entertainment sectors. Strong written and verbal communication skills. Strong customer service skills. Ability to coordinate multiple projects. Creativity and proven problem solving skills. Ability to work non-traditional hours to include evenings and weekends. Proven ability and knowledge to work with professionals in the live entertainment business. Ability to work well with faculty, staff, students, and the general public. Additional Information Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; sit; stoop, kneel and crouch. The employee is frequently required to use hands to feel; reach with hands and arms; and talk or hear. The employee is occasionally required to lift and move up to 25 pounds. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment ranges from moderate to very loud. In keeping with its access, excellence and impact mission, The University of Texas at El Paso is committed to an open, diverse, and inclusive learning and working environment that honors the talents, respects the differences, and nurtures the growth and development of all. We seek to attract faculty and staff who share our commitment. The University of Texas at El Paso is an Equal Opportunity/Affirmative Action employer. The University does not discriminate on the basis of race, color, national origin, sex, religion, age, disability, genetic information, veteran status, sexual orientation, or gender identity in employment or the provision of services in accordance with state and federal law. Discrimination on the basis of sex includes an employee's or prospective employee's right to be free from sexual harassment under Title IX of the Higher Education Amendments of 1972. Inquiries—including the filing of a Formal Complaint or reporting an incident—about the application of Title IX may be referred to the Title IX Coordinator, who can be reached by phone at (915) 747-8358, by email at <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=mailto:titleix@utep.edu" target="_blank">titleix@utep.edu</a>, or by mail at 500 W. University Ave., El Paso, TX, Kelly Hall, Room 312. For accommodation information for employees and applicants with disabilities, please contact UTEP's Equal Opportunity Office at <a href="https://apptrkr.com/get_redirect.php?id=6827549&amp;targetURL=mailto:eoaa@utep.edu" target="_blank">eoaa@utep.edu</a>. To apply, visit <a href="https://apptrkr.com/6827549" target="_blank">https://zahr-prd-candidate-ada.utshare.utsystem.edu/psp/ZAHRPRDADA/EMPLOYEE/HRMS/c/HRS_HRAM_FL.HRS_CG_SEARCH_FL.GBL?Page=HRS_APP_JBPST_FL&amp;Action=U&amp;FOCUS=Applicant&amp;SiteId=2&amp;JobOpeningId=14653&amp;PostingSeq=1</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-4f7eb2d7005acd4fa18567836297b25c

