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Personal Care Coordinator Sr CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Personal Care Coordinator Sr and help shape the future of healthcare where you'll be an integral part of our Case Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. The Personal Care Coordinator Sr will perform a wide variety of advanced support activities for plan members. You will ensure regular communication of the member's annual Health Needs Assessment (HNA) or Health Risk Assessment (HRA) and care plan with the member, primary care provider (PCP) and health care team. You will regularly assess the quality of service given to the member's care by identifying barriers and assisting in improving these barriers for all levels of care. You will maintain strong working relationships with the PCP and health care team to ensure member access to timely services and coordination of care. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Maintains strong working relationships when collaborating with the PCP and health care team to ensure timely communication of member's clinical information and ensures appropriate documentation of all interventions. Also, notifies member's care team of key event triggers.</li>
<li>Collaborates with licensed professionals in development of a care plan for each member, incorporating the HNA or HRA all assessment findings. Facilitates communication of care plan to the PCP and member, as necessary.</li>
<li>Develops and implements a member's specific care plan which includes prioritized Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) goals.</li>
<li>Facilitates and participates in interdisciplinary team meetings as applicable.</li>
<li>Processes and maintains complex or sensitive documentation of member's case and care plan within CalOptima Health's medical management system.</li>
<li>Facilitates referrals to Behavioral Health Services and identifies the need for referrals to Long-Term Support Services and community resources.</li>
<li>Facilitates transfers to member's assigned case manager in accordance with member needs, when appropriate.</li>
<li>Anticipates longer-term and more unique member needs by providing guidance in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, as appropriate.</li>
<li>Maintains compliance with established departmental productivity guidelines; compiles and conducts basic analyses and reporting of productivity metrics to management as required.</li>
<li>Coordinates and maintains cases in current case load in accordance with case management standards. Assists with collection of health risk or health needs assessments as well as gathers medical records as needed.</li>
<li>Provides regular outreach to assigned members and evaluates quality of service given to members according to department contact standards.</li>
<li>Serves as the main point of contact for assigned members to anticipate longer term member needs.</li>
<li>Works with Case Management staff to expedite the resolution of member concerns. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High School diploma or equivalent required PLUS 2 years of experience working with the needs of members, such as but not limited to pediatric members, seniors or persons with disabilities (SPD) and/or special populations (e.g., homeless or at risk of homelessness) in a customer/member service capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Bachelor's degree in healthcare management, social work, human services or related field. </li>
<li>2 years of experience with health maintenance organization (HMO), Medi-Cal and health services. </li>
<li>Experience working with individuals with behavior health conditions or substance use disorders. </li>
<li>Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). </li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6757445&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 9, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6757445" target="_blank">https://jobs.caloptima.org/jobs/personal-care-coordinator-sr-505-city-parkway-west-california-united-states-2d201e5c-584f-4826-bd77-999a1a3af3d3</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-08c2a3f2190e1348bf04fb69d1b86160

Personal Care Coordinator Sr

Member Liaison Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Member Liaison Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our CS - Member Liaison team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program. You will also serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>85% - Member Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.</li>
<li>Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.</li>
<li>Coordinates members' health care and social service needs within and outside the health network and CalOptima Health during the original interaction.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program.</li>
<li>Guides members in understanding and accessing the benefits under the Whole-Child Model program.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Initiates referrals to internal and external care management departments and government agencies.</li>
<li>Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes, helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Collaborates with interdepartmental staff in call resolution as needed.</li>
<li>Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.</li>
<li>Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience as a call center agent or customer/member services representative in health care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity. </li>
<li>Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6757493&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 9, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6757493" target="_blank">https://jobs.caloptima.org/jobs/member-liaison-specialist-customer-service-505-city-parkway-west-california-united-states-33e8b0be-b4dd-42d0-9530-e2df2d63a939</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-537ce69475a85e4fb5e079ee955c18f2

Member Liaison Specialist (Customer Service)

