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Grants Payment Manager/Senior Grants Payment Manager The Simons Foundation is seeking a Grants Payment Manager/Senior Grants Payment Manager (dependent upon experience level and qualifications). This position is responsible for managing all aspects of the payments process for the Simons Foundation and the Simons Foundation International, within our grants management system, the Simons Award Manager (SAM). In 2024, this included processing 3,165 payments totaling over $486 million, as well as scheduling over $400 million in new commitments across 844 awards for both funding entities. The Grants Payment Manager/Senior Grants Payment Manager oversees the scheduling and approval of all grant and gift-related payments. They manage payment modifications and holds, and ensure compliance with the foundation's policies, including carry-forward requirements and the unspent funds process. The Grants Payment Manager/Senior Grants Payment Manager also oversees the administration of over 600 Institution Profiles across 30 countries, which includes the oversight of contacts and user administration and the submission and approval of banking details. They are also responsible for all payment and institution-related reporting. The role requires strong collaboration across internal teams and with external grantees. This position will report to the Vice President, Grants Management and currently manages two Grants Payment Assistants. This position is a full-time position based on-site at the Simons Foundation's New York City offices. Visit the <a href="https://apptrkr.com/get_redirect.php?id=6682236&amp;targetURL=https://www.simonsfoundation.org/careers/" target="_blank">Simons Foundation career page</a> to learn more. ESSENTIAL FUNCTIONS/RESPONSIBILITIES 
<ul>
<li>Oversees all aspects of the monthly payment process, including the submission and approval of payment details, the scheduling of payments, the modification of payments, and the resolution of payment-related holds. </li>
<li>Manages Institution Profiles, which include automated clearing house and wire transfer payment details, as well as contacts and user information for the institutions. </li>
<li>Reviews and approves Authorized Institution Officials responsible for submitting payment details. </li>
<li>Produces all grant-related reports, including the monthly payment schedule, quarterly and annual reconciliations and reports, and other reports as needed. </li>
<li>Reconciles payment data in the Simons Award Manager (SAM) against the finance department's records to ensure accuracy. </li>
<li>Builds strong relationships with other departments at the foundation, most importantly the finance and business information technology departments. </li>
<li>Continually improves payment process workflows, reporting, and related standard operating procedures. </li>
<li>Serves as a key representative of the grants department in cross-functional meetings regarding payment policies and processes. </li>
<li>Acts as the subject-matter expert for payment functions, providing guidance, best practices, and risk analysis for SAM. </li>
<li>Creates payment-related deliverable templates, instructions, and FAQs for internal and external use. </li>
<li>Oversees the payment deliverable submission and review process, ensuring timely and accurate processing. </li>
<li>Ensure grantee compliance with unspent funds, carry-forward policies, and other payment-related requirements. </li>
<li>Manages and provides guidance to two Grants Payment Assistants, ensuring accurate and timely execution of their responsibilities. </li>
<li>Performs any other duties or tasks as assigned or required.</li>
</ul>
 MINIMUM QUALIFICATIONS Education 
<ul>
<li>Bachelor's degree</li>
</ul>
 Experience 
<ul>
<li>At least 5-8 years of experience in grants administration, financial operations, or a similar role, preferably in a nonprofit, foundation or research institution setting. </li>
<li>Experience with reconciling financial data is essential. </li>
<li>Experience managing staff, delegating tasks, and mentoring team members.</li>
</ul>
 Related Skills &amp; Other Requirements 
<ul>
<li>Ability to work independently and manage others </li>
<li>Superb Excel and PowerPoint skills </li>
<li>Strong attention to detail </li>
<li>Excellent interpersonal skills </li>
<li>Exceptional written and verbal communication skills </li>
<li>The ability to complete multiple tasks while working under deadlines with competing priorities </li>
<li>Familiarity with grant management systems (like SmartSimple, ProposalCentral, or similar) is a plus.</li>
</ul>
 COMPENSATION AND BENEFITS 
<ul>
<li>The full-time annual compensation range for this position is $90,000 - $135,000, depending on experience level and qualifications. </li>
<li>In addition to competitive salaries, the Simons Foundation provides employees with an outstanding benefits package.</li>
</ul>
 REQUIRED APPLICATION MATERIALS 
<ul>
<li>Please submit a resume and cover letter stating your interest in the position.</li>
</ul>
