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Claims Resolution Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Claims Resolution Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will be the first line of contact for CalOptima Health providers. You will assist providers with questions related to the payment of claims and resolution of claims payment issues. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - Claims Support
<ul>
<li>Responds to provider questions and researches issues regarding claims payments, denials, resolves claim issues, contractual and/or CalOptima Health agreements, established payment methodologies, division of financial responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures.</li>
<li>Follows up with providers as needed. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Ensures accurate and timely documentation regarding all issues, and/or inquiries are entered in Facets.</li>
<li>Routes escalated calls to the appropriate departments and/or management. </li>
</ul>
</li>
<li>5% - Completes other duties or projects as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience in claims resolution required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>1 year of call center experience with high call volumes or customer service experience required. </li>
<li>1 year of HMO, Medi-Cal/Medicaid and healthcare/managed care experience required. </li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>n/a</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>n/a</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6824042&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 23, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6824042" target="_blank">https://jobs.caloptima.org/jobs/claims-resolution-specialist-customer-service-505-city-parkway-west-california-united-states-4e3fd218-8652-4990-a6d7-d5e994892d39</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-3ee5c0b7e906304183fde18e41900662

Claims Resolution Specialist (Customer Service)

Grievance Resolution Specialist CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Grievance Resolution Specialist and help shape the future of healthcare where you'll be an integral part of our Grievance &amp; Appeals team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 You will be responsible for coordinating the grievance and appeal resolution process. You will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions and pharmacy and vision decisions. You will have frequent external contact with members and families, health care providers, health networks, third party administrators and regulators. You will collaborate with internal departments such as Customer Service, Provider Relations, Pharmacy and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Maintains adequate information in CalOptima Health's systems; ensures data collection, summarization, integration and reporting, including case creation and management and events/activity tracking.</li>
<li>Gathers pertinent information regarding the grievances and appeals received, including member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.</li>
<li>Coordinates and participates in case discussions with operational experts to result in a final case disposition as needed.</li>
<li>Evaluates case details, proposes recommendations, or makes decisions as applicable, ensures the organization's decision is implemented according to the Grievance and Appeals policies and case resolution.</li>
<li>Develops resolution letters and correspondence to members and providers.</li>
<li>Communicates with internal and external customers to ensure timely review and resolution of grievances or appeals.</li>
<li>Initiates referrals to the Quality Improvement department as applicable and facilitates responses to members according to CalOptima Health policy. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists with health networks' compliance process.</li>
<li>Meets performance measurement goals for Grievance and Appeals Resolution Services (GARS).</li>
<li>Identifies trends and root cause of issues, proposes solutions, or escalates ongoing issues to management. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 1 year of experience in grievances and appeals, claims, regulatory compliance, customer service or related field required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate degree in business, health care administration or related field. </li>
<li>Experience in health care practice standards for both government and commercial plans. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6824005&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 31, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6824005" target="_blank">https://jobs.caloptima.org/jobs/grievance-resolution-specialist-505-city-parkway-west-california-united-states-132a29ad-c6dc-41d4-83e2-463f783089a5</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-b91eeef896b1c44e908896c55c9a9cbb

Grievance Resolution Specialist

Regulatory and Contract Compliance Specialist (Contracts Specialist Sr) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Regulatory and Contract Compliance Specialist (Contracts Specialist Sr) and help shape the future of healthcare where you'll be an integral part of our Contracting team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 You will support the development, implementation and ongoing monitoring of the Contracting department's regulatory compliance activities and ensure department policy and procedure updates. You will be responsible for analyzing and interpreting regulatory requirements issued by the Centers for Medicare and Medicaid Services (CMS) and Department of Healthcare Services (DHCS).You will monitor policy updates, DHCS All Plan Letters (APLs) and other regulatory guidance to assess operational impacts. You will recommend appropriate actions to Contracting leadership and support implementation activities to ensure full compliance within the department's policies, procedures, workflows and provider contract templates. You will track department activities and complete required documentation to demonstrate compliance and obtain necessary approvals from the Regulatory Affairs Compliance (RAC) department. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Interacts with staff and leadership to analyze, identify and make recommendations to the Contracting department's policies, procedures and processes pursuant to obligations imposed by CMS, DHCS or other regulatory agencies.</li>
<li>Collaborates with the RAC department to implement regulatory requirements, update policies and procedures, and coordinate department activities as needed.</li>
<li>Tracks and reports on department activities to demonstrate compliance with regulatory updates and company policies.</li>
<li>Leads and monitors multiple small to medium sized projects under tight timelines simultaneously.</li>
<li>Collaborates closely with Contracting leadership on multiple department projects; keeps leadership informed on progress, issues and status of new contracts, policies and regulatory requirements.</li>
<li>Prepares summaries and detailed reports regarding contracted provider network(s) and assigned projects as needed. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Associate degree PLUS 4 years of experience in the health care field interacting with members, physicians, medical groups, health plans or regulatory agencies, overseeing administrative updates, data analytics or provider relations activities required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Managed care contracting, provider relations or grant writing experience. </li>
<li>Regulatory agency experience. </li>
<li>Project leader experience. </li>
<li>Network operations experience managing provider claims, capitation, network expansion or development.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 310 - $72,096 - $115,353 ($34.66 - $55.4582). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6822034&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 31, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6822034" target="_blank">https://jobs.caloptima.org/jobs/regulatory-and-contract-compliance-specialist-contracts-specialist-sr-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-58d6a7b47fde3a4a97d18824fbf37d4f