Facilities Coordinator CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Facilities Coordinator and help shape the future of healthcare where you'll be an integral part of our Facilities team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will be responsible for providing coordination and administrative support to the Facilities and Environmental Health &amp; Safety (EH&amp;S) departments with day-to-day facilities operations. You will coordinate activities, work with furniture vendors, handle office supplies and support emergency plans. You will also serve as a liaison between employees, management and external vendors/contractors for various projects and administrative tasks. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Program Coordination and Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Coordinates and ensures the completion of all facilities related activities as assigned and assists with EH&amp;S related activities as needed.</li>
<li>Coordinates with furniture vendors, Facilities and IT team members to assist with company-wide additions, moves and changes.</li>
<li>Works with furniture vendors and assists with the coordination of installations and deliveries.</li>
<li>Oversees asset tagging and asset disposal protocols for all furniture.</li>
<li>Monitors vendors and suppliers, ensuring compliance with scopes of work and contract terms.</li>
<li>Maintains vendor contact information current for all Facilities contracted service vendors and manages furniture warranties.</li>
<li>Supports meeting management by monitoring and scheduling calendars, allocating sufficient time for room setups and delivery of necessary equipment.</li>
<li>Coordinates bi-monthly staff meetings and agendas.</li>
<li>Orders office and building supplies for the Facilities department.</li>
<li>Supports the Program Manager with processing construction invoices for payment.</li>
<li>Assists Facilities with processing accounts payable, generating requisitions, generating and following up on work orders, preparing scopes of work and planning space utilization.</li>
<li>Monitors CalOptima Health's off-site equipment, furniture and document storage, including ensuring document inventories are kept current at all times.</li>
<li>Responds to internal 911 calls and coordinates appropriate responses to emergencies.</li>
<li>Assists with emergency preparedness protocols, staff training and manual updates.</li>
<li>Supports with annual policy reviews and updates for both Facilities and EH&amp;S departments.</li>
<li>Tracks and ensures timely payments for post office boxes.</li>
<li>Tracks postage meter balances and ensures postage is reloaded in a timely manner to avoid mailroom disruption.</li>
<li>Assists with the mass notification systems and coordinates regular meetings with the appropriate departments.</li>
<li>Maintains lost and found procedures. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of administrative support experience in facilities management or property 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>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Bachelor's degree in business administration, finance, construction management or related field. </li>
<li>International Facility Management Association (IFMA) Certified Facility Manager (CFM) or Facilities Management Professional (FMP) designation. </li>
<li>Real Property Administrator (RPA) or Certified Property Manager (CPM) designation. </li>
<li>Experience working in a public sector environment.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment more than 50 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6757467&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 9, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6757467" target="_blank">https://jobs.caloptima.org/jobs/facilities-coordinator-505-city-parkway-west-california-united-states-407de075-ca56-4131-b772-5c42ff449579</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-4cea5ddaa275b04bae097a6e4faac375

Facilities Coordinator

Actuarial Analyst Sr 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 Actuarial Analyst Sr 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. You will perform actuarial analysis on projects and support the Financial Analysis and other departments within CalOptima Health. You will also develop and design reports, create and maintain databases to support the business requirements of the team and continually improve data acquisition and reporting methods. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Actuarial Analysis 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>Prepares, analyzes and reports the monthly Incurred But Not Reported (IBNR) reserve estimate.</li>
<li>Prepares the semi-annual Chronic Illness &amp; Disability Payment System (CDPS) risk score and analyzes and reports the financial impact for the risk score adjusted capitation rate.</li>
<li>Prepares the annual rate development template/bid for all lines of business.</li>
<li>Generates and analyzes monthly enrollment, claims and utilization reports.</li>
<li>Provides support to the Accounting department in preparing reports related to claims data and/or reserve estimation for internal and external auditors.</li>
<li>Designs reports from the data warehouse as needed and ensures data integrity.</li>
<li>Analyzes and assists in making recommendations regarding the monthly IBNR reserve estimate and the financial aspects of certain major policy issues.</li>
<li>Cross-trains as backup for various departmental functions.</li>
<li>Supports with ad-hoc analysis requests. </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 actuarial science, business administration, finance, economics, mathematics or other related field PLUS 2 years of actuarial 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 actuarial exams with passing scores required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Master's degree in actuarial science, business administration, finance, economics, mathematics or other related field. </li>
<li>Experience with managed health care programs and financial modeling.</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: 312 - $84,092 - $134,548 ($40.43 - $64.6865). 
<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 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=6760887&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 October 21, 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/6760887" target="_blank">https://jobs.caloptima.org/jobs/actuarial-analyst-sr-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-3b253af7e5ab41468b638081759ce147

