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Manager Grievance &amp; Appeals (Provider Services) CalOptima CalOptima Health is seeking a highly motivated an experienced Manager, Grievance &amp; Appeals (Provider Services) to join our team. The Manager Grievance &amp; Appeals (Provider Services) will provide daily oversight and technical management for provider services, including provider disputes, provider grievances and provider appeal to ensure compliance with state, federal and accreditation standards applicable to CalOptima Health. The incumbent will work with CalOptima Health management staff and other affiliated health networks with a close interface to the program and process, including areas such as Utilization Management, Claims Administration, Delegation Oversight, Quality Improvement and health network relations. The incumbent will research complex claims problems, isolate root causes and partner with various entities for resolution. The incumbent will communicate with all levels of internal staff, regulatory agencies, health networks, providers, vendors, community-based organizations and medical groups. Position Information: 
<ul>
<li>Department: GA - Provider Disputes </li>
<li>Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>50% - Program Oversight
<ul>
<li>Identifies and analyzes trends, collaborates with the Director to provide trends and makes recommendations for improvement.</li>
<li>Stays current on the local, state and federal health care environment, identifying issues that may impact CalOptima Health's programs as they relate to claims, provider disputes, grievances and provider appeals.</li>
<li>Develops, implements, maintains and reviews the adequacy of the CalOptima Health provider grievance systems, reporting, policies and functions to achieve stated goals, including, but not limited to, complaint resolution and timely responsiveness for all lines of business, to ensure compliance with all relevant regulatory requirements pertaining to provider disputes.</li>
<li>Works with the Audit and Oversight department and key departments to ensure internal departments and external partners (e.g., health networks and delegates) are up to date with regulatory, departmental and organizational changes impacting the grievance and appeals processes.</li>
<li>Ensures timely and effective data collection, summarization, integration and reporting, including, but not limited to, productivity, status and trend reports for specific committees such as the Quality Improvement Committee, Grievance and Appeals Committee, Quality Assurance Committee of the Board of Directors and other ad hoc reporting as required.</li>
<li>Serves as CalOptima Health's primary point of contact and subject matter expert related to provider services (disputes, grievances and appeals).</li>
<li>Participates in Department of Managed Healthcare (DMHC), Department of Health Care Services (DHCS) and Centers for Medicare and Medicaid (CMS) audits related to area of responsibility for all CalOptima Health programs. </li>
</ul>
</li>
<li>45% - Leadership
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.</li>
<li>Manages, hires, mentors and develops department staff.</li>
<li>Oversees the development and maintenance of internal policies and procedures and desktops to ensure compliance with all state and federal regulations for multiple lines of business.</li>
<li>Manages and makes recommendations on the development and maintenance of an effective dispute, appeals and grievance process and systems consistent with CalOptima Health policies and stated goals, including, but not limited to mechanisms to monitor provider disputes, grievances and appeals involving Legal, DMHC, DHCS, Independent Medical Review, Medi-Cal State Hearings, Office of Administrative Hearings and Appeals, CMS and external review agencies for CMS.</li>
<li>Partners with the management to ensure appropriate training and auditing tools are developed and maintained for the department. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, nursing, healthcare administration or related field PLUS 3 years of health care management experience in a related area of responsibility (provider disputes and appeals, claims administration, appeals and grievances) required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>3 years of leadership experience required. </li>
<li>Experience in health maintenance organization, Medi-Cal/Medicaid, Medicare Advantage, Medicare Part D, Special Needs Plans, Medicare-Medicaid Plans and/or the Program of All-Inclusive Care for the Elderly required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Experience with process improvement implementation.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6357344&amp;targetURL=https://alliantbenefits.cld.bz/24caloptimacabenguide" target="_blank">2024 CalOptima Health Benefits Guide</a> and our <a href="https://apptrkr.com/get_redirect.php?id=6357344&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 16, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6357344" target="_blank">https://jobs.caloptima.org/jobs/manager-grievance-appeals-provider-services-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-cf7b2c04c4b10840a8654602344b5194

Manager Grievance & Appeals (Provider Services)