Regulatory and Contract Compliance Specialist (Contracts Specialist Sr)

Facilities Control Specialist Job No: 552338 Work Type: Staff Location: Southern California: Long Beach Categories: Bargaining Unit: Unit 6 - Teamsters Local 2010, Appointment Type: Probationary, Time Basis: Full Time, Job Search Category/Discipline: Trades Job Summary Under the supervision of the Supervising Building Services Engineer, responsibilities include but are not limited to installation, maintenance and repair of all types of electric, electronic, and pneumatic control systems and related Energy Management/Building Automated Control systems. Key Responsibilities 
<ul>
<li>Monitor campus-wide building heating, ventilation, and air conditioning equipment and energy demand to ensure effective and efficient operation while maintaining building occupant comfort.</li>
<li>Maintenance, installation, and repair of campus-wide building automation control system components and all associated heating, ventilation, and air conditioning equipment.</li>
<li>Respond to Facilities Management Customer Service generated work orders and after- hours emergencies to resolve reported control systems failures and heating, ventilation, and air conditioning related problems.</li>
<li>Assist energy management consultants in re-commissioning and modernization of existing building automation system control components to increase the efficiency and reliability of campus heating, ventilation, and air conditioning equipment.</li>
<li>Schedule as required heating, ventilation, and air conditioning equipment to ensure thermal comfort and ventilation needs for occupied space.</li>
</ul>
 Knowledge Skills and Abilities The ideal candidate possesses hands-on experience with electrical, electronic, and pneumatic controls, along with programming expertise in Energy Management Systems, particularly those manufactured by Staefa/Talon and Niagara. They are proficient in operating trade-specific tools and equipment, demonstrate strong record-keeping and work order completion skills, and can effectively interpret technical documentation. Excellent interpersonal, written, and verbal communication abilities are essential, as is prior experience working in a university or large institutional setting. Ability to communicate with an ethnically and culturally diverse campus community. Ability to follow all university policies, procedures, and guidelines including but not limited to safety, civility, information security, and non-discrimination policies and procedures. Ability to contribute to a positive university experience for each and every student and assist in achieving the university's commitment to a "vision of excellence." Education and Experience 
<li> Equivalent to four years of journey-level experience diagnosing, repairing, and maintaining large, complex, and sophisticated heating, ventilation, refrigeration and air conditioning, and water treatment systems; installing, inspecting, servicing, repairing, replacing, and calibrating building automation and control systems; and using programming features of building automation systems. </li>
<li> Solid work record. Physical Summary 
<ul>
<li>Heavy work - Job involves lifting more than 40 pounds. Approximately half of the incumbent's time will be spent walking, standing, squatting, kneeling, or climbing.</li>
</ul>
 Licenses / Certificates </li>
<li> Valid California driver's license required. Employees who are required to operate motorized vehicles and/or use their personal vehicle more than once a month on university business are required to take a mandatory Defensive Driving course and enroll in the DMV Employee Pull Notice (EPN) Program. Department FM Engineering Services Classification Facilities Control Specialist Compensation Salary placement is determined by the education, experience, and qualifications the candidate brings to the position, internal equity, and the hiring department's fiscal resources. CSU Classification Salary Range: The CSU Classification Salary Range for this position is $6,705 - $9,768 per month. Time Base 1.0 time-base, 40 hours per week. Duration of Appointment This is a regular position. Benefits Excellent benefits through CalPERS (health, vision, dental), tuition fee waiver, generous vacation and sick leave, and 14 paid holidays each year. Application Procedures Click Apply Now to complete the CSULB Online Employment Application. PLEASE FILL OUT THE APPLICATION COMPLETELY It is important that all sections of the on-line application are filled out completely and accurately. Please include all relevant education and experience. Your application will be used to determine whether you meet the minimum qualifications for this position. Additional Information The person holding this position is considered a 'mandated reporter' under the California Child Abuse and Neglect Reporting Act and is required to comply with the requirements set forth in CSU Executive Order 1083 Revised July 21, 2017 as a condition of employment. A background check (including a criminal records check) must be completed satisfactorily and is required for employment. CSULB will make a conditional offer of employment, which may be rescinded if the background check reveals disqualifying information, and/or it is discovered that the candidate knowingly withheld or falsified information. Failure to satisfactorily complete the background check may affect the continued employment of a current CSU employee who was conditionally offered the position. Due to the nature of this position, current CSULB employees are subject to a criminal record check unless they have successfully completed a criminal background check through CSULB within the past 12 months. CSULB is not a sponsoring agency for staff and management positions (i.e. H-1B Visas). California State University Long Beach expects respectful, professional behavior from its employees in all situations. Acts of harassment or abusive conduct are prohibited. Demonstrated appropriate professional behavior, treating others with civility and respect, and refusing to tolerate abusive conduct is expected of all employees. Equal Employment Statement Consistent with California law and federal civil rights laws, CSULB provides equal opportunity in employment without unlawful discrimination or preferential treatment based on race, sex, color, ethnicity, national origin, or other protected status. CSULB complies with Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, the California Equity in Higher Education Act, California's Proposition 209 (Art. I, Section 31 of the California Constitution), other applicable state and federal anti-discrimination laws, and CSU's Nondiscrimination Policy. We prohibit discriminatory preferential treatment, segregation based on race or any other protected status, and all forms of discrimination, harassment, and retaliation in all university programs, policies, and practices. Accommodations We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact <a><a href="mailto:StaffHR-Accommodations@csulb.edu" target="_blank">StaffHR-Accommodations@csulb.edu</a></a>. Out of State Employment Policy California State University, Long Beach, as part of the CSU system, is a State of California Employer. As such, the University requires all employees upon date of hire to reside in the State of California. As of January 1, 2022 the . Out of State Employment Policy California State University, Long Beach, as part of the CSU system, is a State of California Employer. As such, the University requires all employees upon date of hire to reside in the State of California. As of January 1, 2022 the <a href="https://calstate.policystat.com/policy/10899725/latest/" target="_blank">CSU Out-of-State Employment Policy</a> prohibits the hiring of employees to perform CSU-related work outside the state of California. Application Closes: 12 January 2026 To apply, visit <a href="https://apptrkr.com/6796203" target="_blank">https://careers.pageuppeople.com/873/lb/en-us/job/552338</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-b3b9ffe751e918499ca3043e1ad6be3f</li>

