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The mission of the Uniformed Services University of the Health Sciences (USU) is to support the readiness of America’s Warfighter and the health and well-being of the military community by educating and developing uniformed health professionals, scientists, and leaders; by conducting cutting-edge, military-relevant research, and by providing operational support to units around the world.
The USU Department of Medical and Clinical Psychology (MPS), F. Edward Hébert School of Medicine (SOM), in Bethesda, Maryland, invites applicants for the position of Assistant or Associate Professor (tenure-eligible track). MPS has a doctoral program in Clinical Psychology accredited by the American Psychological Association. The University and the department value and foster an inclusive environment that is diverse, supportive, and open to differing perspectives. Applicants from diverse backgrounds are strongly encouraged to apply.
Duties:&nbsp;The incumbent will serve as an Assistant or Associate Professor in MPS, and as such, will be responsible for teaching MPS graduate-level courses in areas of major expertise, mentoring military and/or civilian doctoral students, overseeing thesis and dissertation studies, and providing lectures to medical and graduate students as needed. The incumbent will engage in programmatic research with the expectation to develop a nationally visible, extramurally supported program of research in support of USU and/or the DoD mission. The incumbent will also assist with curriculum design, engage with multiple administrative assignments, contribute to Equity, Diversity, and Inclusion initiatives across the University, and participate in professional, university, and departmental service activities.
Performs other duties as assigned.
Qualification Requirements: Requires a minimum of an earned Ph.D. degree in Clinical Psychology, Health Psychology, or relevant psychology field from an accredited university or institution; experience in graduate-level teaching and mentorship, curriculum design, and research; demonstrated ability to work with diverse populations in an inclusive manner; exceptional interpersonal skills; outstanding written and oral communication skills; academic accomplishments, reflected by scientific publications in peer-reviewed journals appropriate to the academic rank; and active membership and involvement in scholarly societies.
The successful candidate must be academically qualified for a faculty appointment at the Assistant or Associate Professor level in accordance with SOM and USU academic policies.
The following knowledge and/or experiences are highly desirable but not a requirement:&nbsp;Administrative and/or leadership experience; openness to working with military and/or veteran populations; and grant-writing skills
Nominees for this position shall be required to successfully complete a security background investigation. Failure to meet the background investigation requirements will result in the withdrawal of the position offer or removal from the position.
Relocation expenses i.e., PCS or relocation incentives as described in 5 U.S.C 5733 may be authorized in accordance with applicable travel regulations, command policy and available command funding.
Recruitment Incentive may be authorized.
<a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2021/09/09/executive-order-on-requiring-coronavirus-disease-2019-vaccination-for-federal-employees/" target="_blank">Executive Order (EO) 14043, dated September 9, 2021, “Coronavirus Disease 2019 Vaccination for Federal Employees</a>.&nbsp;To ensure compliance with an applicable preliminary nationwide injunction, which may be supplemented, modified, or vacated, depending on the course of ongoing litigation, the Federal Government will take no action to implement or enforce the COVID-19 vaccination requirement pursuant to Executive Order 14043 on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees. Therefore, to the extent a Federal job announcement includes the requirement that applicants must be fully vaccinated against COVID-19 pursuant to E.O. 14043, that requirement does not currently apply. Federal agencies may request information regarding the vaccination status of selected applicants for the purposes of implementing other workplace safety protocols, such as protocols related to masking, physical distancing, testing, travel, and quarantine.
U.S. Citizenship is required.
Instructions for Applicants: To receive consideration, applicants must specify in their cover letter the academic rank(s) for which they are applying.&nbsp;Review of applications will begin approximately 30 days following the initial job posting and will continue until the position is filled. Applicants should submit (1) a letter of interest, (2) curriculum vitae, and (3) the names of three individuals who can be contacted to provide references,&nbsp;as one combined PDF&nbsp;to:
Ms. Trish Crum Department of Medical &amp; Clinical Psychology (MPS) Uniformed Service University of the Health Sciences (USU) 4301 Jones Bridge Road Bethesda, MD 20814 <a href="mailto:tricia.crum@usuhs.edu" target="_blank">tricia.crum@usuhs.edu</a>&nbsp;
USUHS is an Equal Opportunity Employer with a strong commitment to racial, cultural, and ethnic diversity.

