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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)

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

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

Program/Policy Analyst (Provider Data)

Talent Staffing Representative (Human Resources Representative) 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 Talent Staffing Representative (Human Resources Representative) and help shape the future of healthcare where you'll be an integral part of our HR - Talent team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Under general supervision, you will work closely with hiring managers to gain exposure to recruiting, evaluating job candidates and advising managers throughout the recruitment process. You will be responsible for full-cycle regular and temporary recruitments, including recruiting, screening, interviewing, advertising and negotiating offers with internal and external applicants. Also, you will be responsible for negotiating offers with contracted staffing agencies and source candidates as needed by the Talent Acquisition team. You will create processes to ensure accuracy of records, conduct analysis of various HR recruitment matters and may recommend solutions to management and employees. You will exercise some control over ongoing work priorities to ensure the best talent is hired, as well as act with discretion and judgment within the HR department and with CalOptima Health employees. You will also oversee the CalOptima Health telework program and assist departments in identifying, selecting and deploying employees to regular telework. In addition, you will provide support for managers and monitor the program for management. Lastly, you may provide training, write reports and essentially be the organization's resident telework expert. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>60% - Talent Acquisition
<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>Interacts and develops relationships with hiring managers to anticipate their recurring staffing needs to fit the needs/demands of the business.</li>
<li>Works closely with hiring managers to schedule and review service level agreements (SLAs) and determine job requirements for hiring before recruitment begins.</li>
<li>Determines applicant requirements by studying the job description and job qualifications.</li>
<li>Evaluates applicants by discussing job requirements and applicant qualifications and ensures applicants are interviewed on a consistent set of qualifications.</li>
<li>Arranges and schedules applicant interviews with management by coordinating schedules and going through next recruitment steps at the completion of the interview.</li>
<li>Provides on-going interview training for hiring managers.</li>
<li>Participates in the preparation of job offer analyses and proposed pay rates, using consistent methodology and fact-based reasoning; presents offers to HR Manager and Director for review and approval.</li>
<li>Begins to develop networks through industry contacts, association memberships, trade groups and employees.</li>
<li>Researches and recommends sources (e.g., professional networking sites, etc.) for active and passive candidate recruitment. Begins to build networks to find qualified passive candidates.</li>
<li>Provides advice and support to management and staff on recruitment and participates in the decision-making processes at each level.</li>
<li>Assists the HR team in identifying and implementing recruitment process improvements.</li>
<li>Monitors and identifies trends associated with key performance indicators (time-to-fill, etc.) and service level targets. </li>
<li>Collaborates with internal and external resources to identify root causes and best practices to develop appropriate action plans.</li>
<li>Works with temporary staffing agency, including, but not limited to, screening, identifying, interviewing, hiring, invoicing and completing other administrative duties associated with the program. </li>
</ul>
</li>
</ul>
<ul>
<li>30% - Telework
<ul>
<li>Oversees all aspects of the telework program, including full, partial, temporary and occasional programs as well as handling all inquiries, processing all deployments, return to work initiations and other day-to-day items.</li>
<li>Ensures all data is updated and accurate in the Human Resources Information System (HRIS).</li>
<li>Maintains all records, performance management tools and continually tracks progress for each teleworker.</li>
<li>Trains managers on how to monitor performance of teleworkers, including measuring performance and providing feedback, establishing performance measures and communicating to an employee their standing on performance.</li>
<li>Coordinates and monitors Telework Safety Reviews to ensure employees meet safety protocols and CalOptima Health guidelines while teleworking.</li>
<li>Coordinates and assists the Environmental Health and Safety department with Home Office Evaluations to ensure employees meet all assessment requirements.</li>
<li>Partners with functional areas within HR and across the agency to change employee worksite arrangements.</li>
<li>Confers with management, supervisors and employees to gain knowledge of work situations requiring training and to better understand changes in policies, procedures, regulations, business initiatives and technologies.</li>
<li>Measures telework satisfaction through focus groups, questionnaires or surveys.</li>
<li>Reviews and evaluates employee telework suitability with managers based on eligibility criteria, department needs and employee's work style.</li>
<li>Conducts discussions with managers about telework and department impact and the effects on full office workers and guides departments in the creation of plans to ensure adequate office supervision.</li>
<li>Recommends enhancements to the overall program through surveys and coordinates plan of action to implement improved changes. </li>
<li>Maintains and updates telework policies and guidelines. </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 human resources management, business administration, communications or related field PLUS 3 years of HR or related administration experience with 2 of those years in recruiting or staffing 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>Experience with an applicant tracking system (ATS). </li>
<li>Experience with a vendor management system (VMS). </li>
<li>Program 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: 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 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=6751651&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/6751651" target="_blank">https://jobs.caloptima.org/jobs/talent-staffing-representative-human-resources-representative-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-53d3f8acb534f746b79f335ae78c0e07