Facilities Control Specialist

St. Charles Community College (SCC) is located in the greater St. Louis Region, one of the fastest growing areas&nbsp;in the state of Missouri. As an employee of SCC, you will join a positive and dynamic team of faculty and staff who are focused on the success of students. We offer a wide range of employee benefits including a comprehensive insurance program, robust retirement plan, generous paid time off programs, and paid&nbsp;holidays. You will share our core values, our beautiful student-centered campus and work among top&nbsp;professionals and educators in the industry.
POSITION SUMMARY&nbsp;St. Charles Community College is seeking an enthusiastic, student-centered Digital Content Specialist to&nbsp;coordinate the writing, training, and collating of various information with college departments for publication&nbsp;to internal and external mediums. The position will serve as project manager for the implementation of a new website.
PRIMARY DUTIES AND RESPONSIBILITIES&nbsp;• Creation of a college system digital content strategy, including writing content for the&nbsp;college department home pages and managing/updating websites as necessary.
• Coordinates the writing, review, and integration of college documents for various publication and&nbsp;administrative mediums.
• Writing and designing the practical communication elements for use in web,&nbsp;print, and other mediums for all departments. Creates user-guides for faculty and staff for publishing individual SCC web&nbsp;pages.
• Maintains and reviews the accuracy of new and existing documents for internal and external&nbsp;publications for the internet.
• Updates and preserve common elements found on SCC web pages, links, email addresses, phone&nbsp;numbers, and contact information.&nbsp;• Provide general support services, including preparation of various financial and budgetary requests.
• Performs miscellaneous job-related duties.
MINIMUM KNOWLEDGE AND EXPERIENCE&nbsp;Bachelor's degree or higher in English, journalism, communication, or related field plus three years of&nbsp;experience coordinating or participating in the oversight of a digital content program with experience in&nbsp;Associated Press style writing, or Associates degree plus six years' experience, or High School diploma with&nbsp;nine years of experience or a combination of education and experience.
EXPECTATION AND CORE VALUES&nbsp;Our respectful, inclusive, and empowering work environment celebrates our accomplishments with our&nbsp;commitment to:
• SCC values student success and expects employees to be student-centered.
• SCC values teamwork and expects employees to demonstrate collaborative communication.
• SCC values innovation and encourages responsible risk-taking and create problem-solving.
• SCC values accountability and expects employees to demonstrate excellent customer service and&nbsp;professionalism.
Requires regular and predictable attendance.&nbsp;**Will be subject to a criminal background check.
REPORTING RELATIONSHIP&nbsp;Generally, reports to a Director; but may vary upon organizational need
<a href="https://www.stchas.edu/about-scc/administration/board-policies/article-iv/articleiv01policy" target="_blank">St. Charles Community College is an Equal Opportunity Employer</a>.