Music Library Specialist/Student Supervisor Amherst Campus Full Time JR6107 Amherst has taken a leadership role among highly selective liberal arts colleges and universities in successfully diversifying the racial, socio-economic, and geographic profile of its student body. The College is similarly committed to enriching its educational experience and its culture through the diversity of its faculty, administration and staff. Job Description: Amherst College invites applications for the Music Library Specialist/Student Supervisor position. The Music Library Specialist/Student Supervisor is a full-time, year-round position, starting at $22.37 per hour - commensurate with experience. The Music Library Specialist/Student Supervisor is responsible for managing the library services, operations, programs, and collections of the Music Library. The position provides quality customer service in all circulation, reserve, and reference activities; and effectively works with student assistants, and contributes to music collection development and selection. Participates fully as a member of the Access Services department. Collaborates with the other Access Services student supervisors to develop and maintain best practices &amp; policies for student employment in the department. Summary of Responsibilities: Music Library operations 
<ul>
<li>Supervises stack maintenance and undertakes reorganization projects in the Music Library </li>
<li>Contributes to music collection development and selection with the Arts &amp; Humanities Librarian and the Collection Development &amp; Acquisitions Librarian through the purchase of scores and the establishment and maintenance of standing orders and approval plans; consults with music faculty about collection needs </li>
<li>Collaborates with the Arts &amp; Humanities Librarian on goals and planning for services and policies in the Music Library </li>
<li>Collaborates with the Digital Initiatives and Web Services department on supporting digitization initiatives in the music collection </li>
<li>Maintains media stations, manages audio production and other multi-media equipment, and supports new digital media in the library and the instruction of students in their use. Collaborates with the Weekend Access Services Assistant to maintain and replace circulating equipment </li>
<li>Manages and helps rethink the space of the Music Library </li>
<li>Responds to users about overdue and billing notices generated by the online system relating to the Music Library collections </li>
<li>Coordinates signage, maintains supplies, and oversees maintenance of photocopiers and printers for the Music Library </li>
</ul>
 Music Library staffing 
<ul>
<li>Assumes responsibility for staffing the Music Library circulation desk </li>
<li>Creates and manages the Student Assistant schedule during the academic year and for breaks </li>
<li>Provides backup staffing when students aren't available </li>
<li>Provides responsive and inclusive service at the Music Library </li>
<li>Welcomes users, maintains borrower accounts, explains policies, and makes referrals to other library or campus departments as appropriate </li>
<li>Hires, trains, and supervises student assistants for the Music Library, ensuring that they understand and carry out library policies and procedures </li>
<li>Supports student desk attendants in resolving customer service issues in a user-focused, equitable way </li>
<li>Collaborates with the Access Services student supervisor team to coordinate training needs, ensure desk staffing, monitor the Access Services Supervisors' email inbox, and set attendance/behavior expectations for student employees in the department </li>
</ul>
 Processes print and electronic reserves for the Music department 
<ul>
<li>Solicits syllabi/reading lists from faculty and Academic Department Coordinators </li>
<li>Checks assigned journal articles and book chapters for availability from the Library's databases and on the web </li>
<li>Collects materials and delegates digitization, assuring quality of electronic copies </li>
<li>Enters bibliographic citations, stable links and PDF files into eReserve Plus database for each course requested </li>
<li>Creates print reserve collection, maintaining accurate course and material listings in library database </li>
<li>Communicates with faculty and Academic Department Coordinators for clarification, copyright, and other issues </li>
<li>Collaborates regularly with the Reserves Team to establish and update departmental workflows for reserve processing </li>
<li>Shares monitoring of and responding to messages in the reserves email account with the reserves team </li>
<li>Provides backup support for reserve processing in non-music disciplines </li>
</ul>
 Access Services Team 
<ul>
<li>Provides backup support at Frost Library to meet departmental needs </li>
<li>Attends regular department, library, division, and collegewide meetings </li>
<li>Creates a professional development plan and participates in service opportunities in consultation with supervisor </li>
<li>Maintains documentation for areas of responsibility </li>
</ul>
 Supports other library departmental initiatives 
<ul>
<li>Outside of peak reserve processing season, provides support to other library departmental projects </li>
</ul>
 Qualifications: Required 
<ul>
<li>Bachelor's Degree </li>
<li>1 year of work experience in an academic or research library </li>
<li>5 years of equivalent work experience in lieu of minimum education and related experience </li>
<li>Demonstrated knowledge of music and experience handling music-related material </li>
<li>Demonstrated exceptional customer service, including creative problem-solving and a commitment to equitable access </li>
<li>Demonstrated close attention to detail and organizational skills </li>
<li>Proficient computer skills and demonstrated ability to learn and apply new technologies to existing operations </li>
<li>Ability to independently manage multiple priorities and tasks </li>
<li>Ability to work closely and problem-solve with colleagues from all library departments, students, faculty, and staff </li>
<li>Strong verbal and written communication skills </li>
<li>Required reference and background checks </li>
</ul>
 Preferred 
<ul>
<li>1 year of supervisory experience, demonstrating evidence of interviewing, onboarding, scheduling, and planning the ongoing training of a team of workers </li>
<li>Bachelor's degree in music, or equivalent combination of education, training, or experience </li>
<li>1 year of experience working in a music library </li>
</ul>
 Amherst College is pleased to provide a comprehensive, highly competitive benefits package that meets the needs of staff and faculty and their families. Benefits are an important part of our overall compensation, so it is critical that you review all of the options to ensure it meets your total compensation requirements. Click here for<a href="https://apptrkr.com/get_redirect.php?id=6332761&amp;targetURL=https://www.amherst.edu/offices/human_resources/benefits" target="_blank"> Benefits Information</a>. Interested candidates are asked to submit a resume and cover letter online at<a href="https://apptrkr.com/get_redirect.php?id=6332761&amp;targetURL=https://amherst.wd5.myworkdayjobs.com/Amherst_Jobs" target="_blank"> https://amherst.wd5.myworkdayjobs.com/Amherst_Jobs</a>. Please be sure to upload all requested documents prior to clicking Submit. Applications cannot be revised once submitted. (Current employees and students should apply by clicking on the Jobs Hub icon from their Workday home screen) Review of applications will begin July 7th and will continue until the position is filled. Expected start date is early October 2025. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. To apply, visit <a href="https://apptrkr.com/6332761" target="_blank">https://amherst.wd5.myworkdayjobs.com/en-US/Amherst_Jobs/job/Amherst-Campus/Music-Library-Specialist-Student-Supervisor_JR6107</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-835e94f32626d34d8ed257e9555e49ba