 Our Commitment to Expanding Pathways to Science &amp; Opportunities for All: Many of the greatest ideas and discoveries come from a diverse mix of minds, backgrounds, and experiences. The Simons Foundation is committed to advancing basic science and mathematics to benefit humankind and expand our collective understanding of our world. As part of our mission, we support partners, programs, and initiatives that seek to broaden the scientific community and open pathways to science and mathematics careers. The Simons Foundation provides equal opportunities to all applicants without regard to race, religion, color, age, sex, pregnancy, national origin, sexual orientation, gender identity, genetic disposition, neurodiversity, disability, veteran status, or any other protected category under federal, state, and local law. To apply, please visit: <a href="https://apptrkr.com/6682236" target="_blank">https://simonsfoundation.wd1.myworkdayjobs.com/en-US/simonsfoundationcareers/details/Grants-Payment-Manager-Senior-Grants-Payment-Manager_R0001973</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-831cdee1a00c2b46b9cdf1876a0e06cd

Grants Payment Manager/Senior Grants Payment Manager

Executive Director of Operations Thank you for your interest in employment with Nevada System of Higher Education (NSHE), System Administration and System Computing Services. We want your application process to go smoothly and quickly. We ask that you keep in mind the following when completing your application: 
<ul>
<li>Draft applications are saved automatically and can be accessed through your candidate home account. </li>
<li>Final applications must be submitted prior to the close of the recruitment. Once a recruitment has closed, applications will no longer be accepted. </li>
</ul>
 If you need assistance or have questions regarding the application process, please contact our Human Resources department at (775) 784-4901. Job Description The Nevada System of Higher Education (NSHE) invites applications for the position of Executive Director of Operations. This is a renewable, full-time, non-tenured, administrative position and reports to the Chancellor. The position may be located in either Reno or Las Vegas, Nevada. The NSHE is comprised of eight institutions: two universities, a state university, four community colleges and a research institute. The public system of higher education in Nevada continues to experience growth with significant challenges and opportunities in serving over 110,500 students and 15,000 employees. The Executive Director of Operations provides strategic and administrative leadership for cross-functional operational services that support the mission and effectiveness of System Administration (SA). Reporting directly to the Chancellor, the Executive Director ensures the seamless coordination of enterprise services, administrative logistics, support mechanisms, and key operational initiatives. The Executive Director fosters continuous improvement, service innovation, and accountability in operational workflows and collaborates with institutional partners and internal divisions to ensure consistency and responsiveness in service delivery. SALARY GRADE: * This position offers a competitive compensation package commensurate with the candidate's education, experience, and certification/training. In addition to base salary, employees enjoy a comprehensive benefits package that includes: <a href="https://apptrkr.com/get_redirect.php?id=6658838&amp;targetURL=https://pebp.nv.gov/Plans/getting-to-know-your-plan/" target="_blank">Comprehensive Health Insurance</a>: includes health, dental, vision, and life insurance. Additionally, an employer paid long term disability plan is included. <a href="https://apptrkr.com/get_redirect.php?id=6658838&amp;targetURL=https://nshe.nevada.edu/system-administration/departments/finance/retirement/" target="_blank">Outstanding Retirement Plan</a>: professional employees are required to participate in the 401(a) Retirement Plan Alternative (RPA). Employee contributions of 19.25% are matched 100% by the employer and employees experience an immediate vesting in the plan. Employees who currently or previously participated in Public Employees Retirement System (PERS) of Nevada may be eligible to continue in the PERS plan. <a href="https://apptrkr.com/get_redirect.php?id=6658838&amp;targetURL=https://nshe.nevada.edu/wp-content/uploads/file/BoardOfRegents/Handbook/title4/T4-CH03%20Professional%20Staff.pdf" target="_blank">Paid Leave</a>: generous annual leave (accrual of 2 days per month), sick leave (granted 30 days at time of hire), 12 paid holidays, and paid family leave. <a href="https://apptrkr.com/get_redirect.php?id=6658838&amp;targetURL=https://nshe.nevada.edu/wp-content/uploads/file/BoardOfRegents/Handbook/title4/T4-CH03%20Professional%20Staff.pdf" target="_blank">Education Benefit</a>: employees and their qualified dependents may take advantage of a tuition savings benefit. Faculty may take up to six credits per semester at a reduced rate and their dependents may access an unlimited number of credits, if they meet specific criteria. Additional Perks: Employee assistance programs and professional development opportunities. *Pursuant <a href="https://apptrkr.com/get_redirect.php?id=6658838&amp;targetURL=https://nshe.nevada.edu/wp-content/uploads/file/BoardOfRegents/Handbook/title4/T4-CH03%20Professional%20Staff.pdf" target="_blank">NSHE Policy</a>: "Initial placement must fall between the minimum salary and Q2/median/mid-range on the applicable salary schedule." To view the salary range for this position, please visit: <a href="https://apptrkr.com/get_redirect.php?id=6658838&amp;targetURL=https://nshe.nevada.edu/wp-content/uploads/file/BoardOfRegents/PGManual/chapters/Chapter%2003%20-%20Salary%20Schedules.pdf" target="_blank">Salary Schedules</a> and select "Administrative Faculty, Grade E." APPROXIMATE STARTING DATE: December 1, 2025 MINIMUM QUALIFICATIONS: A Bachelor's degree from an accredited institution in public administration, business administration, higher education administration, or related field with a minimum of seven (7) years of progressively responsible leadership experience in operations, administration, or related areas. Experience coordinating high-level projects and managing internal processes across complex organizational structures. Preferred Qualifications: 