Talent Staffing Representative (Human Resources Representative)

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)

Network Analyst III Montana State University Position Information Announcement Number: STAFF - VA - 26191 For questions regarding this position, please contact: Adam Edelman <a href="https://apptrkr.com/get_redirect.php?id=6735683&amp;targetURL=mailto:aedelman@montana.edu" target="_blank">aedelman@montana.edu</a> 406-994-5091 Classification Title: Net Sys/Comm Analyst III Working Title: Net Sys/Comm Analyst III Brief Position Overview As members of the MSU IT community, analysts participate in and support IT efforts, projects, and initiatives, provide technical leadership and assist other support personnel with problems related to the usage of services across the network services portfolio. Network analysts perform technically skilled precision work and provide complete, enterprise level, engineering, installation, management, maintenance and support of network and telecommunications equipment, software, services, communications cabling, and related infrastructure including UPS, PDU, racks and cabinets. Network analysts respond to issues, troubleshoot, diagnose, and repair these items to address problems found in data centers, telecommunications rooms, and at field sites on and off the MSU Bozeman campus according to standard procedure and industry best practices. Network analysts' work schedules may require non-standard working hours including mornings, evenings, weekends, and holidays. Position Number: 4M-TBD, 4M0903 Department: UIT Network Support Division: VP for Information Technology Appointment Type: Classified Contract Term: Fiscal Year Semester: If other, specify From date: If other, specify End date: FLSA: Exempt Union Affiliation: FOCUS-MFPE FTE: 1.0 Benefits Eligible: Eligible Salary: Salary range of $40.032 to $56.045 hourly, commensurate with experience, education, and qualifications Contract Type: Classified Salary If other, please specify: Recruitment Type: Open Position Details General Statement Join us at our beautiful Montana State University campus located in Bozeman, Montana for an exciting opportunity to contribute to our successful and talented team and excellent leadership in University Informational Technology in Network Support Services. The Network Analyst III is a senior position within the team, is a subject matter expert, and functions as a primary and an escalation resource for the team. The network analyst III is expected to participate in the mentoring and development of junior staff. All network analysts support the MSU community, including end users. A commitment to customer service is required. Excellent opportunity with exceptional benefits including tuition waiver opportunities for self and immediate family members. Network analysts specialize and develop focused expertise and are expected to be able to work under general to direct supervision to complete a variety of tasks within the network services team's domain ranging in difficulty from basic and routine to complex. Duties and Responsibilities • Installation and configuration of switches, routers, firewalls, voice gateways, servers, access points, and IP phones. • Maintain, enhance, and develop documentation, including diagrams, drawings, and procedures. • Apply routing, switching, network security, telecommunications, and communications cabling, standards and best practices to scenarios encountered. • Manage network infrastructure built using various network components and protocols to achieve and highly available network services. • Assist with annual inventory of parts and material. • Maintain and submit records of time and materials required to complete projects and tasks. • Support the configuration of monitoring systems to alert on abnormal configuration or operation; maintain monitoring functionality as changes occur. • Provide guidance for student employees. • Participate in performance-related goal setting and achievement to meet personal and organizational goals and objectives. • Organize, prioritize, and communicate on-going work to meet multiple task and project timelines. • Attend and participate in trainings and other professional development activity. Participate in projects, complete tasks, and perform job-related duties as assigned. Required Qualifications – Experience, Education, Knowledge &amp; Skills 1. Bachelor's Degree in Computer Science, Information Systems, Computer Engineering, or other related field, or an equivalent combination of education and applicable experience. 2. Relevant knowledge of networking, telecommunications, and communications cabling components and systems. 3. Advanced knowledge of network technologies which may include Cisco routing, switching, security, and telephony technologies, and Aruba wireless technologies. 4. Demonstrated experience in an enterprise environment supporting an enterprise production network. 5. Demonstrated experience in one or more of the following: Cisco networking, Unified Communications, VoIP, Aruba Wireless in an enterprise setting. 6. Demonstrated experience in technical implementation projects, working independently on enterprise systems, and assisting in enterprise project planning. Preferred Qualifications – Experience, Education, Knowledge &amp; Skills 1. Significant experience in an enterprise environment deploying and upgrading Cisco or Aruba network equipment or software. 2. Substantial experience relating to Cisco routing, switching, telephony, and security and Aruba wireless technologies from design and planning to implementation. 3. Demonstrated experience with Solarwinds Orion or similar management platform. 4. Knowledge of National Electric Code and TIA/EIA standards for the installation of telecommunications cable and equipment. 5. Demonstrated experience building and maintaining network and telecommunication room infrastructure and installing equipment. The Successful Candidate Will • Will possess strong active listening skills. • Has the ability to think intuitively and analytically to break down and resolve problems. • Has the ability to work independently without the need for direct supervision. • Has the ability to learn the complexities and unique aspects of the systems and infrastructure in place. • Has the ability to show initiative and follow through on tasks in a fast-paced work environment. • Has the ability to work in a team environment, supporting other units. • Has the ability to work toward shared goals where individual efforts complement group efforts. • Has the ability to engage others in the unit in accepting and developing a customer-service orientation in all aspects of the operation. • Has the ability to anticipate and resolve technical problems. • Has the ability to establish and maintain effective working relationships across the IT Community. • Represents the department and university in a professional and courteous manner. • Demonstrated ability to communicate effectively with diverse populations. • Demonstrated ability to handle competing demands and maintain high levels of customer service and response. • Effective oral and written communication skills. • Ability to maintain clean and orderly networking spaces in a manner consistent with industry best practices. • Ability to monitor equipment and inventory levels for asset management and tracking, restock scheduling and other reporting purposes. • Ability to maintain and submit records of time and materials required to complete projects and tasks. • Ability to follow standard incident management, problem management, change management, and request fulfillment processes in accordance with procedures in place. Position Special Requirements/Additional Information This position is not eligible for sponsorship. Must possess a valid driver's license, an acceptable driving record, and meet all State of Montana requirements to operate State/University vehicles. (If successful candidate possesses a valid out-of-state driver's license, must obtain a valid Montana driver's license within 60 days of hire.) This job description should not be construed as an exhaustive statement of duties, responsibilities or requirements, but a general description of the job. Nothing contained herein restricts Montana State University's rights to assign or reassign duties and responsibilities to this job at any time. Work schedule may include times outside normal business hours including mornings, evenings, weekends, and holidays. Physical Demands To perform this job successfully, an individual must be able to perform each essential duty satisfactorily with or without reasonable accommodations. The requirements listed above are representative of the knowledge, skill, and/or ability required. Job may include working outside and working outside during adverse weather conditions, exposure to electrical, mechanical, noise and other hazards, work in dark and/or restricted spaces, use of ladders and/or power and hand tools. This position has supervisory duties?: No Posting Detail Information Number of Vacancies: 2 Desired Start Date: Upon completion of a successful search Position End Date (if temporary): Open Date: Close Date: Applications will be: Screening of applications will begin on November 24, 2025; however, applications will continue to be accepted until an adequate applicant pool has been established. Special Instructions This position is not eligible for sponsorship. EEO Statement Montana State University is an equal opportunity employer. MSU does not discriminate against any applicant on the basis of race, color, religion, creed, political ideas, sex, sexual orientation, gender identity or expression, age, marital status, national origin, physical or mental disability, or any other protected class status in violation of any applicable law. In compliance with the Montana Veteran's Employment Preference Act, MSU provides preference in employment to veterans, disabled veterans, and certain eligible relatives of veterans. To claim veteran's preference, please complete the veteran's preference information located in the Demographics section of your profile. Applicant Documents Required Documents 1. Resume 2. Cover Letter To apply, visit <a href="https://apptrkr.com/6735683" target="_blank">https://jobs.montana.edu/postings/49228</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-7c487bc857454f4cb3d06b00641ccc5e