Assistant Director - Special Facilities Management

Supervisor Finance (Contracts) 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 Supervisor Finance (Contracts) and help shape the future of healthcare where you'll be an integral part of our Procurement &amp; Vendor 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>
 You will be responsible for day-to-day activities of the Procurement and Vendor Management department. You will support leadership in managing procurement projects that involve highly technical specifications and complex evaluation processes. You will be responsible for highly visible procurement and contract administration that requires close communication and collaboration with CalOptima Health's leadership. You will provide ongoing contract administration and project support for the lifecycle of the resulting contract. You will serve as a subject matter expert for new projects and initiatives, and will assist leadership with developing scopes of work, preparing schedules, identifying required resources, negotiating contracts, and ensuring compliance with regulatory and statutory requirements. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>35% - Supervisory 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>Supervises the day-to-day activities of purchasing staff members, including performance measurement, evaluation and professional development.</li>
<li>Supervises, trains and provides performance goals for direct staff.</li>
<li>Develops and maintains subordinate team's work schedule to achieve optimal coverage and productivity; performs daily time management and authorization for staff.</li>
<li>Interviews potential candidates and makes recommendations for second round interviews and/or hiring of a candidate.</li>
<li>Mentors Procurement and Contract Managers, and other department staff in certain aspects of the procurement process as needed.</li>
<li>Serves as resource for the department and CalOptima Health staff regarding public procurement.</li>
<li>Participates in the initiation, development, and recommendation of contracting procedures.</li>
<li>Provides oversight and support to ensure effective communication, development, and implementation of projects, programs, and new initiatives in a cross-functional capacity.</li>
<li>Develops and maintains relationships with all stakeholders to ensure collaboration on the project or program. </li>
</ul>
</li>
<li>35% - Contract Execution and Management
<ul>
<li>Negotiates, organizes, develops and administers contracts and amendments for highly visible and complex procurement projects.</li>
<li>Provides regularly scheduled reports regarding the status of contracts and assignments.</li>
<li>Communicates with both internal and external customers to help facilitate contracting efforts.</li>
<li>Assists in the development of internal processes to monitor effectiveness and performance of existing contracts.</li>
<li>Conducts regular contract review meetings with business owners, internal leadership, and vendors as necessary to ensure compliance with contract requirements.</li>
<li>Monitors performance and utilization trends of assigned vendor contracts to assess new opportunities for cost savings and other performance issues.</li>
<li>In collaboration with leadership, leads contract related duties including contract execution, amendments, corrective action plans, contract termination, and any close-out activities. </li>
</ul>
</li>
<li>15% - Procurement
<ul>
<li>In collaboration with leadership, leads all solicitation activities including development of work scopes, release, questions and answers, proposal and bid review, vendor selection, protests, and post-solicitation de-briefings.</li>
<li>Conducts formal and informal procurements using all procurement methodologies, such as requests for proposals (RFP), requests for quotations (RFQ), qualification based selections (QBS), piggybacks, and invitations for bids (IFB).</li>
<li>Reviews requisitions and creates purchase orders for their specific projects.</li>
<li>Acts as subject matter expert for procurement-related questions and internal policies and procedures. - (Essential) </li>
</ul>
</li>
<li>10% - Project Management
<ul>
<li>Collaborates with business partners or subject-matter experts, Information Technology (IT), and other internal departments as necessary on projects that involve system impacts.</li>
<li>Ensures that projects are delivered in the agreed upon timelines and with minimal disruptions.</li>
<li>Manages multiple large complex projects and priorities simultaneously.</li>
<li>Manages changes to contracts using appropriate negotiation skills.</li>
<li>Creates and maintains comprehensive project and procurement documentation such as intake forms, project objectives, scopes of work, project plans, status reports, solicitation documentation, contract negotiations, and provides timely responses to project inquiries. </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 English, business administration or related field PLUS 5 years of public agency vendor contracting experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>2 years of experience in a lead role required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Master's degree in business administration or related field. Law degree. </li>
<li>Experience in procurement and contract negotiation in a health-care industry and HIPPA requirements with emphasis on public procurement in California. </li>
<li>Experience with IT procurement. </li>
<li>Experience with construction and public works, prevailing wage, bonding, and insurance.</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: 314 - $99,902 - $159,843 ($48.03 - $76.8476). 
<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=6829535&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 18, 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/6829535" target="_blank">https://jobs.caloptima.org/jobs/supervisor-finance-contracts-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-77a0a6b3d56f3642b60902c1c68a6625

Supervisor Finance (Contracts)

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)

Director, Actuarial Services (Director IV) 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 Director, Actuarial Services (Director IV) and help shape the future of healthcare where you'll be an integral part of our Financial Analysis 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. The Director of Actuarial Services will oversee the team responsible for leading all actuarial functions across the organization. You'll refine information into concise narratives for use by the Executive Director of Finance as well as other members of senior leadership. Additionally, you'll be responsible for providing leadership, mentoring staff and collaborating to achieve organizational goals. Finally, you'll play a critical role in advancing CalOptima Health's mission through data-driven insights and operational efficiency. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>45% - 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>Directs all aspects of actuarial functions and is accountable for the performance of the team.</li>
<li>Maintains policies, procedures and standards for all department activities.</li>
<li>Supports the Executive Director in departmental budget forecasts as needed.</li>
<li>Implements efficiency improvements such as streamlining processes.</li>
<li>Leads in the design, development, implementation and maintenance of report suites and dashboards for all levels of CalOptima Health management.</li>
<li>Hires, manages, trains, supports, develops and evaluates direct reports.</li>
<li>Performs ongoing staff and workflow analysis; establishes plans to ensure the team is adequately staffed.</li>
<li>Provides strategic direction and guidance to staff, ensuring responsibilities are carried out in alignment with established departmental and organizational policies.</li>
<li>Ensures improvement of knowledge and skill level is continuous for all department staff. </li>
</ul>
</li>
<li>45% - Financial Support
<ul>
<li>Serves as subject matter expert in producing and maintaining incurred but not reported (IBNR) reserve estimates for all lines of business to provide the Accounting department with needed information for the month-end close.</li>
<li>Directs the development of appropriate reimbursement rates and other financial contract provisions between CalOptima Health and the state of California; activities include completion of the annual Medi-Cal rate development template (RDT) and all supplemental data/rate requests as required by the state.</li>
<li>Serves as lead authority on provider capitation rate development and pricing adjustments as appropriate.</li>
<li>Directs and supports the team with the semi-annual Chronic Illness and Disability Payment System (CDPS) risk adjustment process.</li>
<li>Develops actuarial studies and related financial operational processes and analytic tools to leverage system automation and enhance accuracy for actuarial analysis.</li>
<li>Informs the Executive Director of significant changes or unusual trends in revenue, utilization and costs and proposes recommendations for consideration.</li>
</ul>
</li>
</ul>
 5% - Other 
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in finance, math, business, statistics, economics, actuarial services or other related field PLUS 7 years of actuarial or analytics experience within health care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>3 years of experience in a finance leadership role responsible for actuarial and/or analytics at a health plan, including direct supervision of staff, required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Advanced degree in a related field. </li>
<li>Tableau or Power BI experience. </li>
<li>Experience leveraging artificial intelligence or machine learning for predictive analytics model development. </li>
<li>Fellow of the Society of Actuaries (FSA).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>Associate of the Society of Actuaries (ASA).</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: 323 - $204,199 - $326,717 ($98.17 - $157.0756). 
<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=6824092&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/6824092" target="_blank">https://jobs.caloptima.org/jobs/director-actuarial-services-director-iv-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-392729b5aa16034db8b0989062a21dc7