<ul>
<li>Master's degree in Public Administration, Organizational Leadership, or a related field preferred. </li>
<li>Experience in higher education operations at the system or campus level. </li>
<li>Demonstrated ability to manage executive-level logistics and implement cross-unit administrative systems. </li>
<li>Familiarity with strategic planning, continuous improvement methodologies, or enterprise administrative tools. </li>
</ul>
 Working Conditions and Travel Requirements 
<ul>
<li>Occasional travel to NSHE institutions and System Administration (SA) sites may be required. </li>
<li>Work is primarily performed in a standard office environment. </li>
<li>Extended hours may be necessary during project implementation phases or in support of events. </li>
</ul>
 KNOWLEDGE, SKILLS, AND ABILITIES: Successful candidates must possess the following knowledge, skills and abilities. It is recommended that applicants for this position address each of the following items in the letter of application: 
<ul>
<li>Knowledge of operational practices and service models in higher education or public organizations. </li>
<li>Skill in strategic planning, workflow coordination, and process improvement. </li>
<li>Ability to develop and implement operational systems that serve multiple stakeholders. </li>
<li>Strong communication, facilitation, and organizational skills. </li>
<li>Ability to exercise discretion, maintain confidentiality, and manage sensitive projects. </li>
<li>Capacity to work across functional areas and institutional lines with diplomacy and accountability. </li>
<li>Proficiency in technology platforms related to project management, scheduling, workflow tracking, and communication. </li>
<li>Understanding of logistical systems, workflows, and shared services in complex organizations. </li>
<li>Familiarity with administrative system tools and project management practices. </li>
<li>Excellent interpersonal and communication skills, including written reporting and executive briefings. </li>
<li>Ability to analyze operational problems and recommend data-informed solutions. </li>
<li>Strong time management, task coordination, and attention to detail. </li>
<li>Ability to work effectively across diverse stakeholders and institutional partners. </li>
</ul>
 RESPONSIBILITIES: The duties of this position will include, but not be limited to: 
<ul>
<li>Provide oversight for operational logistics, including internal communications processes (e.g., message routing, executive briefing flows, and cabinet-level information tracking), scheduling infrastructure, space coordination, and key project timelines to ensure consistent and efficient systemwide coordination. </li>
<li>Serve as a strategic project manager for Chancellor-level initiatives requiring multi-unit coordination and cross-functional input. </li>
<li>Coordinate the logistical planning and execution of executive-level meetings, retreats, and systemwide convenings. </li>
<li>Support strategic and operational planning cycles in collaboration with the Chancellor and executive team. </li>
<li>Act as a liaison between the Chancellor's Office and operational stakeholders across institutions to ensure consistency and responsiveness. </li>
<li>Coordinate special projects related to organizational planning, auxiliary service delivery, or external partnerships. </li>
<li>Contribute to risk management, business continuity, and emergency preparedness planning in alignment with institutional operations. </li>
<li>Execute and support daily logistical activities that enable the communication, scheduling, and coordination framework established by the Chancellor's Office, ensuring smooth day-to-day operations across the system. </li>
<li>Assists in the development of standardized operational processes to support administrative efficiency and collaboration. </li>
<li>Implementation of protocols and tools to improve scheduling, tracking, and task management across system office initiatives. </li>
<li>Maintains progress on key operational initiatives as directed by the Chancellor. </li>
<li>Facilitate communication, scheduling alignment, and system-level planning activities related to academic program reviews, accreditation reporting timelines, and academic master planning efforts, in coordination with institutional leadership. </li>
<li>Provides logistical support for Chancellor-initiated academic planning sessions, system-level academic forums, or special meetings involving institutional academic leadership, in coordination with the Vice Chancellor for Academic Affairs. </li>
<li>Supports the Chancellor's Office and the Vice Chancellor for Academic Affairs in tracking key academic planning timelines and reporting milestones to support system-level coordination and communication. </li>
<li>Implement and refine shared services that improve administrative support, operational tracking, and internal efficiency. </li>