Actuarial Analyst Sr

Data Governance Technical Analyst (Data Warehouse Programmer/Analyst) 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 Data Governance Technical Analyst (Data Warehouse Programmer/Analyst) and help shape the future of healthcare where you'll be an integral part of our Enterprise Data and Systems Integrations 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 skilled and passionate Data Governance Technical Analyst to join our team. This position requires a blend of technical expertise, analytics experience, compliance knowledge and strong stakeholder engagement skills to establish and mature our data governance framework. You will work cross-functionally with CalOptima Health's leadership, data stewards, and security teams to establish/support data governance goals, policies, standards, processes and procedures. You will facilitate cross-domain collaboration and communication of organizational data standards. Utilizing tools such as Office 365/Power BI/SQL/SharePoint/Visio, your exemplary visual and written documentation skills will drive data stewardship and improve corporate data literacy. Also, you will have programming skills to automate processes (e.g. Python), a foundational understanding of big data platforms (e.g. Microsoft Fabric/Databricks/Snowflake), and a basic grasp of Azure fundamentals. By strengthening data accountability and operational consistency, this position enables informed healthcare decision-making, reduces internal/external regulatory risk, and improves organizational performance. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>90% - Technical Responsibilities
<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>Plays a key role in establishing an enterprise-wide data governance framework, with a focus on governing data as an enterprise asset, addressing regulatory requirements, and protection of sensitive data through organization behavior, policies, standards, principles, processes, governance metrics and related tools.</li>
<li>Serves as a liaison between Business and Technology to ensure that data related business requirements for governing data are clearly defined, communicated, and well understood and considered as part of operational prioritization and planning. </li>
<li>Establishes, manages and participates in a data stewardship program to foster a culture of data, including interviewing and engaging with data owners and data stewards across the organization.</li>
<li>Serves as the technical owner of the data catalog. Responsibilities include maintaining business and enterprise data dictionaries per CalOptima Health standards, defining and documenting metadata, ensuring consistent technical and business term mappings.</li>
<li>Creates and maintains process maps, workflows, data flow diagrams to support data stewardship, data classification and data quality processes. Communicate content effectively to both business and technical stakeholders. </li>
<li>Documents the origin, movement, transformation and enrichment of critical data assets through the organization's systems to improve transparency and traceability. </li>
<li>Queries and analyzes large-scale healthcare datasets and business logic (e.g., claims, pharmacy, patient data) using SQL and other tools.</li>
<li>Develops and maintains automation scripts to streamline data governance processes/tasks.</li>
<li>Facilitates the development and implementation of data protection standards and adoption requirements across the enterprise in partnership with the cybersecurity team.</li>
<li>Assists in regulatory compliance efforts related to data management while ensuring all data governance activities align with regulatory requirements such as HIPAA and other relevant industry standards.</li>
<li>Maintains clear, comprehensive documentation of data definitions, validation processes, analytic methodologies, and project deliverables.</li>
<li>Prepares and presents data governance maturity scorecards, KPIs/metrics/operational dashboards to senior management that track initiative effectiveness and adoption.</li>
<li>Provides employee engagement sessions to strengthen data literacy and reinforce data governance principles, practices, roles, and accountability expectations.</li>
<li>Manages multiple projects simultaneously, ensuring timely delivery and alignment with stakeholder expectations. </li>
<li>Participates in Data Governance Council meetings and contributes to policy development. </li>
</ul>
</li>
</ul>
 