Music Library Specialist/Student Supervisor

Position: Vice President of Philanthropy 
Location: Hybrid – Miami, FL 
Reports to: CEO
Compensation: Salary $115K–$140K (DOE) + 75% of Medical, dental, and vision plan covered, retirement account with 50% matching, discretionary board bonus, and robust PTO.
Position Summary
As VP of Philanthropy, you’ll build and lead a multi-disciplinary development team, architect CLEO’s long-term fundraising strategy, and partner with our board and senior leadership to accelerate revenue growth—from major gifts and corporate partnerships to digital campaigns and institutional grants. You will own a $4M+ fundraising portfolio and scale CLEO’s proven playbook nationwide. You’ll build and manage a high-performing team, cultivate transformative partnerships, and embed equity and data-driven rigor into every campaign. Reporting directly to the CEO and partnering closely with the Board Development Committee, you will translate our Vision 2030 into ambitious fundraising strategies that fuel CLEO’s top strategic priorities.&nbsp;
Key Responsibilities
1. Team Leadership &amp; Structure
<ul>
<li>Recruit, onboard and manage:
<ul>
<li>Major Gifts &amp; Stewardship Manager</li>
<li>Corporate Partnerships Specialist</li>
<li>Donor Communications Specialist</li>
</ul>
</li>
<li>Set clear KPIs, conduct quarterly performance reviews, and foster a culture of collaboration, inclusion, and accountability.</li>
</ul>
2. Major Gifts &amp; Strategic Fundraising
<ul>
<li>Lead cultivation, solicitation, and stewardship strategies across a dynamic portfolio of donors and corporate partners</li>
<li>Cultivate and secure $100K+ gifts and seven-figure multi-year commitments from individual donors, foundations, and impact investors.</li>
<li>Lead transformational gift prospecting—with the CEO and Board—to expand CLEO’s reach into new regions and sectors.</li>
<li>Oversee RISE monthly giving and CLEO Collective circles, ensuring conversion, retention, and upgrade strategies.</li>
</ul>
3. Corporate &amp; Cause Marketing
<ul>
<li>Develop and execute a pipeline of corporate sponsorships and CSR partnerships, targeting $75K+ commitments.</li>
<li>Serve as the principal liaison to corporations, co-designing cause-marketing campaigns that align with CLEO’s equity and resilience priorities.</li>
</ul>
4. Digital &amp; Donor Communications
<ul>
<li>Oversee digital fundraising campaigns (peer-to-peer, social appeals, automated drip emails), in partnership with the Digital Communications team. 
	Establish and track metrics—cost-per-dollar, conversion rates, donor lifetime value—using Instrumentl or comparable platforms.</li>
</ul>
5. Grants Oversight &amp; Compliance
<ul>
<li>Supervise grant writer and all grant strategy, writing, submission, and reporting—especially multi-year federal and foundation proposals aligned with Vision 2030. 
	Ensure 100% compliance with funder deliverables and steward relationships to secure renewals.</li>
</ul>
6. Board &amp; Cross-Team Collaboration
<ul>
<li>Serve as staff liaison to the Board Development Committee: deliver quarterly fundraising dashboards and briefing memos.</li>
<li>Train and activate board members as individual fundraisers—matching them to prospects and co-creating tailored cultivation plans.</li>
<li>Partner with Communications, Programs, and Policy teams to surface compelling impact stories for proposals and pitches.</li>
</ul>
7. National Expansion &amp; Community Engagement
<ul>
<li>Identify and cultivate donors in key U.S. markets beyond Florida to fuel CLEO’s national growth strategy.</li>
<li>Plan and host cultivation events in key markets—both virtual and in-person—ensuring they’re accessible and mission-aligned.</li>
</ul>
Qualifications 
Required
<ul>
<li>8+ years of progressive nonprofit development leadership, including major gifts, corporate partnerships, and digital fundraising.</li>
<li>Proven track record securing $100K+ gifts and multi-year commitments; experience managing $3 million+ annual revenue.</li>
<li>Expertise designing and running capital campaigns and planned-giving vehicles.</li>
<li>Deep commitment to climate justice, equity, and community-driven solutions.</li>
<li>Exceptional communication and storytelling skills; ability to inspire diverse stakeholders.</li>
<li>Proficiency with CRM/fundraising platforms (Razors Edge, Instrumentl, EveryAction, Salesforce, etc.) and analytics tools.</li>
<li>Demonstrated success partnering with boards and empowering them as fundraisers.</li>
</ul>
Preferred
<ul>
<li>Experience in mid-sized to large nonprofits ($3 million–$10 million budgets) scaling nationally.</li>
<li>Advanced degree in nonprofit management, public administration, fundraising, or related field.</li>
<li>Familiarity with EveryAction, C3/C4 lobbying tracking, and federal grant compliance.
		</li>
</ul>
Why CLEO?
<ul>
<li>Mission-Driven Impact: Play a pivotal role in reversing the climate crisis ensuring a livable more sustainable future for all</li>
<li>Growth &amp; Autonomy: Build your team, influence national strategy, and shape a best-in-class development operation.</li>
<li>Collaborative Culture: Work alongside passionate leaders, expert program teams, and an engaged Board.</li>
<li>Competitive Compensation: Salary $115K–$140K + Medical, dental, and vision plan, retirement account with 50% matching, and robust PTO. 
	&nbsp;
		</li>
</ul>
To Apply: 
Please submit your resume, a cover letter outlining your fundraising philosophy, and two examples of major-gift successes to <a href="mailto:info@cleoinstitute.org" target="_blank">info@cleoinstitute.org</a> with the subject line “VP Philanthropy Application.”
CLEO is an equal-opportunity employer committed to diversity, equity, and inclusion in all aspects of our work. We strongly encourage candidates from underrepresented communities to apply.