<li>Facilitate workflow and documentation processes for high-level projects, ensuring milestones and deliverables are met. </li>
<li>Oversee administrative support teams responsible for document flow, scheduling, calendaring, distribution, and logistical support. </li>
<li>Monitor and enhance operational policies, identifying areas for procedural updates and system alignment. </li>
<li>Coordinating briefings and developing dashboards on operational metrics, status updates, and service outcomes. </li>
<li>Coordinates implementation of administrative systems that enhance non-academic operations across System Administration offices. </li>
<li>Evaluates existing workflows and assists with process improvements to reduce inefficiencies. </li>
<li>Provides user support and documentation for system-level administrative platforms. </li>
<li>Serves as a liaison to institutional staff for administrative coordination of projects. </li>
<li>Serves as a liaison to the System Administration Academic Affairs unit to facilitate cross-functional planning, document tracking, and workflow improvement related to academic operations. </li>
<li>Provides logistical and formatting support for Board of Regents agenda submissions related to Chancellor initiatives and ensures materials meet required timelines and submission standards. </li>
<li>Supports academic calendaring, event logistics (e.g., commencement attendance coordination, etc.), and shared platforms. </li>
<li>Coordinate special projects related to auxiliary service delivery or external partnerships. </li>
<li>Foster a culture of service excellence, accountability, and collaboration across the SA operational teams. </li>
<li>Manages select auxiliary functions such as mail services, fleet operations, or central office support systems. </li>
<li>Monitors service-level quality, vendor performance, and operational compliance in auxiliary areas. </li>
<li>Identify, recommend, and implement improvements to enhance the user experience and ensure operational reliability. </li>
</ul>
 TO APPLY: The application process will be handled through the Workday on-line search process. Application materials must include a current resume, detailed cover letter, and names, email addresses and telephone numbers of four professional references willing to be contacted. Applicants should fully describe qualifications and experience, since the initial review will serve to evaluate applicants based on documented, relevant qualifications and professional work experience. Applications will be considered incomplete without all requested materials. References will only be contacted for those who advance to the final phase of the search and with prior consent of the applicant. The review of materials will begin immediately. Materials should be addressed to Sherry Olson, Human Resources, and are to be submitted via on-line application at <a href="https://apptrkr.com/get_redirect.php?id=6658838&amp;targetURL=https://nshe.nevada.edu/system-administration/departments/human-resources/careers/" target="_blank">https://nshe.nevada.edu/system-administration/departments/human-resources/careers/</a> For assistance with NSHE's on-line applicant portal, contact Sherry Olson at (775) 784-4901. INTERNAL APPLICANTS: Current employees within the Nevada System of Higher Education MUST use the "Find Jobs" process within Workday to find and apply for jobs at NSHE institutions. Once you log into Workday and type "Find Jobs" in the search box which will navigate to the internal job posting site. Locate the specific job posting by typing the requisition number (e.g. R0000000) in the search box. APPLICATION DEADLINE: Applications may be submitted until the position is filled. Application materials must include a current resume, detailed cover letter, and names, email addresses and telephone numbers of four professional references willing to be contacted. Applications will be considered incomplete without all requested materials. The review of materials will begin immediately, however, for full consideration applications should be submitted by Sunday, November 2, 2025. For more information about the Nevada System of Higher Education, please visit our website at <a href="http://www.nevada.edu" target="_blank">www.nevada.edu</a>. The Nevada System of Higher Education hires only United States citizens and non-citizens lawfully authorized to work in the U.S. The NSHE is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, physical or mental disability, genetic information, sexual orientation, gender identity or gender expression. Exempt Yes Full-Time Equivalent 100.0% Required Attachment(s) Application materials must include a current resume, detailed cover letter, and names, email addresses and telephone numbers of four professional references willing to be contacted. Posting Close Date Note to Applicant A background check will be conducted on the candidate(s) selected for hire. References will be contacted at the appropriate phase of the recruitment process. As part of the hiring process, applicants for positions in the Nevada System of Higher Education may be required to demonstrate the ability to perform job-related tasks. All document(s) must be received on or before the closing date of the job announcements. Schedules are subject to change based on organizational needs. HR will attempt to verify academic credentials upon receipt of hiring documents. To apply, visit <a href="https://apptrkr.com/6658838" target="_blank">https://nshe.wd1.myworkdayjobs.com/en-US/NSHE-external/job/System-Administration-Office---North/Executive-Director-of-Operations_R0149446?workerSubType=dddb2e55fbdf014cc806bd19c034ed08</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-9250fbc69b49a8458f13096a3295d759