Director, Actuarial Services (Director IV)

Director Premium Billing and Member Enrollment (Director II) CalOptima Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Director Premium Billing and Member Enrollment (Director II) 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. CalOptima Health is looking for a strategic thinker with a proven track record of leading a high-performing team to establish and manage the Enrollment and Billing function related to Health Insurance Exchange/Marketplace/Covered California product operations. As the Director, you'll serve in a leadership role to define and scale up their own team, roadmap, implement, and manage operationalization of this capability at CalOptima Health, and drive closing the people, process, and technological gaps between current state and future state operations to support enrollment and billing capabilities for the Covered California line of business. This role will be critical in standing up and continuing to successfully execute seamless enrollment, accurate billing, and regulatory compliance for the product line expansion. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>45% - 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>Directs, hires and trains department managers and staff.</li>
<li>Reviews and develops the performance of department staff and sets monthly or quarterly goals.</li>
<li>Serves as the key point of contact and advisor for executive leadership when making strategic decisions impacting the operations of the Enrollment and Billing function at CalOptima Health.</li>
<li>Develops and executes the 12-18-month roadmap to operationalize Enrollment and Billing capabilities for Covered California line of business - integrating with existing Medi-Cal workflows (where applicable), defining new operational processes, and configuring existing and/or new systems to support Covered California line of business.</li>
<li>Builds out and leads Enrollment and Billing function at CalOptima Health (i.e., recruiting, coaching, and retaining team, setting up governance structure, collaborating cross-functionally with other CalOptima Health functions to identify teams' dependencies, etc.).</li>
<li>Oversees the timely and accurate completion of Covered California enrollment capabilities inclusive of ingestion and processing of 834 enrollment files, plan changes, cancellations, and grace-period management per Covered California rules. </li>
</ul>
</li>
<li>50% - Program Oversight
<ul>
<li>Implements and oversees end-to-end premium billing capability -including invoice generation, member payments, financial reconciliation (including subsidies) and refunds-ensuring regulatory compliance.</li>
<li>Reconciles membership and premium data with Covered California and internally at CalOptima Health to support regulatory requirements and data accuracy internally on a cyclical basis.</li>
<li>Manages the end-to-end enrollment and billing processing and reconciliation for the off-exchange population.</li>
<li>Oversees integration and management of the enrollment and billing capabilities that third party vendors and delegated health network are responsible and accountable for.</li>
<li>Leads vendor and technology selection for vended capabilities and oversees implementation and integration with the organization's processes and technologies.</li>
<li>Leads the development of processes and configuration of core admin system to support implementation and ongoing optimization of the premium billing capability at CalOptima - inclusive of partnering with CalOptima Health's Information Technology teams (and potentially vendor teams), overseeing system and data integrations, etc.</li>
<li>Develops and manages the annual departmental budget. </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 business, health administration, finance, or related field PLUS 7 years in health-plan operations with at least 5 years in health insurance exchange/marketplace and/or commercial Individual and Family Plan (IFP) enrollment and billing 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>3 years of progressive management/leadership experience required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Knowledge and prior experience at a health plan leading enrollment and billing functions for an exchange or commercial product. </li>
<li>Specific experience with Covered California.</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: 321 - $181,257 - $290,011 ($87.14 - $139.4282). 
<ul>
<li>The base pay offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office </li>
</ul>
 A <a href="https://apptrkr.com/get_redirect.php?id=6824863&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> 
<ul>
<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 October 13, 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/6824863" target="_blank">https://jobs.caloptima.org/jobs/director-premium-billing-and-member-enrollment-director-ii-505-city-parkway-west-california-united-states-ee0bc9cf-38a1-4124-be64-0b430f44db76</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-facf3ef77d8102469ba67f2032a32789