Vice President of Philanthropy

Customer Service Representative CalOptima CalOptima Health is seeking a highly motivated Customer Service Representative to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Health's members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers. Position Information: 
<ul>
<li>Department: Customer Service </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>80% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Maintains departmental productivity and quality standards.</li>
<li>Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.</li>
<li>Serves as a resource for other team members. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.</li>
<li>Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.</li>
<li>Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.</li>
<li>Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High School diploma or equivalent PLUS 6 months of experience in a call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>Typing speed of 35 words per minute (WPM) required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>6 months of Medi-Cal/Medicaid or health services experience.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6337909&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 15, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6337909" target="_blank">https://jobs.caloptima.org/jobs/customer-service-representative-505-city-parkway-west-california-united-states-7d5bf04b-390c-46e1-91cb-12f6a1dd6e9a</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-fa21bddb4c4a0240925cf86da2f60f27

Customer Service Representative

Interdisciplinary Team Lead (Program Specialist) CalOptima CalOptima Health is seeking a highly motivated Program Specialist (Interdisciplinary Team Lead) to join our team. The Program Specialist (Interdisciplinary Team Lead) will be responsible for supporting the Manager PACE Center by holding primary responsibility for scheduling meetings and follow ups with the Interdisciplinary Teams (IDT), documenting attendance, recording decision-making, and managing authorizations for multiple IDT. The incumbent will interact with various clinical and non-clinical staff to coordinate participant care. Position Information: 
<ul>
<li>Department: PACE- Clinic </li>
<li>Salary Grade: 305 - $55,966 - $83,949 ($26.91 - $40.3601) </li>
<li>Work Arrangement: Full Office **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Coordinates calendars, meeting space, equipment and schedules to support IDT functions.</li>
<li>Serves as a scribe to all IDTs by tracking authorizations, service delivery requests and care coordination authorizations that are approved by the IDT.</li>
<li>Tracks and communicates to the Quality Improvement team the status of service delivery requests, including approved, denied or modified to ensure compliance with regulatory requirements.</li>
<li>Tracks and communicates the status of initial, semi-annual and annual assessments for all members of the IDT on behalf of the manager.</li>
<li>Assigns and tracks completion of PACE participant care plan approval.</li>
<li>Ensures completion of required documentation in electronic health records within 30-day requirement.</li>
<li>Serves as a liaison between manager and members of IDT and follows up on the progress of projects and activities assigned to other staff.</li>
<li>Determines the priority of matters of attention for the manager and redirects to supervisor, staff or handles matters directly as appropriate.</li>
<li>Provides back-up support to the Administrative Assistant by taking IDT minutes.</li>
<li>Maintains accurate and timely documentation in participant electronic health records.</li>
<li>Provides administrative support for specific and/or ongoing projects, such as regulatory audits by generating reports, logs, calendars and mailings as appropriate.</li>
<li>Attends and participates in in-services, staff meetings and case conferences as indicated. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, health care administration, public health, public policy or related field PLUS 2 years of administrative experience in a health 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>1 year of experience working with the frail or elderly population required with relevant experience within the last 3 years required. </li>
<li>CPR and First-Aid Certification required or must be obtained within six (6) months of date of hire.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6322849&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 8, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6322849" target="_blank">https://jobs.caloptima.org/jobs/interdisciplinary-team-lead-program-specialist-pace-garden-grove-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-57516b5c0f361d49a2dff80b78f313ae

Interdisciplinary Team Lead (Program Specialist)