Associate/Assistant Professor, Department of Medical & Clinical Psychology (MPS)

Charleston Area Medical Center (CAMC) Institute of Academic Medicine/West Virginia University (WVU) – Charleston Division seeks an Endocrinologist for a fulltime academic position as Assistant Professor at the Robert C. Byrd Health Sciences Center, West Virginia University, Charleston Division located in the capital city of Charleston, WV. Job duties include: provide clinical care and teach medical students and residents in the area of Endocrinology; scholarly activities are highly encouraged.&nbsp;
Job Requirements (must be met by the time of appointment):
<ul>
<li>MD, DO degree or foreign equivalent degree from an accredited program</li>
<li>Board Certified or Board Eligible in Endocrinology</li>
<li>Eligible for WV Medical License</li>
<li>Willingness to participate in appropriate academic, clinical research or other scholarly activity as may be required of clinical faculty</li>
</ul>
Benefits include:
<ul>
<li>Excellent benefits package with generous PTO</li>
<li>Salary commensurate with qualifications and experience</li>
<li>Vibrant community</li>
<li>Superb family environment</li>
<li>Unsurpassed recreational activities</li>
<li>Outstanding school systems</li>
</ul>

Assistant Professor Internal Medicine Endocrinologist

In partnership with Charleston Area Medical Center (CAMC) and West Virginia University School of Medicine – Charleston Division we are seeking an Interventional Pulmonologist at Assistant Professor level to join the Department of Medicine, Pulmonary Critical Care Section.&nbsp;&nbsp; This is an exciting opportunity to join a well-established program with flexibility in the position to suit the needs and expertise of the applicant.&nbsp; In addition to providing excellent patient care, the successful candidate will be actively involved in the teaching of medical students, internal medicine residents, and fellows in the pulmonary critical care fellowship.
Charleston Area Medical Center provides a wide breath of Pulmonary and Critical Care services including a Comprehensive Cancer Center, Renal transplant program, large endoscopy suite providing advanced bronchoscopy techniques, specialty critical care units including Neurosurgical and Cardiothoracic ICUs, and advanced cardiovascular support including TAVR, Mitral Clip, and ECMO.
At CAMC, you will join a distinguished team of extraordinary physicians committed to making a difference in the lives of patients locally and statewide.&nbsp; Practice advanced medicine in a collaborative atmosphere and a highly satisfying academic environment while providing the best possible pulmonary critical care for our patients.&nbsp; We recruit nationally for elite physicians who are recognized leaders in their specialty or subspecialty and utilize the most current techniques in pulmonary critical care; and placing the highest emphasis on achieving great quality outcomes. The community offers the cultural diversity and amenities of a metropolitan area in a safe, family-friendly environment with exceptional schools, affordable housing options and abundant recreational opportunities.
Job Requirements:
<ul>
<li>MD, DO degree or foreign equivalent degree from an accredited program</li>
<li>Completed residency in Internal Medicine; fellowship in Pulmonary Disease Critical Care and one year additional fellowship training in Interventional Pulmonology.</li>
<li>Eligible for unrestricted WV Medical License</li>
<li>Candidates for Assistant Professor rank must be board eligible in Pulmonary Disease Critical Care and in Interventional Pulmonology</li>
<li>Candidate for Associate and Full Professor rank must be board certified in Pulmonary Disease Critical Care and Interventional Pulmonology</li>
<li>All qualifications must be met by time of appointment.</li>
</ul>
Benefits include:
<ul>
<li>Excellent benefits package with generous PTO</li>
<li>Salary commensurate with qualifications and experience</li>
<li>Vibrant community</li>
<li>Superb family environment</li>
<li>Unsurpassed recreational activities&nbsp;</li>
<li>Outstanding school systems</li>
<li>Create your legacy while serving, educating, learning and making a difference from your very first day.</li>
</ul>