Executive Director of Operations

Configuration Management Analyst (ITS Analyst Int) 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 Configuration Management Analyst (ITS Analyst Int) and help shape the future of healthcare where you'll be an integral part of our Medical Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. The Configuration Management Specialist will serve as a critical liaison between business and technical teams within the Clinical Operations Configuration and Application Configuration department, operating within an Agile framework. You'll oversee the clinical application configuration request lifecycle from intake to delivery, ensuring effective prioritization, capturing business requirements and coordination and alignment with organizational goals through iterative and collaborative processes. Additionally, you'll work closely with business stakeholders, Information Technology (IT), shared services and the JIVA vendor in Agile ceremonies to deliver high-quality configuration solutions. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>60% - Feature Planning, Prioritization and Requirements Grooming
<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>Backlog Management: Maintains and grooms the configuration request backlog in alignment with Agile principles, ensuring requests are logged, categorized and prioritized based on business needs and strategic objectives for inclusion in sprint planning.</li>
<li>Request Triage and Intake: Acts as the primary point of contact for business stakeholders submitting configuration requests. Triages requests to assess urgency, impact and feasibility, refining them into actionable user stories or tasks for Agile sprints.</li>
<li>Requirements Grooming: Collaborates with business stakeholders in backlog refinement sessions to gather, clarify and document business-level requirements ensuring user stories are well-defined, meet acceptance criteria and align with technical capabilities and organizational goals.</li>
<li>Vendor Collaboration: Participates in Agile ticket review meetings with the JIVA vendor to escalate issues, discuss complex tickets and ensure timely resolution of configuration-related challenges within sprint cycles.</li>
<li>Stakeholder Coordination: Facilitates communication between business units, IT and shared services teams during Agile ceremonies (e.g., sprint planning, daily standups and retrospectives) to establish delivery timelines, resolve dependencies and manage expectations.</li>
<li>Prioritization and Sprint Planning: Works with business stakeholders and the Agile team to prioritize configuration requests while balancing urgency, resource availability and strategic priorities to create sprint goals and optimize delivery schedules.</li>
<li>Task Oversight: Monitors and ensures configuration tasks are completed accurately and on time within sprints, coordinating with the team to address gaps or delays before release.</li>
<li>Daily Standups and Barrier Resolution: Actively participates in daily Agile standups to report progress, address barriers, refine requirements, size tasks and resolve questions, ensuring smooth sprint execution.</li>
<li>Risk and Issue Management: Proactively identifies risks or impediments impacting sprint delivery, escalates as needed during Agile ceremonies and collaborates with the team to implement mitigation strategies.</li>
<li>Documentation and Reporting: Maintains clear documentation of user stories, decisions and processes in Agile tools (e.g., Jira). Provides sprint metrics, backlog health updates and delivery performance reports to stakeholders and leadership during sprint reviews. </li>
</ul>
</li>
<li>30% - Coordinating and Collaborating With IT
<ul>
<li>Change Management Support: Coordinates user acceptance testing (UAT) within sprint cycles, support training efforts and ensure smooth adoption of configuration changes by business users.</li>
<li>Process Improvement: Contributes to Agile retrospectives to identify and implement opportunities to enhance request intake, prioritization and delivery processes, driving efficiency and team effectiveness.</li>
<li>Agile Collaboration: Actively engages in Agile ceremonies, including sprint planning, backlog refinement, sprint reviews and retrospectives to foster collaboration and continuous improvement. </li>
</ul>
</li>
<li>10% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in healthcare administration, information technology, business administration or a related field PLUS 5 years of experience in business analysis, project coordination or clinical systems management, with at least 1 year working in an Agile, Kanban or other software delivery processes required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>1 year of experience with requirements gathering, documentation and Agile prioritization techniques.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Agile and/or project management certifications (e.g., Certified ScrumMaster, SAFe Agilist).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>n/a</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 312 - $84,092 - $134,548 ($40.43 - $64.6865). 