Claims Examiner CalOptima CalOptima Health is seeking a highly motivated Claims Examiner to join our team. The Claims Examiner will be responsible for analyzing and validating claim data elements and claims processing. The incumbent will be responsible for adhering to the regulatory and internal processing guidelines in conjunction with CalOptima Health policies and procedures related to claims adjudication. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>85% - Claims Support
<ul>
<li>Performs thorough review of pending claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services.</li>
<li>Processes non-institutional claim types.</li>
<li>Corrects system generated errors manually prior to final claims adjudication.</li>
<li>Processes claims based upon CalOptima Health contractual agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and CalOptima Health policies and procedures.</li>
<li>Analyzes and validates Medi-Cal pricing; researches, adjusts and adjudicates claims; reviews services for accurate charges and utilizes current billing code sets, including International Classification Diseases (ICD10) codes, Current Procedural Terminology (CPT) codes and/or authorization guidelines as reference.</li>
<li>Validates eligibility and other possible health insurance coverage on the claim.</li>
<li>Alerts manager or supervisor of more complex issues that arise.</li>
<li>Processes claim exception reports as assigned. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 1 year of related claims processing 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>
 Preferred Qualifications: 
<ul>
<li>Experience processing online claims in a managed care environment. </li>
<li>Experience processing Medi-Cal claims.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6329575&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 11, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6329575" target="_blank">https://jobs.caloptima.org/jobs/claims-examiner-505-city-parkway-west-california-united-states-fd7ed77a-73a4-4bd2-9f12-47d82ac1ed30</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-a4cc42329aeb0d40b1127d796b9ce31e

Claims Examiner

Library Technician, Senior Posting Number: 0002176 Location: Contra Costa College Salary: YEARLY: $56,424, step 1 - $68,724, step 5 (see special instructions for initial placement) Position Definition: To perform a wide variety of technical and specialized duties which support library operations; to provide lead duties with responsibility overseeing for the tasks and functions performed by paraprofessional and sub-professional staff assigned to a college library; and provide administrative support to library management staff. Distinguishing Characteristics: Library Assistant - This classification will perform general library clerical duties and receives technical supervision and direction from those in the higher classes. Library Technician - This classification performs technical duties typically involved in library functions. Library Technician, Senior - This classification performs more complex duties involved in overseeing a functional area of a library while providing technical supervision and direction to library staff and students. Examples of Duties/Essential Functions: Duties may include, but are not limited to, the following: 
<ul>
<li>Monitors and maintains records for a variety of library accounts, including but not limited to: library books, subscriptions, electronic resources, student assistant and/or work study funds; compiles statistical data and prepares necessary correspondence and reports for staff and management use. </li>
<li>Performs original and copy cataloging of books and media, and maintenance of records. </li>
<li>Develops and maintains procedural manuals for classified staff and student assistants in the library. </li>
<li>Oversees and performs the processing and circulation of library materials and the processing of library fines; locates and provides information regarding available library materials; answers routine questions. </li>
<li>Reviews library media materials for ADA compliance. </li>
<li>Assists library patrons and staff in the use of library equipment such as computers, photocopiers, scanners and ID card maker. </li>
<li>Ensures the proper maintenance and/or repair of all library technical equipment and facilities. </li>
<li>Oversees a variety of duties involved in stacks maintenance; oversees shelving of library materials; performs general shelf maintenance, including shelf research for lost items; participates in space planning and shifting of the collections as needed. </li>
<li>Ensures proper procedures are followed to open and close library; resolves library user conflicts and emergencies, referring them to higher level staff, or other appropriate services as needed. </li>
<li>Assists in designing and providing library information materials, such as policies, bookmarks and handouts. </li>
<li>Initiates and processes orders for library books, including continuing orders and purchase orders; supervises the ordering and/or renewals of subscriptions to periodicals and electronic resources. </li>
<li>Supervises the receiving of new library books; verifies and processes invoices for payment, and initiates correspondence regarding problems with orders, invoices and statements from vendors; maintains inventory and purchasing records. </li>
<li>Uses integrated library system modules and computer databases to retrieve and modify a variety of records information, including tracking lost, missing and damaged materials. </li>
<li>Selects, trains and supervises student assistants; provides technical supervision to other classified library staff. </li>
<li>Assists in money handling and reconciliation of revenue from fines, printing and copying. </li>
<li>Attends meetings, professional development courses and training as appropriate. </li>
<li>Performs related duties as assigned.</li>
</ul>
 Minimum Qualifications: Education/Experience: EXPERIENCE AND TRAINING Four (4) years of experience in technical library work including technical services, cataloging, circulation and/or information services, with at least one year supervising student assistants or other library staff. EDUCATION/LICENSE OR CERTIFICATE Possession of an Associate degree from an accredited college, with major emphasis in Library Technology, or the equivalent. Knowledge Of: Knowledge of: Standard library practices, techniques, classification systems and terminology, and library materials. Library technical processes related to acquisition, classification and circulation of library materials. Methods and practices of financial record keeping. Operations, procedures, specific rules, best practices and precedents of the library industry and integrated library systems. Technical equipment operations supporting the library. Pertinent District, department, program, local, state and federal laws, rules, regulations, policies and procedures. Modern software application (Microsoft Office Suite, etc.). Skill To: N/A Ability To: Skill/Ability to: Perform responsible and complex library procedures. Perform paraprofessional library duties relating to technical and public services. Analyze situations and make independent decisions in procedural matters without immediate supervision. Communicate effectively, both orally and in writing. Perform simple reference work and assist staff and patrons in locating library materials. Perform difficult and responsible clerical work with speed and accuracy. Establish and maintain cooperative work relationships with those contacted in the performance of required duties. Serve students, staff and colleagues in a helpful, empathetic, professional manner. Prepare and maintain accurate and complete records and reports. Make mathematical calculations quickly and accurately. Use a computer programs and applications to access data and maintain files. Keyboard with accuracy. Demonstrate understanding of, sensitivity to, and respect for the diverse academic, socio- economic, race, ethnicity, gender identity, sexual orientation, age, mental or physical disability, and religious background of all students, faculty and staff, and with all individuals encountered in the performance of required duties. Desirable Qualifications: 
<ul>
<li>Experience working in an academic library (any college or university library setting). Experience with library cataloging.</li>
<li>Strong ability to appropriately take initiative, anticipate department and supervisor needs, and to work independently with minimal direction.</li>
<li>Excellent organizational skills, high attention to detail, and the ability to manage multiple tasks simultaneously in a fast-paced environment .</li>
<li>Strong written and verbal communication skills, including maintaining communications and professional relationships on behalf of the department .</li>
<li>Proficient in higher education administrative software relevant for the operation of the duties of the Library Technician as well as other student information management programs (e.g., Colleague, PeopleSoft), office software (e.g., Microsoft Office Suite, Adobe, Zoom), education-specific platforms (e.g., Canvas, Starfish, or other CRM), library services platform (e.g., Alma, Primo), &amp; library software (e.g., Springshare).</li>
</ul>
 Special Instructions: This Library Technician position provides direct support to the library. Key aspects of this position include assisting students and faculty at the circulation desk; charging, discharging, and filing library materials; processing reserve books and inter-library loan requests from students and faculty; locating the material; providing information regarding available library materials; and answering routine questions; maintains overdue and debt file for non-students; collects and records fines for overdue materials; issues receipts for lost library materials and debt payments; compiles statistical data; generates computer reports for librarians' use; files statistical data; compiles end-of-semester and end-of-year statistical reports; prepares book orders, requisitions, continuing contract orders and library suborders; assists in monitoring student budget; maintains accurate records; orders, receives and processes library materials. Maintains and troubleshoots library photocopiers, printers, scanners, and other equipment; assists students in proper usage of the machine; arranges for repairs; &amp; performs related duties as assigned. Support in cultivating a culturally responsive environment for the office. NOTE: New employees will be placed at the first step which is $56,424 per year, second step $59,268 per year or third step at $62,268 per year (depending upon experience). Based on current salary placement guidelines, all step increases for which an employee becomes eligible shall take place on July 1st of each fiscal year. These increases will occur, on annual basis, until the maximum step of $68,724 per year is reached on the salary schedule. Job Close Date: 7/23/2025 Open Until Filled: No To apply, visit <a href="https://apptrkr.com/6319943" target="_blank">https://www.4cdcareers.net/postings/11491</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-d255caa19da36f4995cf60f5221fefcf