Assistant Professor Internal Medicine Interventional Pulmonology Critical Care 

The Associate Dean for Medical Education provides leadership and oversight for the development of high-quality, integrated curricular content and develops and oversees programs that ensure student success in the pre-clerkship phase of the curriculum and USMLE licensure examinations. Candidates must be faculty-eligible at or above the rank of Associate Professor.
Northeast Ohio Medical University is an AA/EEO Employer. The university has a strong commitment to the principles of diversity and inclusion and to maintaining working and learning environments that are free from all forms of discrimination. Women, individuals with disabilities, veterans and minorities are strongly encouraged to apply.
Pay Grade: 18
Location: Rootstown, OH
Principal Functional Responsibilities&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
CURRICULAR DESIGN AND TEACHING
Oversee the development and delivery of an integrated curriculum in foundational sciences.
Develop and deliver pre-matriculation content that supports student success in the early medical school curriculum.
Develop and deliver a course for USMLE Step 1 preparation.
Develop and deliver a course for USMLE Step 2 preparation.
Ensure students have sufficient curricular and co-curricular content that is appropriate and well-aligned with USMLE and NBME content specifications.
Champion and facilitate basic science-clinical science integration throughout the curriculum.
Provide leadership in identification and problem-solving of student and faculty challenges with curricular content.
ACADEMIC SUCCESS TEAM LEADERSHIP
Lead a team of faculty assigned to advise and tutor students at risk.
Assist students who seek help and/or face challenges in the M1 and M2 academic years including preparation for USMLE licensure exams.
CURRICULUM LEADERSHIP
Serve as administrative chair of the Pre-Clerkship Curriculum Sub-Committee.
Advise M1 and M2 course directors with respect to content and format alignment with USMLE examinations.
Participates in educational scholarly work.
Qualifications&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
Education/Degrees:
PhD, MD or DO degree required.
Must be eligible for faculty appointment.
Experience:
<ul>
<li>Five to seven years of experience directly related to principle functional responsibilities including but not limited to the following: Experience and activities in teaching, research, administration, and service to qualify for a senior level faculty appointment Experience with graduate medical education, with demonstrated leadership in curriculum development and assessment and medical education, particularly at the undergraduate level.</li>
</ul>
Key Skills, Personal Characteristics, and Key Competencies&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
<ul>
<li>Proven leadership skills with an ability to lead faculty. Requisite attributes will include: demonstrated abilities to inspire others and to work collaboratively, creatively and constructively with others and negotiate skillfully; strong organization skills; recognition as a respected member of the medical education and professional community; and a passion for teaching and learning as well as for the development of students, staff members, faculty members and academic programs. Ability to connect with key stakeholders including faculty, students, and other peers. General understanding of accreditation principles in the area of curriculum.</li>
</ul>
Core Competencies
<ul>
<li>Leadership: NEOMED creates positive change by educating and training Ohio’s next generation of health professionals, educators and researchers through experiential learning, high-impact research, strategic partnerships and innovation. By designing an environment where ideas and connections can flourish, NEOMED is transforming health care. Exceptional Experience: By creating a welcoming, supportive and well-resourced environment, NEOMED sets the stage for meaningful interactions among its students, faculty, staff, alumni, partners and community members. The University empowers every individual to participate fully in the campus experience and the community that NEOMED serves. Diversity, Equity and Inclusion: NEOMED recognizes, appreciates and celebrates all of the ways-from backgrounds to viewpoints-that people are different. The University’s culture is grounded in respect and thrives on the uniqueness of each individual. NEOMED encourages everyone’s participation by fostering policies and practices that ensure fair and just access, treatment and opportunities for all. People: Talent is NEOMED’s most valuable asset. The University invests in developing its faculty and staff to realize their fullest potential. As it works to attract and retain a diverse workforce and student body, NEOMED embraces opportunity and growth across all levels of the institution. Talent Management: NEOMED leadership strives to align department and individual talent management efforts with the university strategic plan and objectives through workforce planning, recruiting the right talent onboard and helping develop employees to their optimal potential and capabilities. Operational Excellence: NEOMED will create a culture of operational excellence by establishing clear administrative practices and eliminating waste. Leaders strive to meet customer expectations through a continuous improvement of the operational processes and creating a culture of employee</li>
</ul>