Digital Content Specialist

Established&nbsp;in 1865, the George Washington University Law School is the oldest law school in the nation’s capital. The Law School is accredited by the American Bar Association and is a charter member of the Association of American Law Schools. GW Law is an urban campus located in downtown DC’s Foggy Bottom neighborhood, near to a vibrant mix of museums, restaurants, government and international organizations, the White House, and more. Additional information about the Law School can be found at&nbsp;<a href="https://www.law.gwu.edu/" target="_blank">https://www.law.gwu.edu/</a>.
The George Washington University Law Library seeks a qualified librarian for its Head of Legal Technology &amp; Instructional Services position to begin as early as September 15, 2023. As a member of the library’s dynamic, collaborative Instructional Technology Services team, the librarian in this position has primary oversight for the Office of Legal Technology &amp; Instructional Services. This position leads the development and delivery of services supporting the integration of library resources into the curriculum, the curation and use of the library’s growing electronic resources collection, the use of scholarly communication technologies and services, and the undertaking of digital initiatives. As the subject specialist for legal pedagogy and technology competency, this position works to improve student success by embedding the library in online teaching and learning spaces, integrating librarians into the face-to-face curriculum, and supporting faculty adoption of technologies to achieve learning outcomes.
The Law Library supports the curricular and teaching requirements of the Law School, the research and publication needs of the law faculty, and the study and research needs of the law students; and provides to the scholarly community at large access to a research collection of material about the law and its history. Additional information about the Law Library can be found at&nbsp;<a href="https://www.law.gwu.edu/library" target="_blank">https://www.law.gwu.edu/library</a>.
Please note that initially the librarian in this position will be required to work at the university's Foggy Bottom campus in Washington, DC; the ability to work remotely in the future will be assessed and determined by the supervisor in accordance with Law School and University policies.
Essential Duties and Responsibilities:&nbsp;
Oversees, coordinates, and/or performs activities of the Office of Legal Technology &amp; Instructional Services, which includes coordination of workflow, training and evaluation of staff, and oversight of personnel issues.
Instructional Services
<ul>
<li>Serves as subject matter expert for law pedagogy, legal technology, and related topics; creates an overall strategic vision to improve the student experience through the integration of technology into the curriculum, integrates Law Library services and instructional programs into Law School initiatives with a focus on legal practice technologies</li>
<li>Oversees the integration of library resources and academic technologies including technology competencies into the curriculum and learning spaces;&nbsp;participates in identifying, implementing, and supporting technology-driven solutions and strategies to enhance the Law School’s teaching and learning experience; stays abreast of technology-focused learning trends and best practices in law schools including technology-related pedagogy as well as technologies used in law practice; develops library-focused reusable learning objects and modules for course site development; partners with Law School faculty and programs on the adoption of tools and techniques to improve teaching and learning; supports faculty with the adoption and integration of instructional technologies to achieve pedagogical outcomes</li>
<li>Develops and delivers programming on technology competencies, the use of existing and emerging legal technologies, and provides guidance on building technology competencies</li>
<li>Serves as liaison for Bloomberg Law, Lexis, and Westlaw online research services account managers and student representatives, coordinates their activities at the law school, performs password management for these research systems and communicates developments regarding these services with library colleagues and law school offices</li>
</ul>
Scholarly Communications
<ul>
<li>Coordinates department activities to identify, develop, and promote strategic scholarly communication services and programs; provides outreach, education, and training; identifies and implements best practices in documenting and strengthening access to the Law School’s intellectual output; provides vision and expertise on scholarly visibility and impact and online identity management; oversight of the online repository process for Law School scholarship and archives including data entry; supports staff, student, and faculty posting to content management systems such as CampusPress and open-access scholarship-sharing networks (SSRN) and digital commons (BePress)</li>
<li>Oversees library’s digital initiatives such as digital content creation, online exhibits, and web publishing; oversees content sharing via the library website, LibGuides, and the law school portal; ensures search engine optimization, accessibility and security compliance for all library managed online platforms</li>