Library Technician, Senior

Supervisor Information Technology Services (Infrastructure) CalOptima CalOptima Health is seeking a highly motivated Supervisor Information Technology Services (Infrastructure) to join our team. The Supervisor Information Technology Services will assist the manager with overseeing technical assistance regarding hardware/software related requests through Information Technology Service Management (ITSM) elements such as incident management and request fulfillment. The incumbent will also assist with all requests for computer audits, disaster recovery planning and execution of such plans. The incumbent will assist management either directly or through the efforts provided by direct reports, which consist of assigned technical and operational personnel in the Information Technology (IT) group. The incumbent will provide oversight of assigned staff members in the day-to-day operations of the computer infrastructure and operations center units and will monitor and administer reviews for their staff. The incumbent will ensure that all policies and procedures of the organization and IT department are followed and executed in a professional manner. Position Information: 
<ul>
<li>Department: ITS- Infrastructure </li>
<li>Salary Grade: 314 - $99,902 - $159,843 ($48.03 - $76.8476) </li>
<li>Work Arrangement: Full Office **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>50% - Supervisory
<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>Responds to, updates and completes tickets generated by the Service Desk Ticket system and assigns them to other areas of the IT group accordingly.</li>
<li>Operates an efficient and trouble-free IT infrastructure environment in support of the company's day-to-day business operations.</li>
<li>Assists in recruitment, develops, mentors, supervises and appraises subordinates to provide an efficient and effective operation. Prepares and administers performance evaluations and recommends salary adjustments for staff when appropriate.</li>
<li>Supervises the daily activities of assigned staff to ensure timely and effective reporting, tracking, follow-up and communication of status to management and end-users. Develops and maintains subordinate team's work schedule to achieve optimal coverage and productivity. Performs daily time management and authorization for staff.</li>
<li>Ensures the physical safety of staff in the event of an emergency on premise and at remote sites.</li>
<li>Evaluates and recommends new technologies in desktop, mobility, server, network and storage technology to support business needs.</li>
<li>Collaborates with the team in creating new knowledge articles and updating and migrating existing knowledge articles to the ServiceNow Knowledge Base.</li>
<li>Monitors the Automatic Call Distribution (ACD) queue and ensure timely responses and resolutions within Service Level Agreements (SLAs) </li>
</ul>
</li>
<li>5% - Service Desk Support
<ul>
<li>Ensures that on-boarding tickets have been completed prior to the start date of a new hire, all equipment has been set up and tested and requested folder permissions granted.</li>
<li>Ensures that off-boarding tasks are completed timely, including the retrieval of assets and removal of credentials.</li>
<li>Advises and recommends improvements in organizational, operational, procedural and workflow plans.</li>
<li>Plays a key role in internal Outage processes, assigning tickets and promoting to Problems when necessary and assists in coordinating teams to troubleshoot to resolution.</li>
<li>Participates with on-call support for any production processing and/or infrastructure issues supported by the IT group.</li>
<li>Assists in managing the operation of a data center and its related infrastructure components, including coordinating the monitoring activities for data center server, storage and network communications.</li>
<li>Monitors communications on incident status to end-users and management and participates in more complex IT problem solving and advanced project work.</li>
<li>Aids in asset management and e-waste of IT infrastructure hardware.</li>
<li>Monitors and assigns tickets ensuring they are promptly distributed to the appropriate team members based on priority, complexity and skill set.</li>
<li>Provide and communicate daily and weekly ServiceNow metrics.</li>
<li>Assists with monthly server patching using Tanium. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, computer science or related field PLUS 3 years of senior level desktop, server, storage, network or telephony communications support experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>3 years of progressive experience in Microsoft Office 365, Windows PC systems, Active Directory, and/or Microsoft SharePoint Online required. </li>
<li>Experience deploying, troubleshooting and managing Windows 10/11 and macOS/iOS devices in a corporate environment required. </li>
</ul>
 Preferred Qualifications: 
<ul>
<li>ITSM/ Information Technology Infrastructure Library (ITIL) certifications related to the provisioning of services. </li>
<li>CompTIA Security+, CompTIA A+ or HDI Support Center Analyst (SCA) certification. </li>
<li>Microsoft Windows certification. </li>
<li>Apple Certified Support Professional (ACSP), Microsoft Office Specialist (MOS) or equivalent experience. </li>
<li>2 years of supervisory experience or entry level leadership role, scheduling, delegating tasks and assigning resources. </li>
<li>Experience using IT service management solutions. </li>
<li>Government and/or health care experience with general understanding of Protected Health Information (PHI) and Personally Identifiable Information (PII).</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6296758&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 25, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6296758" target="_blank">https://jobs.caloptima.org/jobs/supervisor-information-technology-services-infrastructure-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-acefa7cc4dc431458ce3f79fb4eba29e