<ul>
<li>The 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=6690109&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/6690109" target="_blank">https://jobs.caloptima.org/jobs/configuration-management-analyst-its-analyst-int-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-fbbc5fdf6f1905409041aa43c02ebef8

Configuration Management Analyst (ITS Analyst Int)

Supervisor Utilization Management (Prior Authorization) 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 Supervisor Utilization Management (Prior Authorization) and help shape the future of healthcare where you'll be an integral part of our UM - Prior Authorization 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 monitor and supervise the department operations to ensure service standards are met. You will make recommendations regarding assignments based on assessment of workload serve as a resource to the Prior Authorization staff regarding CalOptima Health's policies and procedures and regulatory requirements governing authorization processing. Lastly, you will provide ongoing monitoring and development of staff. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>50% - Supervisory Functions
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists the manager as needed to ensure departmental and agency goals are met.</li>
<li>Identifies learning opportunities for staff and develops training materials (e.g., desktop procedures and/or Microsoft PowerPoint presentations) to provide education.</li>
<li>Interviews potential candidates and makes recommendations for second round interviews and/or hiring of a candidate.</li>
<li>Creates staffing assignments based on authorization priority, workload, current staffing and review of timeliness reports.</li>
<li>Trains, audits, supervises and coaches Prior Authorization staff.</li>
<li>Reviews staff monthly productivity metrics and identifies and conducts performance feedback and/or counseling/corrective action meetings with the assistance of Human Resources as necessary.</li>
<li>Reviews workflows, procedures and/or policies and recommends or implements changes as appropriate.</li>
<li>Reviews denials and modifications of member notifications prior to mailing and collaborates with staff to implement updates as necessary. </li>
</ul>
</li>
<li>45% - Program Support
<ul>
<li>Assists in the monitoring of appropriate benefit checks, application of guidelines to determine medical necessity, appropriate routing and timely completion of authorization requests.</li>
<li>Assists with the collection, monitoring and analysis of prior authorization indicators and activities.</li>
<li>Provides coverage and expertise for other teams within the Utilization Management department.</li>
<li>Conducts prior authorization presentations to internal or external customers.</li>
<li>Serves as a subject matter expert (SME) to departmental staff, internal departments and affiliated health networks regarding authorization rules and processes. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Associate degree in Nursing (ADN) PLUS 3 years of clinical nursing experience required, preferably in a managed care environment; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>2 years of progressive leadership experience, including direct supervision of staff in managed care and/or utilization management required. </li>
<li>1 year of utilization management/prior authorization review experience required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Bachelor of Science degree in Nursing (BSN).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>Current and unrestricted California Board Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license required.</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322). 
<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=6687180&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/6687180" target="_blank">https://jobs.caloptima.org/jobs/supervisor-utilization-management-prior-authorization-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-501b7ec506de63449aa238e8339c5068

Supervisor Utilization Management (Prior Authorization)

Program Manager (Quality Incentives) 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 Manager (Quality Incentives) and help shape the future of healthcare where you'll be an integral part of our Quality Analytics team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Under the general direction of the Director of Quality Initiatives, You will collaborate and coordinate with leadership to design, implement and evaluate quality incentive programs. You will support with leading, implementing and optimizing pay for value incentive programs across our provider and hospital network. You will interact with CalOptima Health's executives and management, legal counsel and state and federal regulatory agencies. Additionally, you will support CalOptima Health staff on related projects as needed. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - Program Management
<ul>
<li>Leads end-to-end management of provider incentive programs, health network pay-for-value initiatives and hospital quality pay for value models.</li>
<li>Collaborates with cross-functional teams and vendors to develop program strategies and performance metrics.</li>
<li>Monitors quality incentive program performance, identifies improvement opportunities and implements data-driven enhancements.</li>
<li>Communicates program goals, progress and outcomes to internal stakeholders and external partners.</li>
<li>Participates in meetings with providers, health networks and hospital partners to review performance for quality measures and CalOptima Health's pay for value (P4V) programs.</li>
<li>Assists partners with understanding and implementing best practices to improve performance.</li>
<li>Assists in the implementation of quality improvement grant programs that utilize unearned incentive dollars.</li>
<li>Assists management in the development of specifications and scope of work for a Request for Proposal (RFP), Request for Quote (RFQ) or Request for Inquiry (RFI) to support new program development as needed.</li>
<li>Supports program design, development and implementation of quality programs impacting, but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), Managed Care Accountability Sets (MCAS) and Centers for Medicare &amp; Medicaid Services (CMS) STARs quality measures consistent with the quality program and workplan.</li>
<li>Produces slide decks, summaries, root cause analyses, impact analyses and other reports as needed by leadership.</li>
<li>Applies analytical skills to evaluate data based on project specifications; requests and interprets data to support decision-making and communicates insights to cross-functional stakeholders.</li>
<li>Establishes key performance indicators (KPIs) and metrics to monitor project progress and performance, providing regular updates to senior management.</li>
<li>Leads performance and quality improvement projects, Plan Do Study Act or other formats as needed.</li>
<li>Reviews evidence-based literature for best practices to incorporate into strategy.</li>