Associate Dean for Medical Education

Program Assistant (Quality Initiatives) CalOptima CalOptima Health is seeking a highly motivated Program Assistant (Quality Initiatives) to join our team. The Program Assistant (Quality Initiatives) will be responsible for providing administrative support for projects and department leadership. The incumbent will coordinate department meetings, take minutes and coordinate internal and external communication. The incumbent will organize and prepare materials for committee meetings, such as the Stars Steering Committee and several monthly meetings with external delegates. The incumbent will also interact with other departments and external stakeholders. Additionally, the incumbent will coordinate work and processes with other administrative staff within CalOptima Health. Position Information: 
<ul>
<li>Department: Quality Analytics </li>
<li>Salary Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - 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>Provides support to staff, including preparing meeting materials, maintaining minutes, routing documents, conducting data entry and handling incoming and outgoing correspondence per administrative policy.</li>
<li>Provides administrative support for specific and/or ongoing department projects, such as generating reports, logs, calendars and mailings, applying general business practices and CalOptima Health policies and procedures.</li>
<li>Serves as a liaison between directors and departmental staff and follows up on the progress of projects and activities assigned to the director's subordinates or other staff.</li>
<li>Assists with department expenses and budgeting, including processing requisitions for payment.</li>
<li>Coordinates approved travel arrangements in accordance with CalOptima Health's travel policy for the department.</li>
<li>Handles all incoming invoices and expense reports for the director and other management staff as appropriate.</li>
<li>Coordinates work with other administrative staff and supports the coordination of staff efforts within the department.</li>
<li>Coordinates the calendar and schedule of the department director, including scheduling appointments, meetings and events. Exercises discretion in committing time, evaluating needs and making meeting arrangements.</li>
<li>Determines priority of matters of attention for the director, redirects matters to staff or handles matters personally, as appropriate.</li>
<li>Maintains confidential and sensitive information and files regarding management projects, policy and personnel, ensuring appropriate follow-up.</li>
<li>Maintains department directory, organization chart, SharePoint and paid time off calendar.</li>
<li>Collects data, identifies pertinent information and assists with preparing reports and presentations. </li>
</ul>
</li>
</ul>
<ul>
<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 experience in a previous administrative support role 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>Associate's degree in health care management, health care administration or related field.</li>
<li>Health care 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=6639342&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 29, 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/6639342" target="_blank">https://jobs.caloptima.org/jobs/program-assistant-quality-initiatives-505-city-parkway-west-california-united-states-bbca2d4d-7202-4456-a151-be62a3b755fb</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-bff749b3549afa43abf246d29a53a9e4

Program Assistant (Quality Initiatives)

Member Liaison Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Member Liaison Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our CS - Member Liaison team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program. You will serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>85% - Member Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.</li>
<li>Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.</li>
<li>Coordinates members' health care and social service needs within and outside the health network and CalOptima Health during the original interaction.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program.</li>
<li>Guides members in understanding and accessing the benefits under the Whole-Child Model program.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Initiates referrals to internal and external care management departments and government agencies.</li>
<li>Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes, helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Collaborates with interdepartmental staff in call resolution as needed.</li>
<li>Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.</li>
<li>Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience as a call center agent or customer/member services representative in health care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity. </li>
<li>Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6687129&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is November 11, 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/6687129" target="_blank">https://jobs.caloptima.org/jobs/member-liaison-specialist-customer-service-505-city-parkway-west-california-united-states-c3fb6d6c-517c-418f-8d64-895099286932</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-de8018e655f9b64388465261ce5f3fed

Member Liaison Specialist (Customer Service)