Supervisor Information Technology Services (Infrastructure)

Program/Policy Analyst Sr (Medi-Cal Compliance) CalOptima CalOptima Health is seeking a highly motivated Program/Policy Analyst Sr (Medi-Cal Compliance) to join our team. The Program/Policy Analyst Sr (Medi-Cal Compliance) will coordinate and maintain CalOptima Health's relationship with regulatory agencies and ensure CalOptima Health and its First Tier, Downstream and Related Entities (FDRs) comply with all appropriate standards, regulations, contractual provisions, federal waivers and laws. Specifically, the incumbent works to enhance and strengthen CalOptima Health's policy infrastructure, platform and strategies at the state level, including contract compliance, statutory and regulatory obligations with the Department of Health Care Services (DHCS). The incumbent requires the ability to complete a variety of independent detailed analyses, including the development, review and response to corrective action plans. The incumbent will be responsible implementing Corrective Action Plans (CAPs), supporting regulatory audits, validating regulatory guidance and developing regulatory communications for CalOptima Health stakeholders. The incumbent will interact with CalOptima Health's executives and department management, FDR's management, legal counsel and state and federal regulatory agencies. The incumbent will also support other key CalOptima Health staff on related projects. Position Information: 
<ul>
<li>Department: OOC - MediCal Regulatory Affairs &amp; Compliance </li>
<li>Salary Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>85% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Works with all of CalOptima Health's departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message.</li>
<li>Assists in the management of CalOptima Health's daily relationship with the DHCS for CalOptima Health's Medi-Cal program.</li>
<li>Maintains open lines of communication to ensure the ongoing trust and confidence of regulators in the program and management.</li>
<li>Researches, analyzes and makes recommendations regarding the policy implications of major initiatives for CalOptima Health's Medi-Cal program, e.g., integration of new benefits and populations.</li>
<li>Works with business areas at all levels of leadership to validate regulatory communications from regulators impacting CalOptima Health's Medi-Cal program.</li>
<li>Supports process improvements for the Office of Compliance department.</li>
<li>Serves as a Medi-Cal regulatory subject matter expert and lead for CalOptima Health's compliance issues and investigations.</li>
<li>Supports management in the readiness, coordination, oversight and remediation of regulatory audits, including but not limited to validating business area submissions, additional audit requests and written daily reports.</li>
<li>Researches and responds in a professional manner to questions pertaining to the Medi-Cal program.</li>
<li>Works with the director and manager with interactions and responses to regulatory representatives on compliance-related issues as needed.</li>
<li>Reviews and retains working knowledge of Medi-Cal policies and procedures related to assigned programs and projects.</li>
<li>Assists in the creation of communications and strategic alliances with regulators.</li>
<li>Researches and keeps current on the local, state and federal health care environment and health policy, identifying issues that may impact CalOptima Health's Medi-Cal program.</li>
<li>Coordinates the maintenance of public program benefit updates for accurate and consistent application by CalOptima Health and its provider community.</li>
<li>Participates and represents CalOptima Health in meetings and calls with regulators and associations and summarizes key points and impact to CalOptima Health's Medi-Cal program as needed. </li>
<li>10% - Administrative Support</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>Initiates, facilitates and promotes activities to foster compliance awareness and encourages the reporting of compliance issues within the organization and related entities. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in health services administration, public health, public policy or a related field PLUS 4 years of experience in government, public or government affairs role in health care compliance or health plan requirements 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>
 Preferred Qualifications: 
<ul>
<li>Master's degree. </li>
<li>Experience working with regulatory agencies in California. </li>
<li>Experience with Medi-Cal regulatory requirements and/or compliance in the areas of Customer Service, Grievance &amp; Appeals, Quality Improvement, Case Management, Claims Administration and/or Utilization Management. </li>
<li>Certification in Healthcare Compliance (CHC) or other compliance related certifications such as Certified Compliance and Ethics Professional.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>n/a</li>
</ul>
 Knowledge &amp; Abilities: 
<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>
 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>
 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>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6296744&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 25, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. 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/6296744" target="_blank">https://jobs.caloptima.org/jobs/program-policy-analyst-sr-medi-cal-compliance-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-c10c0223e159b943b7243c210753f920