<li>Develops and oversees the process of written tools for programmatic use, including program plans, surveys and evaluation instruments.</li>
<li>Maintains current knowledge of applicable regulations or clinical guidelines related to program development.</li>
<li>Stays current on the local, state and federal health care environment and identifies issues that may impact CalOptima Health's quality program and work plan. </li>
</ul>
</li>
<li>15% - Administration 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>Reviews and assists in updating policies and procedures to ensure knowledge related to assigned programs and projects is kept up to date.</li>
<li>Works with all CalOptima Health departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message. </li>
</ul>
</li>
<li>5% -
<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 healthcare or a related field required PLUS 3 years of experience in program development, program/project management or quality metrics analysis and improvement 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>Master's degree in public health, health administration or related field. </li>
<li>1 year of experience working in a highly matrixed, mission-driven organization.</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: 311 - $77,863 - $124,581 ($37.43 - $59.8947). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for 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=6687168&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/6687168" target="_blank">https://jobs.caloptima.org/jobs/program-manager-quality-incentives-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-f798b55cf9658a43bbd24454ae6ef359

Program Manager (Quality Incentives)

Sr Manager, Individual and Family Plans (Sr Manager II) CalOptima Sr Manager, Individual and Family Plans (Sr Manager II) Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Sr Manager, Individual and Family Plans (Sr Manager II) and help shape the future of healthcare where you'll be an integral part of our Strategic Development 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 role is responsible for supporting the development of new programs and initiatives related to the implementation and ongoing management of new product lines, including commercial. You will also be responsible for managing the regulatory and programmatic aspects of program implementation and will collaborate with cross-functional business owners, Information Technology (IT), Finance, the Office of Compliance and senior leadership to manage program governance and project structure, set program objectives and implement program requirements while working across the organization to understand dependencies for ensuring effective and efficient program delivery. You will also establish, monitor and ensure the successful execution of regulatory filings and ongoing program submissions and maintenance. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>50% - Program Leadership
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.</li>
<li>Hires, manages, trains, reviews and sets goals for the team and staff.</li>
<li>Oversees the development of the Knox Keene Act licensure filing process, including collaboration with legal counsel, state regulators, consultants, internal business owners and staff to complete submissions.</li>
<li>Oversees the development of the Qualified Health Plan application, supporting data and documentation submissions, and management of the QHP certification process prior to open enrollment annually.</li>
<li>Serves as a key leader on the product team and partners cross-functionally across CalOptima Health to ensure successful implementation of the Covered California program.</li>
<li>Fosters ongoing relationships and mutually beneficial partnerships with CalOptima Health departments and external organizations.</li>
<li>Identifies opportunities for program efficiencies, develops new processes to support successful implementation and ensures sound organizational approaches across new lines of business.</li>
<li>Collaborates with other leaders to ensure all programmatic aspects meet regulatory and contractual requirements for marketplace participation.</li>
<li>Oversees programmatic reporting in partnership with business owners and IT.</li>
<li>Collaborates with the Office of Compliance department on annual and ongoing audits. </li>
</ul>
</li>
<li>45% - Program Development
<ul>
<li>Tracks marketplace requirements, regulatory changes that impact the program, and engagements with program staff and leadership to ensure ongoing compliance and engagement.</li>
<li>Partners with business owners, IT and consultants to develop and articulate programmatic requirements that impact program implementation.</li>
<li>Supports cross-functional departments in interpreting Covered California and Department of Managed Health Care requirements and problem-solving issues related to the line of business, including member and provider issues.</li>
<li>Partners with Enterprise Program Management Office (EPMO) project managers and leaders to ensure program implementation and workstreams remain on track and on budget.</li>
<li>Monitors program related processes for legal, financial and regulatory compliance, including but not limited to ensuring adherence to policies and procedures and supporting audit activities. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in a related field PLUS 5 years of experience in managed care plan or other health care related field with at least 2 years of prior experience that must have been in government programs at a managed care plan, including Medicaid/Medi-Cal, Medicare, or Marketplace/Covered California required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>3 years of management level experience required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Experience interfacing with local, state or federal regulators.</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 particular role: (317 - $132,969 - $212,751 ($63.93 - $102.2841)),</li>
<li>This position is approved for Partial Telework. (This position is eligible for Telework in California) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6639376&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 September 22, 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/6639376" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-individual-and-family-plans-sr-manager-ii-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-d6fb4be68588794a8cf21fd09911dfe1

Sr Manager, Individual and Family Plans (Sr Manager II)

Essential Functions: Reporting to the Chief Executive Officer (CEO), the Development Fundraising Manager (DFM) holds a crucial role in developing and implementing effective fundraising strategies to support our organization's mission. This position involves managing relationships with donors, planning and executing fundraising events, and utilizing various marketing tools to maximize outreach and engagement. The ideal candidate will possess strong leadership skills, a passion for nonprofit work, and a proven track record in fundraising.