Director Premium Billing and Member Enrollment (Director II)

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

Program Manager (Provider Data Operations) 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 (Provider Data Operations) 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. You will be responsible for facilitating the planning, design and implementation of programs and initiatives that impact the teams within the Provider Data Operations department. You will review and analyze regulatory and operational requirements and be responsible for full cycle implementation. You will develop a framework for execution, ensuring that programs are aligned with the organization's larger strategy, executed according to requirements and meet the needs of the department. 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 the planning, implementation and management of department initiatives and activities and works collaboratively with impacted business departments.</li>
<li>Acts as a liaison and works with the Regulatory Affairs and Compliance department to analyze, track, implement and ensure delivery of regulatory requirements impacting the Provider Data Operations functional areas.</li>
<li>Facilitates end-to-end implementation of regulatory, operational and technical requirement and ensures timelines and deliverables are fulfilled in cooperation with internal teams, third party vendors and health networks.</li>
<li>Conducts data quality checks, validates processes against requirements and identifies risks, gaps and resolutions.</li>
<li>Completes statement of work and work breakdown structure for projects and business plans for all lines of business.</li>
<li>Collaborates with other department analysts in the development of program measures of success and outcome reports for programs.</li>
<li>Creates and maintains thorough documentation, including policies and procedures, standard operating procedures (SOPs), job aids and training materials, following best practices for retention and accessibility.</li>
<li>Provides analytical support and technical expertise on requests for information from management and other staff regarding provider-related issues and trends.</li>
<li>Supports management and leadership by analyzing strategic options and providing data-driven recommendations.</li>
<li>Stays current on the local, state and federal health care environment to identify public policy and market trends that may impact CalOptima Health's provider programs and/or mission. </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 a health-related field PLUS 3 years of experience in program development, including strategic planning for a start-up program and implementing the program 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>3 years of experience working in a health plan or independent physician association (IPA)/medical group required. </li>
<li>2 years of experience working with data and reports required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Master's degree in health administration or related field. </li>
<li>Project management certificate. 
<ul>
<li>Project management experience. </li>
</ul>
</li>
<li>Experience working with provider network operations. </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=6823996&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/6823996" target="_blank">https://jobs.caloptima.org/jobs/program-manager-provider-data-operations-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-a2d05cb76b92f84a8e51e3822f450ba8

Program Manager (Provider Data Operations)

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

Sr Manager, Member Retention & Outreach (Sr Manager I)

Enterprise Release &amp; Environment Architect (ITS Architect IV) 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 Enterprise Release &amp; Environment Architect (ITS Architect IV) and help shape the future of healthcare where you'll be an integral part of our IT - Application Development 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 the end-to-end release management lifecycle and the governance of all Information Technology (IT) environments (development, testing, staging, production) within the CalOptima Health organization. The primary responsibility of this role is to plan, schedule, and coordinate software releases across multiple, complex systems, ensuring quality benchmarks and regulatory requirements are met while minimizing risk to the production environment. You are in a critical role that orchestrates software delivery across the organization while ensuring strict compliance with healthcare regulations like Health Insurance Portability and Accountability Act (HIPAA). You will act as the gatekeeper to the production environment, coordinating with various teams to protect the integrity and stability of the systems that manage patient data and core business operations. Also, you will promote operational excellence, encourage cross-functional collaboration, and ensure the stability, scalability, and efficiency of our release and environment processes. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>50% - Release Management
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. </li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. </li>
<li>Develops and maintains the forward-looking release calendar and master release schedules across the entire enterprise. </li>
<li>Plans and coordinates release windows and cycles with product, project, architecture, and business teams, managing interdependencies effectively.</li>
<li>Serves as the central source of communication regarding project plans, ongoing changes, and release statuses for all stakeholders, from technical teams to executive leadership.</li>
<li>Develops, monitors, and enforces release management processes and policies in accordance with best practices and organizational change management procedures.</li>
<li>Acts as the gatekeeper to the production environment, ensuring all changes adhere to compliance standards (e.g., HIPAA, SOX, etc.).</li>
<li>Facilitates release readiness reviews, milestone reviews, and go-live activities.</li>
<li>Manages risks, dependencies, and escalations related to releases.</li>
<li>Partners with the Development Operations team to optimize CI/CD pipelines and deployment automation.</li>
<li>Provides subject matter expertise and supports large complex projects and/or multiple smaller projects.</li>
</ul>
</li>
</ul>
<ul>
<li>45% - Environment Management
<ul>
<li>Oversees the strategy and operations for non-production environments (DEV, QA, UAT, STG).</li>
<li>Ensures environment availability, stability, and scalability to support development and testing.</li>
<li>Defines environment refresh cycles, data masking practices, and configuration standards. </li>
<li>Collaborates with the Infrastructure and Cloud teams to ensure cost-effective environment provisioning.</li>
<li>Maintains environment inventory, usage dashboards, and access controls. </li>
</ul>
</li>
</ul>
<ul>
<li>5% -
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in computer science, information technology, or related field PLUS 10 years of experience in release and/or environment management required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>5 years of experience working in Agile organizations managing releases and environments required. </li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Prior experience working in the healthcare industry, particularly with healthcare plans, to understand the unique regulatory and compliance requirements. </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: 317 - $132,969 - $212,751 ($63.93 - $102.2841). 
<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=6823971&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 25, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6823971" target="_blank">https://jobs.caloptima.org/jobs/enterprise-release-environment-architect-its-architect-iv-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-3b47a54105ebbd46965cad10e7bec0f5