Network Analyst III

Provider Relations Rep 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 Provider Relations Rep and help shape the future of healthcare where you'll be an integral part of our Provider Relations 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 assisting with provider relations and service interactions, including but not limited to developing and training external provider education programs, identifying gaps in network composition and services and assisting the network contracting staff in prioritizing contracting needs. You will ensure that all provider orientations, site visits, access and availability studies are completed within compliance and established time frames. You will also provide support with identifying and remediating operational shortfalls as well as researching and resolving claims. 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>Builds and maintains relationships with all network providers.</li>
<li>Performs outreach, monitoring and resolution of operational and/or contractual issues. </li>
<li>Identifies network gaps and performs recruitment to address community network needs.</li>
<li>Completes new provider orientation for all applicable product lines within the CalOptima Health community network.</li>
<li>Conducts site visits to service providers with training and education, resolves issues, educates and interprets staff/providers on policies and procedures, collects credentialing information and reviews Healthcare Effectiveness Data and Information Set (HEDIS) information.</li>
<li>Works with providers to ensure adherence to contract regulatory requirements and to communicate and meet the established CalOptima Health's strategic goals.</li>
<li>Represents CalOptima Health at community and health plan-sponsored events.</li>
<li>Creates and delivers presentations on various CalOptima Health topics to the provider community. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects or duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in business administration, health care administration or related field PLUS 2 years of experience in a health care or managed care setting 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>Valid driver's license and vehicle, an acceptable driving record and current auto insurance or other approved means of transportation, will be required for work away from the primary office 30% of the time or more.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>N/A</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 306 - $58,205 - $90,217 ($27.98 - $43.3736). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6722700&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 November 26, 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/6722700" target="_blank">https://jobs.caloptima.org/jobs/provider-relations-rep-505-city-parkway-west-california-united-states-f94551bf-ebf9-4be2-a196-62153df72053</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-90b1f409d7dcce458805517d6cad341a