<ul>
<li>10% - 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 computer science, health informatics, data analytics, or related field PLUS 5 years of professional experience in data governance, data management, or enterprise information 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>2 years of hands-on health care experience, including working with administrative and clinical data required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Certification in data management or related areas (e.g. DAMA CDMP, etc.). </li>
<li>Exposure to industry standard data catalog, automated data discovery and data lineage tools (e.g., Atlan, Microsoft Purview, Collibra, Alation, Informatica, etc.). </li>
<li>Experience creating reports using Power BI. </li>
<li>Experience scripting and automating repetitive tasks using Python. </li>
<li>Familiarity with Microsoft Azure Data &amp; Analytics ecosystems (e.g. Fabric, Synapse, Databricks). </li>
<li>Exposure to data modeling tools (e.g., Erwin, ER Studio, etc.). </li>
<li>Experience in regulated industries (e.g. government). </li>
<li>Familiarity with Agile methodologies. </li>
<li>Passionate about improving the U.S. health care system and helping ensure every patient receives the best care possible.</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 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=6757411&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 9, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6757411" target="_blank">https://jobs.caloptima.org/jobs/data-governance-technical-analyst-data-warehouse-programmer-analyst-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-df94cb910829254a9c3331e6a988cff1

Data Governance Technical Analyst (Data Warehouse Programmer/Analyst)

Medical Case Manager (High Risk Pregnancy) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Medical Case Manager (High Risk Pregnancy) and help shape the future of healthcare where you'll be an integral part of our Case Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager, High-Risk Pregnancy, will facilitate communication and coordination among all participants of the health care team and the member to ensure that the services provided promote quality, cost-effective outcomes. You will be a resource for high-risk pregnancy members, delegated plan Case Managers, Personal Care Coordinators (PCCs) and community partners to address medical, behavior and psychosocial concerns. In conjunction with other team members, you will develop and make recommendations for a comprehensive individualized care plan at all levels of care. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Case Management
<ul>
<li>Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.</li>
<li>Reviews and analyzes member health risk assessment (HRA) answers and uses clinical judgment to assign a care management level (CML).</li>
<li>Reviews Interdisciplinary Care Team (ICT) summaries and individual care plans (ICP) to ensure compliance with Centers for Medicare and Medicaid Services (CMS) and Model of Care requirements.</li>
<li>Works collaboratively with the PCCs to develop care plans for members, including those who are pregnant, using member HRA data.</li>
<li>Utilizes all other available data to formulate care plans in the absence of an HRA.</li>
<li>Ensures and facilitates communication between PCCs and delegated plan PCCs to achieve favorable member health outcomes.</li>
<li>Responds appropriately to case management triggers generated as part of the HRA or ICT process.</li>
<li>Anticipates needs for those at risk of transitioning of care and proactively support reducing the risk of re-entering a higher level of care.</li>
<li>Acts as an integral part of the team, providing verbal and written support of member needs.</li>
<li>Collaborates and communicates with the member, family, significant other(s), physicians, health network (HN) designee and other health care providers to support and accomplish goals identified on the individualized care plan in all care settings.</li>
<li>Accepts referrals for case management and serves as CalOptima Health's liaison to community agencies, organizations and state personnel.</li>
<li>Provides case management consultation and education to members, their families and the HNs.</li>
<li>Acts as an advocate to assist in the coordination of the client's identified psychosocial needs, utilizing community resources and support when appropriate.</li>
<li>Participates in proactive identification of patients appropriate for care management.</li>
<li>Initiates appropriate follow-up and the development of an individual care plan incorporating assessment, education, resource planning and coordination of services of those patients accepted for case management.</li>
<li>Assists, as requested, to collect and analyze data from initial/annual/updated health risk assessments, stratification tools, outcome measures and internal/external reports to identify trends, individual issues, problems and resources that are most appropriate to meet client's needs.</li>
<li>Develops and maintains a network of current community resources and services where members can be referred for assistance.</li>
<li>Performs regular review of cases and events to identify patterns/trends and to ensure the department's compliance with CMS, Department of Health Care Services (DHCS) and National Committee for Quality Assurance (NCQA) standards.</li>
<li>Maintains documentation of case management plans/interventions and statistics required to demonstrate activities of the ICT and the impact of case management, quality and care settings that best meet the member's needs.</li>
<li>Serves as a liaison and resource between CalOptima Health and the HNs departments, as applicable.</li>
<li>Develops and maintains a good working relationship with all areas. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Associate degree in nursing (ADN) or related field PLUS 3 years of clinical experience working with pregnancy and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Bachelor of Science degree in Nursing (BSN), public health or a related field. </li>
<li>Active and unrestricted Registered Nurse CCM certificate. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). </li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>Current unrestricted Registered Nurse (RN) license to practice in the state of California required.</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) NOTE: Training will be held in the office for the first 4 weeks from 8:00am - 5:00pm, on Tuesdays and Thursdays. </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6753575&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 8, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6753575" target="_blank">https://jobs.caloptima.org/jobs/medical-case-manager-high-risk-pregnancy-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-2aff510fae8fb6448a86895170bc50fc