<li>Coordinates department efforts to identify, implement, and support web-based and digital marketing strategies and services; provides guidance to faculty, staff and students on using content management systems managed by the library such as Drupal, Springshare, CampusPress, social media, and digital signage; provides guidance on system functionalities and use of graphics and formatting; performs content editing</li>
</ul>
Electronic Resources
<ul>
<li>Provides vision and expertise to develop and maintain the electronic resource collection; leads interdepartmental library efforts to select, implement, maintain, and provide access to electronic resources, including collaboration with Burns Law Library colleagues, GWU campus libraries, and electronic resource vendors&nbsp;&nbsp;</li>
<li>Leads review of electronic resource licenses, manages license compliance issues, and evaluates resource usage-based feedback, web analytics, and vendor-supplied statistics</li>
<li>Oversees department efforts to create user awareness of the electronic collection, manage authentication for access to electronic resources, and improve end-user support services; coordinates gathering, analyzing, and formatting of usage data from the proxy server and vendor/publisher-supplied data for library reporting and decision-making</li>
</ul>
Other
<ul>
<li>Monitors the Library’s ticketing systems and responds to user inquiries&nbsp;</li>
<li>Drafts and implements procedures and practices&nbsp;</li>
<li>Creates and contributes to research guides, bibliographies, instructional recordings, and other finding aids and publications</li>
<li>Participates in reference and research services, including reference desk duties and the faculty liaison program</li>
<li>Participates on library, university, and consortia committees</li>
<li>Performs other duties as assigned</li>
</ul>
Minimum Qualifications:
<ul>
<li>Graduate degree in library or information science (e.g., MLS) from an ALA-accredited institution or completion of degree requirements by the time of appointment</li>
<li>JD, LLB, or LLM from an ABA-accredited institution or completion of degree requirements by the time of appointment, and</li>
<li>Minimum of three years of post-graduate degree experience working in law libraries, including a demonstrable history of supervisory duties or potential for rapid growth into supervisory duties</li>
</ul>
Preferred Qualifications:
<ul>
<li>Knowledge and understanding of trends and best practices relevant to legal education and legal technology competencies</li>
<li>Knowledge of pedagogical trends employed by law schools, learning management technologies, digital objects, and digital content creation</li>
<li>Demonstrated knowledge of instructional design theory</li>
<li>Experience with scholarship repositories, scholarly impact metrics, content management systems, desktop publishing software, search engine optimization and web analytics tools, and knowledge of online publishing standards</li>
<li>Experience with web design and proficiency with web authoring software, including experience with emerging technologies and use of browser plug-ins and applications</li>
<li>Experience with SaaS; online product technology/setup, including proxy server functionality and authentication protocol; web browser and operating system configuration; web design (HTML, CSS, Javascript); and content management system administration</li>
<li>Experience with Ex Libris Alma electronic resource management and AlmaAnalytics</li>
<li>Demonstrated basic or general knowledge and understanding of trends relevant to any of the areas of the department</li>
<li>Demonstrated ability to promote teamwork and collaboration with the goal of fostering an efficient and positive service role for the library; to form a strong rapport with colleagues, law faculty, and law students</li>
<li>Experience in providing general legal reference assistance</li>
<li>Reference experience in a law library environment</li>
<li>Demonstrated superior customer service skills</li>
<li>Writing skills and oral communication skills that demonstrate the ability to convey information clearly and accurately with customers, colleagues, and supervisors</li>
<li>Demonstrated organizational and time management skills</li>
<li>Demonstrated attentiveness to detail</li>
<li>Demonstrated ability to work well independently and as part of a team</li>
</ul>
APPLICATION PROCEDURE:&nbsp; Please complete an online application, available at <a href="https://www.gwu.jobs/postings/103761" target="_blank">https://www.gwu.jobs/postings/103761</a> , to include uploading a resume and cover letter and providing contact information for three professional references. Review of applications will begin September 1, 2023, and continue until the position is filled. Only complete applications will be considered.
Employment offers are contingent on the satisfactory outcome of a standard background screening.
The university is an Equal Employment Opportunity/Affirmative Action employer that does not unlawfully discriminate in any of its programs or activities on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity or expression, or on any other basis prohibited by applicable law.