Provider Relations Rep

About Synergos
Synergos is a global nonprofit organization solving complexissues and deeply entrenched societal problems around the world byadvancing Bridging Leadership, a style of leadership which buildstrust and collective action. Our experience over the last 35 yearsin more than 30 countries tells us that collaboration, sharedvision, and deeper understanding releases more and bettersolutions.
Today we help create enabling environments across sectors sothat communities can better address the most urgent challenges ofour time: poverty, social injustice, and climate change. Our workhas employed our Bridging Leadership methodology in a variety ofareas: child safety and education in Bangladesh, leadershipdevelopment in Ethiopia, agricultural development in Nigeria, youthentrepreneurship in MENA, maternal health in Namibia, small townregeneration in South Africa, non-profit capacity building inBrazil and more.
In addition to our program work, we manage a global network forleading philanthropic individuals and families called The GlobalPhilanthropists Circle (GPC). Members of the GPC use BridgingLeadership approaches to collaborate with and learn from theirpeers through a rich program of learning events and byparticipating in Collaborative Communities. Members share Synergos’commitment to create a more just, equitable, peaceful andregenerative world. Leading with inner work, we nurture a deeptrust among our members and cultivate a brave space to sharechallenges and shift perspectives as the role of philanthropycontinues to transform.
About the Opportunity
Synergos is seeking an experienced Managing Director, GlobalPhilanthropists Circle to lead our network of philanthropists, acritical and growing arm of our organization.
This position is a full-time role reporting to the CEO and is akey member of the leadership team. The Managing Director willmanage the Global Philanthropists Circle, a global network withmembers from 30 countries that supports values-drivenphilanthropists and social investors to better address systemiccauses of poverty and inequity. They will oversee and supervise aglobal team with functions including planning, project management,budgeting and financial management, staffing, mentoring,resourcing, marketing and evaluation. The Managing Director willhave oversight over relationship management as well as membershipinitiatives including learning journeys, member meetings,collective action initiatives, and other programs with a goal ofattract new members and retain current members
Key Responsibilities
Strategy and Operations
<ul>
<li>Lead a process to clarify the value proposition, futurestrategic direction and sustainable business model of our work withphilanthropists.</li>
<li>Implement the strategic direction for Philanthropy at Synergosensuring adequate systems, staffing, and resources are in place tosuccessfully deliver on its ambitious mission and goals.</li>
</ul>
Program and Business Development
<ul>
<li>Working with the Philanthropy team and other Synergosdepartments, design and execute a strong offering of products,programs, and services, including but not limited to membershipnetworks, collective action initiatives, and advisory service formembers that enhance their impact in line with Synergos’ mission,and drives continued/deeper engagement with Synergos overtime.</li>
<li>Design and execute a successful business development andresource mobilization strategy, in collaboration with other membersof the Synergos leadership team, for the global philanthropyprogram at Synergos, aligning to Synergos’ overall goals andmission (inclusive of cultivating new members; identifying andforging strategic partnerships; developing strategies for growthand diversification of income streams; etc.) Through membershipfees and grants, operate the GPC to provide Synergos withadditional unrestricted income to support its other programs andofferings.</li>
<li>Leading with humility, serve as a resource on philanthropy andinternational development trends for members and for other Synergosstakeholders, including the Synergos board.</li>
</ul>
Team Management
<ul>
<li>Align the global Philanthropy team around a shared vision,strategy, and workplan, taking into account the diverse contextsand markets in which staff members work.</li>
<li>Assure capture of data on CRM and drive accountability,evaluation and assessment measures and systems to capture theimpact of the Philanthropy at Synergos.</li>
<li>Support global team members to achieve portfolio- andmarket-specific goals through mentorship, team workshopping, and/oradditional capacity.</li>
<li>Manage departmental budget and ensure responsible use ofresources within the team.</li>
<li>Serve as member of the Synergos Leadership Team, providingguidance and leadership in the overall development ofSynergos.</li>
</ul>
Qualifications
<ul>
<li>At least 15 years of management experience, with a successfultrack record of managing and mentoring a global team, as well asexecuting strategic plans rooted in innovation, impact, andinclusivity.</li>
<li>Exceptional capacity for empathetic listening and authenticrelationship building with and across diverse sets of stakeholders.Ability to build trust-based, generative relationships with teammembers, (U)HNW families, donors, and investors.</li>
<li>Significant experience in building, managing, and facilitatingaction-oriented networks, ideally across public, private, nonprofitsectors and across global geographies.</li>
<li>Exceptional ability to manage and execute complex projects, asevidenced by strong experience in project planning and management,budgeting, and financial management.</li>
<li>A nuanced understanding and lived experience of the currentopportunities and challenges in global philanthropy and socialinvestment.</li>
<li>Experienced communicator and inclusive facilitator. Excellentwritten and verbal communication skills.</li>
<li>Fluency in one or more languages in addition to English andexperience living and working in more than one countrypreferable.</li>
<li>Familiarity with organizing, community / network building, andinclusive facilitation methodologies.</li>
<li>Ability to travel domestically and internationally (up to30%)</li>
</ul>
In-person in Manhattan 2-3 days flexible.
Synergos offers outstanding benefits that include health,dental, vision and life insurances, short-term and long-termdisability coverage, an Employee Assistance Program, 403(b),generous vacation, personal sick leave, parental/adoption leave,commuter benefits, community service day, and much more.
Synergos is committed to creating a diverse and inclusive workenvironment and is proud to be an equal opportunity employer. Weencourage individuals of all backgrounds to apply. We do notdiscriminate against any applicant or employee on the basis ofrace, color, sex (including gender identity, nonconformity,presentation or expression), sexual orientation, religion, nationalorigin, age, mental or physical disability, veteran status, or anyother characteristic made unlawful to consider by applicablefederal, state, or local laws. Synergos is also committed toproviding reasonable accommodations in accordance with theAmericans with Disabilities Act and applicable state and locallaws.
We’re driven by purpose. We’re a values-driven organizationfocused on improving lives around the world. Join us!