Medical Case Manager (High Risk Pregnancy)

Medical Case Manager (LVN) (High Risk Pregnancy) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Medical Case Manager (LVN) (High Risk Pregnancy) and help shape the future of healthcare where you'll be an integral part of our Case Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager (LVN), High-Risk Pregnancy, will facilitate communication and coordination among all participants of the health care team and the member to ensure that the services provided promote quality, cost-effective outcomes. You will be a resource for high-risk pregnancy members, delegated plan Case Managers, Personal Care Coordinators (PCCs) and community partners to address medical, behavior and psychosocial concerns. In conjunction with other team members, you will develop and make recommendations for a comprehensive individualized care plan at all levels of care. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Case Management
<ul>
<li>Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.</li>
<li>Reviews and analyzes member health risk assessment (HRA) answers and uses clinical judgment to assign a care management level (CML).</li>
<li>Reviews Interdisciplinary Care Team (ICT) summaries and individual care plans (ICP) to ensure compliance with Centers for Medicare and Medicaid Services (CMS) and Model of Care requirements.</li>
<li>Works collaboratively with the PCCs to develop care plans for members, including those who are pregnant, using member HRA data.</li>
<li>Utilizes all other available data to formulate care plans in the absence of an HRA.</li>
<li>Ensures and facilitates communication between PCCs and delegated plan PCCs to achieve favorable member health outcomes.</li>
<li>Responds appropriately to case management triggers generated as part of the HRA or ICT process.</li>
<li>Anticipates needs for those at risk of transitioning of care and proactively support reducing the risk of re-entering a higher level of care.</li>
<li>Acts as an integral part of the team, providing verbal and written support of member needs.</li>
<li>Collaborates and communicates with the member, family, significant other(s), physicians, health network (HN) designee and other health care providers to support and accomplish goals identified on the individualized care plan in all care settings.</li>
<li>Accepts referrals for case management and serves as CalOptima Health's liaison to community agencies, organizations and state personnel.</li>
<li>Provides case management consultation and education to members, their families and the HNs.</li>
<li>Acts as an advocate to assist in the coordination of the client's identified psychosocial needs, utilizing community resources and support when appropriate.</li>
<li>Participates in proactive identification of patients appropriate for care management.</li>
<li>Initiates appropriate follow-up and the development of an individual care plan incorporating assessment, education, resource planning and coordination of services of those patients accepted for case management.</li>
<li>Assists, as requested, to collect and analyze data from initial/annual/updated health risk assessments, stratification tools, outcome measures and internal/external reports to identify trends, individual issues, problems and resources that are most appropriate to meet client's needs.</li>
<li>Develops and maintains a network of current community resources and services where members can be referred for assistance.</li>
<li>Performs regular review of cases and events to identify patterns/trends and to ensure the department's compliance with CMS, Department of Health Care Services (DHCS) and National Committee for Quality Assurance (NCQA) standards.</li>
<li>Maintains documentation of case management plans/interventions and statistics required to demonstrate activities of the ICT and the impact of case management, quality and care settings that best meet the member's needs.</li>
<li>Serves as a liaison and resource between CalOptima Health and the HNs departments, as applicable.</li>
<li>Develops and maintains a good working relationship with all areas. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 1 year of clinical experience working with pregnancy and/or managed care experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate degree in nursing (ADN), public health or a related field. </li>
<li>Active and unrestricted Registered Nurse CCM certificate. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>Current unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required.</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) ***Training will be held in the office for the first 4 weeks from 8:00am - 5:00pm, on Tuesdays and Thursdays. </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6753587&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 8, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6753587" target="_blank">https://jobs.caloptima.org/jobs/medical-case-manager-lvn-high-risk-pregnancy-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-6f46a4a5bd072343aa775a9395f14428

Medical Case Manager (LVN) (High Risk Pregnancy)