Head of Legal Technology & Instructional Services

Sr Manager, Member Retention &amp; Outreach (Sr Manager I) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Sr Manager, Member Retention &amp; Outreach (Sr Manager I) and help shape the future of healthcare where you'll be an integral part of our Operations Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 The Sr Manager for Member Retention &amp; Outreach will lead the design of and operationalize member retention and outreach programs for CalOptima's Medicare Advantage line of business. You will be responsible for developing a proactive, data-driven strategy to reduce voluntary disenrollment, improve member satisfaction and experience, and close retention gaps across the lifecycle-ensuring each interaction builds trust, supports continuity of care, and reinforces plan value. Also, you will collaborate closely with departments including Customer Service, Provider Network, Quality, Operations, and Marketing to identify and address root causes of member dissatisfaction and strengthen communication and service recovery processes. You will oversee a blended team of phone-based Retention Specialists and field-based Outreach and Engagement staff focused on reducing voluntary disenrollment, improving experience measures, and supporting member engagement. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>50% - Leadership Functions
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department. </li>
<li>Develops a comprehensive, annual Retention &amp; Outreach Strategy Plan focused on reducing controllable disenrollments, improving Stars and CAHPS performance, and strengthening overall membership stability. </li>
<li>Launches and scales member outreach and support programs - including onboarding, re-engagement, ambassador and repeat-caller initiatives- to improve retention and reduce grievances.</li>
<li>Uses data and analytics to identify predictive risk indicators, inform proactive retention efforts and guide program improvements.</li>
<li>Defines key performance indicators (KPIs) and develops dashboards and scorecards to monitor program effectiveness. </li>
<li>Utilizes matrix management and directs and/or coordinates staff throughout the organization in the implementation of strategic growth and retention plans.</li>
<li>Hires, manages, trains, reviews and sets goals for staff, including assisting in team engagement and management.</li>
<li>Manages and coaches teams through activities such as building strong relationships, documenting initiatives and discussions, identifying gaps/issues/solutions, standardizing tools/templates, implementing quality departmental initiatives and reporting to stakeholders and management team.</li>
<li>Manages and coordinates the day-to-day assignment of resources and shifts in work and priorities based on departmental needs.</li>
<li>Develops, establishes and updates department processes to maintain operational excellence.</li>
<li>Fosters ongoing relationships and mutually beneficial partnerships with internal CalOptima Health departments and external organizations.</li>
</ul>
</li>
</ul>
<ul>
<li>45% - Program Oversight
<ul>
<li>Conducts regular analysis of member disenrollment trends and collaborates with cross-functional partners as well as external provider networks to resolve systemic issues contributing to attrition.</li>
<li>Partners with Quality and Customer Service teams to align outreach with CAHPS and HOS drivers, improving key member experience domains such as access, communication, and coordination of care.</li>
<li>Collaborates with internal departments to ensure analysis and feedback informs operational, services and process improvements.</li>
<li>Establishes and leads a Community Engagement and Partnerships function that strengthens local presence and member connection by enhancing CalOptima OneCare's presence in the community through community events, educational outreach and relationship building efforts that reinforce retention goals.</li>
<li>Collaborates with CalOptima Health departments to plan and execute community outreach activities including member and provider outreach events, and to enhance visibility, trust and engagement.</li>
<li>Develops and oversees multi-touch onboarding campaigns for new members and year-round engagement campaigns (e.g., benefit education, preventive care reminders) to close gaps in care and improve experience. </li>
<li>Partners with internal teams to identify and coach lower performing medical groups and providers on strategies to improve CAHPS-related experience measures, ensuring alignment between provider performance, member satisfaction, and overall retention goals.</li>
<li>Collaborates and supports organizational member experience initiatives including but not limited to: CMS Star Program operational initiatives and Hierarchical Condition Category (HCC) maintenance and improvement activities. </li>
<li>Ensures implementation of OneCare member retention initiatives comply with CMS regulatory requirements and communicates with stakeholders regarding implementation of initiatives. </li>
</ul>
</li>
</ul>
<ul>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in business administration or related field PLUS 5 years of experience in a management position of a health insurance plan, managed care organization or public agency serving Medicare and Medicaid (Medi-Cal) populations required; An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>4 years of progressive leadership experience, including direct supervision of staff required. </li>
<li>Valid driver's license and vehicle, an acceptable driving record and current auto insurance or other approved means of transportation, will be required for work away from the primary office 25% of the time or more.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Master's degree in business administration, marketing, gerontology, health administration or related field. </li>
<li>Medicare Advantage health plan marketing/outreach and operations, Medicare Advantage health maintenance organization (HMO) special needs plans (SNP), and Medicaid/Medi-Cal experience. </li>
<li>Project management experience.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>n/a</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6824074&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 31, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6824074" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-member-retention-outreach-sr-manager-i-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-8b78ae2d5d2fc74c8b365db038b0e604