Managing Director, Global Philanthropists Circle

Miami Dade College, Kendall Campus&nbsp;is now accepting applications for <a>Lead Information Security Administrator</a>. The Lead Information Security Administrator assists in developing security standards and best practices for the institution and recommends security enhancements to management as needed. Develops strategies to respond to and recover from a security incident. Responsible for educating the workforce on information security through training and building awareness.
Duties &amp; Responsibilities
<ul>
<li>Administers security controls which safeguard access to IT resources</li>
<li>Performs security assessments of internal processes and systems; recommends mitigating actions</li>
<li>Investigates security incidents, creates, and distributes related reports</li>
<li>Maintains communication with vendors regarding security system updates and technical support security products</li>
<li>Develops new or modifies existing security controls, processes, policies and procedures</li>
<li>Promotes and administers security awareness among the user community</li>
<li>Researches and recommends security solutions, to include technology architecture, software and hardware</li>
<li>Performs security assessments of 3rd&nbsp;party technology solutions</li>
<li>Coordinates with technology operation counterparts across institution on security initiatives</li>
<li>Conducts electronic document searches in response to requests from the College Office of Legal Affairs</li>
</ul>
Minimum Requirements
<ul>
<li>Bachelor degree in Computer Science, MIS, or a closely related field with a minimum of seven (7) years of progressive experience in computing and security administration CISSP or related certification</li>
<li>All degrees must be from a regionally accredited institution</li>
<li>Knowledge of authentication, IT services access policies, and related internal and external security considerations</li>
<li>Knowledge of encryption systems, including certificate systems</li>
<li>Advanced experience working with network security systems, including firewalls, IDS/IPS, NAC, and network monitoring</li>
<li>Advanced knowledge in large security data set analysis &amp; management of analytics systems</li>
<li>Advanced knowledge of Windows and/or Linux operating systems, IP data network, testing, monitoring and management</li>
<li>Strong understanding of endpoint security solutions to include File Integrity Monitoring and Data Loss Prevention</li>
<li>Knowledge of information technology trends and impact on related security procedures and processes and the current and development</li>
<li>Advanced knowledge of authentication, IT services access policies, and related internal and external security considerations</li>
<li>Experience designing secure networks, systems and application architectures Direct experience with anti-virus software, intrusion detection, firewalls and content filtering methodologies</li>
<li>Ability to work in a multi-ethnic and multi-cultural environment with students, faculty and staff</li>
</ul>

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