Sr Director, Pharmacy Management CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Sr Director, Pharmacy Management and help shape the future of healthcare where you'll be an integral part of our Pharmacy Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Under the direction of the CMO, you will be responsible for strategic planning and leadership, regulatory compliance, and management as well as operational oversight for all aspects of pharmacy services within a managed care organization, including Medi-Cal, Medicare Advantage Part D (HMO D-SNP), and Covered California. You will also be responsible for designing, implementing, and evaluating pharmacy benefit programs that align with clinical goals, financial sustainability, regulatory compliance, and member outcomes. You will develop and direct formulary strategy, utilization management, quality initiatives, and vendor performance-including Pharmacy Benefit Manager (PBM) oversight-and serves as the organization's principal pharmacy advisor to executive leadership and the Board of Directors. You will ensure compliance with Centers for Medicare &amp; Medicaid Services (CMS), state Medicaid, Covered California, Department of Managed Health Care (DMHC), and National Committee for Quality Assurance (NCQA) standards while advancing initiatives to improve population health, medication adherence, and cost-effective drug use. You will be accountable for pharmacy-related quality programs and will contribute to the improvement of CalOptima Health's quality performance including but not limited to Star ratings. This position will require a dynamic, data-driven leader with extensive experience in managed care pharmacy, cross-functional collaboration, and a strong understanding of the regulatory environment governing Medicare, Medicaid, and commercial health plans. You will ensure alignment with CalOptima Health's mission to serve member health with excellence and dignity, respecting the value and needs of each person through collaboration with our providers, community partners and local stakeholders. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>60% - Leadership Responsibilities
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and oversees the Pharmacy department in carrying out all department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals and priorities.</li>
<li>Leads, develops, and implements pharmacy business plan and strategic initiatives in alignment with CalOptima Health's objectives and community mission, while taking ownership of both short- and long-term direction of the department.</li>
<li>Supports CalOptima Health's quality goals by driving improvements in Covered California Quality Transformation Initiative, Star Ratings, Pharmacy Quality Alliance (PQA) adherence measures, Healthcare Effectiveness Data and Information Set (HEDIS) outcomes, and other not yet identified quality programs.</li>
<li>Delivers effective service management through the definition and adoption of a governance practice that uses key performance indicators (KPIs) and metrics to track and measure the quality of service. Continually monitors metrics and the integration of them with key accountabilities to ensure consistency of approach and continual service improvement.</li>
<li>Oversees and ensures pharmacy management operational compliance with organizational standards, policies and procedures, and regulatory requirements while maintaining knowledge of related changes and developing effective communication plans as needed.</li>
<li>Serves as pharmacy subject matter expert to the executive team and CalOptima Health's Board of Directors.</li>
<li>Directs all aspects of running an efficient Pharmacy team, including hiring, supervising, coaching, developing, disciplining, motivating as well as attracting and retaining a high-performing team that achieves department goals that are in alignment with the CalOptima Health Strategic Plan.</li>
<li>Develops, implements, and upholds departmental policies and procedures.</li>
<li>Collaborates with CMO to develop and monitor annual budgets and corresponding business cases to ensure utilization meets strategic, operational, and budgetary goals.</li>
<li>Collaborates with CMO to manage staffing model and succession planning, and monitors related resource allocation for the department.</li>
<li>Collaborates with CMO and other senior leaders to develop projections for future year utilization and cost trends.</li>
<li>Supports senior leadership within CalOptima Health to drive and lead changes by communicating goals clearly and developing relationships with key stakeholders.</li>
<li>Serves in a Pharmacy and Therapeutics (P&amp;T) Committee Leadership role.</li>
<li>Collaborates with leadership and staff across internal departments to share information, support organization goals, and promote positive and collaborative business relationships with vendors and providers. </li>
</ul>
</li>
<li>35% - Program Operations Oversight
<ul>
<li>Leads and manages all pharmacy-related operational and clinical functions, including but not limited to formulary development, prior authorization protocols, and utilization management for Medi-Cal, Medicare, and Covered California lines of business as appropriate.</li>
<li>Directs the Pharmacy team, including clinical pharmacists, pharmacy operations, and analytic staff, fostering a culture of continuous improvement, excellence and innovation, and promotes collaboration between the Pharmacy team and other internal departments and external providers.</li>
<li>Oversees new program development related to pharmacy, including overseeing new program design and implementation for the Covered California line of business.</li>
<li>Collaborates with internal departments (Medical Management, Quality, Compliance, Finance, line-of business leaders, etc.) to optimize member outcomes and drug cost-effectiveness.</li>
<li>Ensures compliance with state and federal regulations, including CMS, DMHC, Covered California, and Medi-Cal Rx.</li>
<li>Leads Pharmacy Benefit Manager (PBM) procurement, contracting, implementation, oversight and vendor management, including contract negotiation, performance evaluation, and rebate management. PBM oversight is a critical requirement of this role including real time oversight of PBM Point of Service prescription fulfillment.</li>
<li>Collaborates with CMO to provide financial oversight, budget planning, and reporting for pharmacy benefit expenditures, ensuring transparency and fiscal responsibility.</li>
<li>Develops and oversees pharmacy-related internal statistical and performance reports and satisfies reporting requirements to external regulators.</li>
<li>Develops, implements, and monitors department's performance standards.</li>
<li>Manages audit preparation and corrective action plans in response to CMS, DHCS, and other regulatory bodies. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Doctor of Pharmacy (PharmD) PLUS 7 years of health plan experience in Medicare Part D and Medicaid required. </li>
<li>5 years of pharmacy management experience with implementation of commercial managed care products, such as products sold on state-based exchanges/Covered California required. </li>
<li>3 years of progressive pharmacy leadership experience within a managed care, health plan, or PBM environment required. </li>
<li>Demonstrated success in directing and overseeing pharmacy benefit strategy, regulatory compliance, and PBM/vendor contracts required. </li>
<li>Experience with CMS audits, DHCS guidelines, and California Medicaid programs required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>15 years of health plan and pharmacy experience in Medicare Part D and Medi-Cal. </li>
<li>Pharmacy Residency in Managed Care or Pharmacy Practice.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>A current, valid and unrestricted California State Pharmacy License and PharmD.</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 324 - $216,737 - $346,778 ($104.20 - $166.7201). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6749750&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 7, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6749750" target="_blank">https://jobs.caloptima.org/jobs/sr-director-pharmacy-management-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-b834097b3b6e134b8064c5e23883c40a