Lead Decision Support Analyst (Principal Financial Analyst) CalOptima CalOptima Health is seeking a highly motivated Lead Decision Support Analyst (Principal Financial Analyst) to join our team. The Principal Financial Analyst (Decision Support) will be responsible for providing highly complex analysis, guidance and expert knowledge on health care finance for various departments within CalOptima Health. The incumbent is a sought-out expert and company-wide resource on matters of health care finance. Working independently, the incumbent will lead complex large-scale analytical initiatives, develop report suites and financial models used to forecast medical cost trends. The incumbent will provide expertise for provider contract negotiations, assess actuarial rate development studies, participate in annual budgeting functions, lead ad-hoc teams and serve as a subject matter expert to staff and other consultants within the department. The incumbent will evaluate high visibility complex issues, perform detailed analysis and communicate well reasoned, thorough solutions to all levels of management within CalOptima Health. The incumbent will work with large amounts of claims, enrollment and provider data. Position Information: 
<ul>
<li>Department: Financial Analysis </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>95% - Financial 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>Shares expert knowledge, mentors, trains and serves as a lead for analytical staff.</li>
<li>Serves as a subject matter expert in the following areas: Medi-Cal provider rate methodology, Medicare provider rate methodology, Department of Health Care Services (DHCS) revenue, Centers for Medicare &amp; Medicaid Services-Medicare Advantage (CMS-MA) revenue, population health member cohort identification, industry standard approaches to health care cost service categorization and metrics.</li>
<li>Forms and leads ad-hoc teams on key initiatives.</li>
<li>Provides expertise and analyses around risk adjustment.</li>
<li>Leads in the design, development, implementation and maintenance of report suites and dashboards for all levels of CalOptima Health management.</li>
<li>Researches, assesses and develops advanced tools, models, reports and approaches to increase accuracy and timeliness of data-driven work projects.</li>
<li>Develops medical expense, revenue and enrollment projections to support the budget process.</li>
<li>Develops financial models and reports to support provider contract negotiations.</li>
<li>Develops return on investment and business case analyses for program initiatives under consideration by management.</li>
<li>Provides clinical and utilization analysis to assist Medical Management with improving outcomes and quality of care for CalOptima Health members.</li>
<li>Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse. </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, finance, economics, actuarial sciences or related field PLUS 8 years of financial analysis experience in managed care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>5 years of experience in Provider Contract Modeling, Provider Rate Analysis and/or Managed Care Contracting in a health care setting required. </li>
<li>1 year of experience writing SQL required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>5 years of analytical experience working with Medi-Cal and/or Medicare payer information. </li>
<li>Experience in an Independent Physician Association (IPA), hospital or health plan setting. </li>
<li>Intermediate to Advanced proficiency in Excel. </li>
<li>Experience with DHCS rate development and/or Medicare Advantage bid process.</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=6691144&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 September 2, 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/6691144" target="_blank">https://jobs.caloptima.org/jobs/lead-decision-support-analyst-principal-financial-analyst-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-92d54e2144852e4496213bad8f60c91f

Lead Decision Support Analyst (Principal Financial Analyst)

Customer Service Representative Sr (OneCare) (Bilingual) 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 Customer Service Representative Sr (OneCare) (Bilingual) and help shape the future of healthcare where you'll be an integral part of our CS - OneCare Customer Service 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 serve as a senior point of contact for OneCare members and providers and assist them with questions and/or complaints related to the OneCare plan services. You will provide information regarding eligibility, enrollment, benefits and services to OneCare eligible members and providers. 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>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>Serves as a senior resource for other team members (i.e., solves complex challenges, answers uncommon questions and shares complex processes and procedures).</li>
<li>Supports in the coordination of member's health care and social service needs both within and outside the medical group and CalOptima Health.</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>Initiates referrals to both internal and external care management departments and other department/government or community agencies.</li>
<li>Maintains departmental productivity and quality standards.</li>
<li>Follows through and completes all member and provider inquiries or requests during the original member and provider interaction. Provides additional follow-up assistance as needed. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience in customer/member service, including 1 year of 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>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese) required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>1 year of Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services experience.</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Part Time, Full Telework (**If the position is Telework, it is eligible in California only**)
<ul>
<li> *We have two schedules available for this role for this part-time role. Please indicate your preferred shift to apply for, enter "both" if open for both shifts. - Monday - Friday, 10:00 a.m. to 3:00 p.m. - Monday - Friday, 1:00 p.m. to 6:00 p.m. </li>
<li>**Training will be held in the office the first 4 weeks from 8:30am - 5:00pm, Monday - Friday. </li>
</ul>
</li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6690097&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is November 12, 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/6690097" target="_blank">https://jobs.caloptima.org/jobs/customer-service-representative-sr-onecare-bilingual-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-b3485a6e5d8eed4aabe9d0bb39035198

Customer Service Representative Sr (OneCare) (Bilingual)