Program/Policy Analyst Sr (Medi-Cal Compliance)

Business Manager Lubbock 41323BR Media and Communication Position Description Manages personnel and budgetary matters for a department or college. Exercises discretion and independent judgment to oversee the activities of staff and the financial processes to ensure fiscal responsibility of department/college. Ensures staff and faculty have the resources to complete their work. Usually serves as a hiring manager and employee service coordinator. Major/Essential Functions Directs, plans, coordinates and supervises the operation and activities of a specialized unit or small department: develops and implements policies and procedures, administers the budget, organizes tasks and sets priorities. Serves as liaison with university personnel and community at large. Works under general supervision with broad latitude for initiative and independent judgment. Serves as manager of college financial and budgetary processes to ensure fiscal responsibility and strategic management of financial resources. Duties to include, but not limited to the following: oversees account reconciliation on a regular/monthly basis, prepares and submits necessary budget paperwork for appointments, budget transfers, and revenue forms. Manages the annual budget prep process to include successfully closing the current fiscal year records and setting up the next fiscal year reporting. Responsible for providing reports for the college's annual Budget Hearings and ensuring accuracy of all financial reporting. Provides oversight of all college appointments, to include verifying correct salaries and FOPs of faculty &amp; staff, reviewing college ePAFs, and processing labor redistributions to ensure all funds are spent correctly and spent each year. Prepares semesterly graduate payroll spreadsheets to verify appointments and assign appropriate FOPs to ensure all funds are used appropriately and spent each year. Responsible for the submission of all college-level administrative appointment stipend ePAFs, as well as faculty appointments on grants/endowments. Provides oversight for all graduate, adjunct, and overload ePAFs for the college to verify FOPs and general appointment details. Provides oversight for all college budget/procurement needs and maintains budgetary processes, to include but not limited to the following: deposit/cash handling procedures, scholarship awarding procedures, cost transfers, labor redistributions, etc. Responsible to ensure all staff members assisting in procurement processes are trained and supported as needed. Responsible to ensure that all scholarship accounts are set up in the STS system and provide scholarship budgets to the Scholarship Committee to ensure that no scholarship is overspent. Required Qualifications Bachelor's degree and four years of experience developing or managing programs or projects. Additional job related education may be substituted for the required experience on a year-for-year basis. Preferred Qualifications General accounting practices and procedures. Course work in accounting. Organizational skills. Ability to manage multiple tasks. Excellent written and oral communication skills, including ability to communicate financial information professionally, clearly, consistently, and transparently to non-financial experts. Excellent word processing abilities. Knowledge of MS Word; MS Publisher; MS Outlook; MS Excel. 5-7 years of TTU accounting work. Working knowledge of the TTU financial system. Special Instructions to Applicant Please include your cover letter and resume with your application. Minimum Hire Rate 4000 To apply, visit <a href="https://apptrkr.com/6310206" target="_blank">workattexastech.com</a> All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information or status as a protected veteran. 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-5fc804ed40430245a641d4257a8e1985

181,436 Administrative Jobs