Sr Director, Pharmacy Management

Salesforce / CRM Architect (ITS Architect III) 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 Salesforce / CRM Architect (ITS Architect III) and help shape the future of healthcare where you'll be an integral part of our IT - Applications 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. You, as the ITS Architect III (Salesforce/CRM), is a seasoned technologist and subject matter expert (SME) that will be responsible for architecting and delivering enterprise-grade Customer Relationship Management (CRM) solutions that drive digital transformation at CalOptima Health. You will focus on the strategic design, integration, and optimization of Salesforce and related CRM platforms to enhance member, provider, and staff engagement. Alos, you will lead the development of scalable, secure, and high-performing CRM architecture that aligns with business goals and regulatory requirements. You will collaborate with cross-functional teams to define CRM roadmaps, evaluate vendor solutions, and implement best practices for data integration, automation, and user experience; this includes working closely with internal teams and external partners to ensure seamless integration with other enterprise systems, including data platforms and cloud services. You will guide technical teams, influence stakeholders, and ensure alignment across strategic initiatives. Lastly, you will also support vendor management, solution governance, and continuous improvement efforts within the Information Technology (IT) organization. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>90% - Technical 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>Leads and designs scalable, secure, and high-performance Salesforce and CRM solutions that align with enterprise architecture standards and business goals.</li>
<li>Serves as a trusted advisor to business and IT stakeholders on CRM capabilities, limitations, and roadmap planning.</li>
<li>Defines and maintains the CRM architectural blueprint, including data models, integration patterns, and system interfaces. </li>
<li>Architects seamless integration between Salesforce and other enterprise systems (e.g., Data warehouses, Member/Provider Portals, Claims Payment Systems).</li>
<li>Defines data governance, synchronization, and migration strategies to ensure data quality and consistency across platforms. </li>
<li>Collaborates with Data Architects to align CRM data models with enterprise data architecture.</li>
<li>Serves as a technical lead to development teams, ensuring adherence to best practices in Apex, Lightning Web Components, and declarative tools.</li>
<li>Works with offshore and local vendor teams, offering Salesforce technical guidance and oversight as required.</li>
<li>Establishes and enforces CRM development standards and code reviews, and releases management processes.</li>
<li>Ensures CRM solutions comply with enterprise security policies, HIPAA, and other regulatory requirements.</li>
<li>Works directly with cross-functional IT teams and business partners on technology solutions to solve business challenges. </li>
<li>Defines and publishes cloud architecture guidelines and documentation to support the commitment to best practices. </li>
</ul>
</li>
</ul>
<ul>
<li>10% - 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 information systems, computer science or related technical discipline PLUS 8 years of progressive, applicable, technical experience in information technology required, including cloud architecture; 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 specifically in Salesforce architecture and CRM solution design, with a proven track record of delivering successful end-to-end implementations from inception to deployment required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Salesforce certifications such as: 
<ul>
<li>Salesforce Certified Application Architect </li>
<li>Salesforce Certified System Architect </li>
<li>Salesforce Certified Technical Architect (CTA) - highly desirable </li>
</ul>
</li>
<li>Experience with cloud-native architecture and distributed systems, especially in the context of CRM platforms and customer data management. </li>
<li>Managed care/health care experience. </li>
<li>Strong vendor management 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 Full Telework (**If the position is Telework, it is eligible in California only**) Position will be Partial Telework for the first 3 months for training purposes. </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6753408&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 8, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6753408" target="_blank">https://jobs.caloptima.org/jobs/salesforce-crm-architect-its-architect-iii-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-c6daf0c631ad8947b3f76f0747bbb037