Enterprise Release & Environment Architect (ITS Architect IV)

Sr Manager, Covered California (Sr. Manager II) 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, Covered California (Sr. Manager II) and help shape the future of healthcare where you'll be an integral part of our Medical Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 The Senior Manager for Covered California will lead the development and implementation of medical and behavioral health clinical operations and medical management programs for new product lines, including commercial products. You will manage regulatory and programmatic aspects, ensuring compliance and effective execution. Also, you will collaborate with health network leadership, information technology (IT), finance, compliance, and senior leaders to define program objectives, structure governance, and coordinate cross-functional efforts. YOu will be responsible for overseeing regulatory filings, program submissions, and improvement initiatives across internal and delegated entities. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>50% - Program Policy and Operations Oversight
<ul>
<li>Oversees the implementation of new programs and priorities within medical management and clinical operations to achieve gained efficiencies and focus on improvements and support of direct member care.</li>
<li>Tracks marketplace requirements, regulatory changes that impact the program, and engagements with program staff and leadership to ensure ongoing compliance and engagement.</li>
<li>Collaborates with business owners, IT, clinical project management, and consultants to define implementation requirements. </li>
<li>Supports cross-functional departments in interpreting Covered California and Department of Managed Health Care (DMHC) requirements and problem-solving issues related to the line of business, including member and provider issues.</li>
<li>Partners with Enterprise Program Management Office (EPMO) project managers and leaders to ensure program implementation and workstreams remain on track and align to the scope of the implementation project.</li>
<li>Monitors program related processes for regulatory compliance, including but not limited to ensuring adherence to policies and procedures, oversight of delegated programs, and supporting audit activities.</li>
<li>Oversees program reporting in coordination with business owners and IT.</li>
<li>Supports audit readiness and compliance through ongoing collaboration with the Office of Compliance. </li>
</ul>
</li>
</ul>
<ul>
<li>45% - Leadership Responsibilities
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department. </li>
<li>Hires, manages, trains, reviews and sets goals for the department and staff.</li>
<li>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>
<li>Manages team communications to ensure consistent operations and enterprise-wide visibility.</li>
<li>Leads implementation of new clinical and medical management programs to improve efficiency and member care.</li>
<li>Identifies and implements process improvements to support successful program launches and organizational alignment. </li>
<li>Collaborates with leadership to align staffing strategies and performance metrics with industry benchmarks.</li>
<li>Builds and maintains partnerships with internal departments, delegated entities, and external organizations.</li>
<li>Ensures program compliance with regulatory and contractual requirements through collaboration with clinical leaders. - </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in health administration, public health or related field PLUS 5 years of experience in managed care plan or other health care related field with at least 2 years of prior experience that must have been in government programs at a managed care plan, including Medicaid/Medi-Cal, Medicare, or Covered California 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>3 years of experience in a management/leadership role required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Master's degree in social work, psychology or related field. </li>
<li>Experience interfacing with local, state or federal regulators. </li>
<li>Behavioral Health clinical operations knowledge and 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: 317 - $132,969 - $212,751 ($63.93 - $102.2841). 
<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=6824119&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/6824119" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-covered-california-sr-manager-ii-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-524132ecb955344ebe1b469059a52236

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