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

<h3>Job Description</h3>
Job Description
???? Ready to make a real difference in people’s lives? ActivStyle is seeking compassionate, driven individuals to join our team—where purpose meets professionalism. As a trusted provider of home-delivered medical supplies, we empower our clients to live with dignity, independence, and comfort.
ActivStyle is currently hiring for a dedicated Customer Service Specialist in our Plattsburgh, NY Office. In this role, you’ll be the friendly voice and knowledgeable guide helping clients access essential products like incontinence supplies, urological items, and other personal care essentials—all delivered discreetly to their door.
If you’re passionate about helping others and thrive in a supportive, mission-driven environment, we’d love to welcome you to the ActivStyle family.
Position Summary:
Customer Service Specialists are responsible for learning and understanding the entire front-end process to ensure successful service for our patients. The Customer Service Specialists works in a fast-paced environment answering inbound calls and making outbound calls. Maybe responsible for obtaining, analyze, and verify the accuracy of information received from referrals, create orders, and or schedule the patient to receive equipment as ordered by their doctor. Customer Service Specialists should educate Patients of their financial responsibility when applicable.
Essential Functions and Job Responsibilities:
<ul>
<li>Develop and maintain working knowledge of current products and services offered by the company</li>
<li>Answer all calls and emails in a timely manner, in adherence to their goals</li>
<li>Document all call information according to standard operating procedures</li>
<li>Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs</li>
<li>Process orders, route calls to appropriate resource and follow up on customer calls where necessary</li>
<li>Review all required documentation to ensure accuracy</li>
<li>Accurately process, verify, and/or submit documentation and orders</li>
<li>Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles</li>
<li>Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required</li>
<li>Must be able to navigate through multiple online EMR systems to obtain applicable documentation</li>
<li>Enter and review all pertinent information in EMR system including authorizations and expiration dates</li>
<li>Communicate with Customer Service and Management on an on-going basis regarding any noticed trends with insurance companies</li>
<li>Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered</li>
<li>Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.</li>
<li>Meet quality assurance requirements and other key performance metrics</li>
<li>Facilitate resolution on customer complaints and problem solving</li>
<li>Pays attention to detail and has great organizational skills</li>
<li>Actively listens to patients and handle stressful situations with compassion and empathy</li>
<li>Flexible with the actual work and the hours of operation</li>
<li>Utilize company provided tools to maintain quality. Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and “How-To” documents</li>
<li>Develop and maintain working knowledge of current HME products and services offered by the company.</li>
<li>Maintain patient confidentiality and function within the guidelines of HIPAA.</li>
<li>Completes assigned compliance training and other educational programs as required.</li>
<li>Maintains compliant with ActivStyle’s Compliance Program.</li>
<li>Assist operations with on-call responsibilities as needed during non-business hours in accordance with company policy.</li>
<li>Depending on the geographic territory and size of the branch location, may require assisting operations with deliveries.</li>
<li>Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.</li>
<li>Perform other related duties as assigned.</li>
</ul>
Competency, Skills and Abilities:
<ul>
<li>Excellent customer service skills</li>
<li>Analytical and problem-solving skills with attention to detail</li>
<li>Decision Making</li>
<li>Excellent ability to communicate both verbally and in writing</li>
<li>Ability to prioritize and manage multiple tasks</li>
<li>Proficient computer skills and knowledge of Microsoft Office</li>
<li>General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.</li>
<li>Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.</li>
<li>Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.</li>
<li>Ability to work independently as well as follow detailed directives</li>
<li>Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction</li>
<li>Computer skills including knowledge of Microsoft Office applications</li>
</ul>
Education and Experience Requirements:
<ul>
<li>High School Diploma or equivalent &amp;</li>
<li>One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry. Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.</li>
</ul>
Physical Demands and Work Environment:
<ul>
<li>Work environment may be stressful at times, as overall office activities and work levels fluctuate</li>
<li>Must be able to bend, stoop, stretch, stand, and sit for extended periods of time</li>
<li>Subject to long periods of sitting and exposure to computer screen</li>
<li>Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use</li>
<li>Must be able to lift 5 to 10 pounds periodically as needed.</li>
<li> Excellent ability to effectively communicate both verbally and written with customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy.</li>
<li>Mental alertness to perform the essential functions of position.</li>
<li>May be exposed to angry or irate customers or patients</li>
<li>May be exposed to hazardous materials, loud noise, extreme heat/cold, direct, or indirect contact with airborne, bloodborne, and/or other potentially infectious pathogen.</li>
</ul>
Amazing Benefits At A Glance:
<ul>
<li>Team Driven and Values Based Culture</li>
<li>Medical, Dental, and Vision Benefits</li>
<li>Paid Time Off (PTO), Holiday Pay, Sick and Safe Time for Applicable States</li>
<li>Employee Assistance Program</li>
<li>Career Growth Opportunities</li>
<li>401(k) and Generous Employer Match Opportunity</li>
<li>$16.00 - 16.50/hour based on experience</li>
</ul>
 At ActivStyle we don’t just accept difference - we celebrate it, we support it, and we thrive on it for the benefit of our team and our community. We are proud to be an equal opportunity workplace and an affirmative action employer. This employer participates in E-Verify. Following acceptance of any job offer, at the start of employment the employer will provide the federal government Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify is unable to verify your eligibility for employment this employer will provide written instructions to provide an opportunity to contact the appropriate agencies and resolve the discrepancy prior to taking any action against continued employment.