Salesforce / CRM Architect (ITS Architect III)

Program/Policy Analyst (Provider Data) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Program/Policy Analyst (Provider Data) and help shape the future of healthcare where you'll be an integral part of our Provider Data Operations team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will be responsible for identifying, consolidating and analyzing provider data integrity reports related to provider directories, terminations and attestations. You will ensure data accuracy, completeness and compliance with both regulatory and internal standards. You will collaborate closely with internal departments and health networks to identify and remediate data discrepancies and gaps. You will work within the Provider Data Operations department and play a key role in conducting research, performing data analysis and preparing documentation and reports to support provider data integrity. You will ensure all provider data aligns with CalOptima Health's policies, procedures and applicable regulatory requirements. You will also have analytical and administrative responsibilities specific to the Provider Data Operations department. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>70% - Program Analysis
<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>Analyzes reports related to provider data to ensure compliance with internal guidelines and external regulations, including but not limited to provider directories, onboarding, attestations, termination processes, health network data for network certification and adequacy and the 274 file.</li>
<li>Collaborates with internal teams and health networks to resolve data quality issues and remediate gaps.</li>
<li>Analyzes provider data for accuracy related to contract setup, directory requirements, Cover California network adequacy, fillings and claim processing.</li>
<li>Conducts data integrity activities to support CalOptima's goal of maintaining a high rate of accuracy.</li>
<li>Reviews and breaks down regulatory requirements to identify data impact for audit process updates and implementation.</li>
<li>Maintains ongoing knowledge of provider data requirements and set up within the organization's provider management systems. </li>
</ul>
</li>
<li>25% - Audit Analysis
<ul>
<li>Maintains ongoing reporting formats for use in data auditing and conducts independent analysis of audit results.</li>
<li>Documents audit findings and prepares detailed reports with recommendations for corrective actions.</li>
<li>Collaborates with health networks, providers and internal departments to obtain audit-related information, presents findings and recommendations as appropriate.</li>
<li>Assists with implementing, monitoring and maintaining a well-documented audit trail.</li>
<li>Analyzes regulatory audit requirements, develops workplans and processes. </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 PLUS 2 years of experience working with provider data in a health care or managed care environment 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>Experience working in utilization management, quality management, provider data management or related areas required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Experience with regulatory compliance and provider data management.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6753496&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 2, 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/6753496" target="_blank">https://jobs.caloptima.org/jobs/program-policy-analyst-provider-data-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-edb207748d14b047b7263124e9d8fe2a

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