Claims Examiner 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 Claims Examiner Sr 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 responsible for analyzing and validating claims elements and claims processing. You will adhere to regulatory and internal guidelines in conjunction with CalOptima Health's policies and procedures related to claims adjudication. You will be responsible for adjudicating more complex claims which require additional research or problem-solving. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>95% - Claims 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>Conducts research and problem solves the more complex claims.</li>
<li>Processes professional and institutional claim types.</li>
<li>Performs thorough review of pending claims for billing errors and questionable billing practices, including duplicate billing and unbundling of services.</li>
<li>Corrects system-generated errors manually prior to final claims adjudication.</li>
<li>Processes claims based upon CalOptima Health's contractual agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and CalOptima Health's policies and procedures.</li>
<li>Analyzes and validates Medi-Cal and/or Medicare claims pricing; researches, adjusts and adjudicates claims; reviews services for accurate charges, utilizing billing code sets and/or authorization guidelines as a reference.</li>
<li>Processes claim exception reports as assigned. </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 2 years 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>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Experience processing online claims in a managed care environment. </li>
<li>Experience processing Medi-Cal and/or Medicare claims. </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: 303 - $51,744 - $72,441 ($24.88 - $34.8274). 
<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=6692128&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is November 13, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6692128" target="_blank">https://jobs.caloptima.org/jobs/claims-examiner-sr-505-city-parkway-west-california-united-states-55768582-cbb1-4f0a-9b91-f24bd96b3864</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-0997c2453663f24f8553ce58bf644157

Claims Examiner Sr

Program Specialist (Sales) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Program Specialist (Sales) and help shape the future of healthcare where you'll be an integral part of our OneCare Sales &amp; Marketing team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Under general supervision, you will assist and support the Director of Sales and Marketing in a wide variety of duties related to broker support. You will work closely with the director to support agents and brokers, including certification, email and phone support and supply requests. Additionally, you will oversee the agent broker payment process. You will also will be responsible for assisting in the research of sales allegations, Complaint Tracking Module (CTM) complaints, grievances, preparing reports, commission reports, submitting check requests to accounting, supporting agent/broker processes and coordinating events related to broker activities. Lastly, you will interface and work collaboratively with internal staff, agents/brokers and providers to ensure that policies and procedures meet regulatory requirements for operations and support other key CalOptima Health provider relations staff on related projects. 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>Serves as the primary health plan support and point person with agent/brokers, other CalOptima Health departments for administrative functions of operating OneCare Health Maintenance Organization Dual Special Needs Plan (HMO D-SNP) Outreach and Education and Provider Relations departments.</li>
<li>Assists the team with quality checks for enrollment, disenrollment and payment processing to ensure the Field Marketing Organizations (FMO), independent agents, community partners and other vendors are compliant with all regulatory and CalOptima Health requirements in accordance with the agreement.</li>
<li>Participates in CalOptima Health workgroups to meet its contractual requirements with the Center for Medicare and Medicaid (CMS), California Department of Health Services (DHCS), Department of Managed Health Care (DMHC) and any other applicable entity.</li>
<li>Supports department staff to maintain health plan management operations, including staying updated with relevant CMS and Medi-Cal regulations and requirements.</li>
<li>Coordinates community events in support of member or provider outreach team functions.</li>
<li>Acts as liaison between CalOptima Health and the community to effectively resolve issues.</li>
<li>Prepares meeting materials, meeting set-up, minute taking, etc., as designated by the director.</li>
<li>Maintains an inventory of marketing, enrollment supplies, including monitoring needs and ordering for supplies, member material and promotional items for the Sales and Marketing department.</li>
<li>Coordinates delivery/shipment of marketing brochures and enrollment/sales kits for the FMO/broker agencies.</li>
<li>Monitors the agent support mailbox and dedicated phone number and responds to inquiries or redirects to appropriate staff or department for assistance.</li>
<li>Provides support for specific and/or ongoing projects, such as generating reports, logs, calendars and mailings, applying general business practices, as well as CalOptima Health policies and procedures.</li>
<li>Maintains confidential and sensitive information and files regarding management projects, policy and personnel, ensuring appropriate follow-up.</li>
<li>Participates in Audit and Oversight Committee meetings as needed. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree PLUS 1 year of work experience in health care administration with demonstrated or potential competence in working with health plan management functions required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Experience with agent/broker field organizations or broker agencies. </li>
<li>Experience in provider relations, Medicare or Medi-Cal enrollment and eligibility.</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: 305 - $55,966 - $83,949 ($26.91 - $40.3601). 
<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=6687144&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is November 12, 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/6687144" target="_blank">https://jobs.caloptima.org/jobs/program-specialist-sales-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-686bb121abedf041a5969a6f34bb8a09

201,018 Medical Assistant Jobs