Customer Service Specialist

<h3>Job Description</h3>
Job Description
Founded in 1954, Vibrant Ingredients is a leading provider of natural, clean label ingredients and systems that power extraordinary food and beverage experiences. The company’s broad portfolio — including natural flavors, botanical extracts, functional nutrition, cold brew coffee, tea essences, and food protection solutions — enhances taste, texture, color, shelf life, and performance across a wide range of applications. Vibrant operates four state-of-the-art facilities across the United States and works with leading brands, manufacturers, and foodservice operators. With vertically integrated capabilities and a proven track record of innovation and execution, Vibrant helps customers accelerate to market without compromise. 
About the role:
We are a trusted partner to our customers when it comes to innovation and an industry leader in clean label ingredients, we are a true partner. We collaborate with our customers in ways that respect people and the environment. A commitment to Purely Better™ drives our innovation team to discover new, on trend solutions. 
As a Customer Service Specialist, they willplay a critical role in delivering exceptional customer support through accurate order processing, proactive communication, and effective problem resolution. Serving as a key liaison between customers and internal teams, this role ensures a smooth, responsive, and professional customer experience while supporting operational and business objectives.
This position is hybrid in structure, requiring regular travel between our corporate office in Lake Mary, FL and our manufacturing facility in Eustis, FL. While the role involves working from multiple locations, it is fully office-based and not remote.
How will you contribute:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodation may be made to enable qualified individuals with disabilities to perform essential job functions. Essential job functions and duties include, but are not limited to:
<ul>
<li>Accurately process customer orders, revisions, and changes in accordance with established policies and procedures.</li>
<li>Serve as the primary point of contact for customers regarding order status, delivery timelines, product availability, and issue resolution.</li>
<li>Communicate proactively with customers and internal stakeholders regarding delays, changes, or issues with a transparent and solutions-oriented approach.</li>
<li>Collaborate closely with Sales, Operations, Planning, Quality, and Logistics to ensure timely order fulfillment and customer satisfaction.</li>
<li>Investigate and resolve customer complaints or discrepancies related to order accuracy, shipments, documentation, or invoicing.</li>
<li>Maintain accurate and up-to-date customer account records within ERP and order management systems.</li>
<li>Monitor open orders and shipping reports to track service metrics and identify gaps or delays throughout the order lifecycle.</li>
<li>Support the development, documentation, and execution of Customer Service Standard Operating Procedures (SOPs).</li>
<li>Participate in cross-functional initiatives to streamline workflows and enhance the overall customer experience.</li>
<li>Coordinate fulfillment priorities and escalate risks or challenges as needed to prevent service disruptions.</li>
</ul>
Minimum Requirements/Qualifications:
<ul>
<li>High school diploma or equivalent required.</li>
<li>Minimum of 3 years of administrative experience in customer service, supply chain, logistics, or manufacturing/distribution environments.</li>
<li>Proficiency in Microsoft Outlook, Word, and Excel.</li>
<li>ERP or Order Management system experience strongly preferred (e.g., SAP, Oracle, Business Central, Great Plains).</li>
<li>Strong verbal and written communication skills with a customer-first mindset and professional etiquette.</li>
<li>Solid understanding of numerical concepts, including credits, percentages, and volumes.</li>
<li>Demonstrated ability to manage multiple priorities, maintain attention to detail, and work effectively in fast-paced environments.</li>
<li>Team-oriented, adaptable, and service-focused with a collaborative approach across departments.</li>
</ul>
Work Environment:
<ul>
<li>May involve exposure to allergens such as Soy, Wheat, Fish, Shellfish, Milk, Egg, Tree Nuts and Sesame.</li>
</ul>
What Vibrant Ingredients can offer you:
<ul>
<li>Generous time off for vacations</li>
<li>Paid Holidays</li>
<li>401(k) with company match</li>
<li>Tuition reimbursement</li>
<li>Medical/Dental/Vision</li>
<li>Health &amp; Wellness programs</li>
</ul>
More about us:
Vibrant Ingredients, headquartered in Lake Mary, FL, is one of the world's leading independent providers of natural ingredients. With a legacy spanning over 70 years, we deliver a diverse portfolio of clean label ingredients and innovative system solutions to the food and beverage industry. Our commitment to quality and performance is reflected in our American-made products, which enhance both taste and functionality. Backed by advanced manufacturing capabilities, we specialize in fermentation, patented cold brew extraction, custom flavor development, and a range of drying and blending technologies. Operating from four state-of-the-art facilities strategically located across the U.S., we ensure the accessibility of real, high-quality ingredients—helping our customers create better-for-you food and beverage for consumers.
"Improving the food and beverages consumed by providing real ingredients from nature that work."
This position is currently classified as on-site.
Employees are eligible to participate in Medical, Dental, Vision, Life Insurance, 401(k), Holidays, Vacation, Tuition Reimbursement Program.
The final salary offered for this position may take into account a number of factors including, but not limited to, location, skills, education, and experience.
The Company reserves the right to modify, update, change and/or make corrections to this job description, at the sole discretion of senior management, at any time during the employee’s employment term, at the sole discretion of management.
EEO Statement
Vibrant Ingredients is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Vibrant Ingredients will work with applicants to meet accommodation needs that are made known to Vibrant Ingredients in advance.
**Please no external recruiters**

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