Responsibilities
Develop and execute comprehensive fundraising plans that align with the organization’s goals. Plan, organize, and manage fundraising events from concept to completion. Cultivate and maintain relationships with donors, sponsors, and volunteers to enhance engagement and support. Utilize and/or implement CRM software for data collection, relationship management, and tracking donor interactions. Write compelling grant proposals and funding requests to secure financial support from foundations and government entities. Conduct research on potential funding sources and maintain databases of prospects. Implement digital marketing strategies including email marketing campaigns using platforms like Mailchimp or similar to reach potential donors. Oversee budgeting for fundraising initiatives ensuring efficient allocation of resources. Collaborate with the marketing team to enhance public relations efforts through social media management and other communication channels. Provide leadership in volunteer management, ensuring effective training and engagement of volunteers during events. Skills
Strong event planning capabilities with experience in events management. Proficient in digital marketing tools. Excellent negotiation skills with the ability to secure sponsorships and partnerships. Experience in proposal writing for grants and funding opportunities. Knowledge of nonprofit management principles including 501(c) (3&amp;4) laws is a plus. Strong analytical skills for data collection and research related to fundraising efforts. Proven ability in strategic planning to align fundraising activities with organizational objectives. Familiarity with budgeting processes within a nonprofit context. Fundraiser experience or background in fundraising is required. This position offers an exciting opportunity for individuals passionate about making a difference through effective fundraising initiatives while working within a dynamic team environment dedicated to advancing our mission.
Required Education and Experience:
<ul>
<li>Bachelor’s degree plus 5+ years minimum fundraising experience Proven success in securing foundation and individual and donor support Well-developed writing, interpersonal and organizational skills.</li>
</ul>
Work Environment: This job operates in a typical office setting. This position routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.&nbsp;
Position Type/Expected Hours of Work: This is a permanent full-time position.&nbsp; This position regularly requires long hours and frequent weekend work.
Travel Requirements: This position may at times require frequent travel throughout the United States and Puerto Rico.
Salary Range: $75,000-$90,000/year&nbsp;Commensurate according to years of experience. All employees must meet a 6-month probationary period. Continuation of this position after one year is dependent on the successful candidate meeting jointly determined performance goals.

Development Fundraiser Manager

Organizational Overview: Food Forward Inc.fights hunger and prevents food waste by rescuing fresh surplusproduce, connecting this abundance with people experiencing foodinsecurity, and inspiring others to do the same. Fruits andvegetables are collected from backyard fruit trees, farmersmarkets, growers, and wholesale produce distributors. Thisrecovered produce is provided free of charge to hunger relieforganizations serving communities, including food banks, agenciesserving unhoused people, domestic violence shelters, transitionalyouth homes, veteran services, family resource centers, LGBTQ+teen/adult/senior services, and more.&nbsp; On an average day, FoodForward is distributing enough fruits and vegetables to meet thedaily recommended servings for more than 270,000 people. See ourcore values below.&nbsp;
Position Overview: Food Forward seeks amotivated nonprofit leader experienced in fundraising operationsand project management. The Associate Director, Operations &amp;Annual Giving is a new position that will play a role insolidifying Food Forward’s growth trajectory by enhancing theoperational efficiency of our Development team. The ideal candidateis a strategist who can work collaboratively across teams toinnovate systems and build scalable revenue streams that will serveour mission. Critical skills include strong verbal and writtencommunication, the ability to translate data into strategy, and theability to lead projects with calm and clarity.
Working with the Chief Development Officer, the AssociateDirector will provide new capacity to a high-performing team.Success in year one will include:
<ul>
<li>Creation of a new KPI/benchmarkreporting workflow that motivates and provides learning for theDevelopment team and the organization’s leadership;</li>
<li>Successful management of theschedules and deliverables for at least three fundraising campaignsthroughout year one, including analysis of results towards abenchmarked increase over previous year;</li>
<li>Completion of a compliance review andrecommendations for improved donor experience (such asacknowledgments, vetting, disclosures, etc);</li>
<li>Demonstrate a deep understanding ofFood Forward’s mission and donor base.</li>
</ul>
CORE RESPONSIBILITIES
Responsible for strategy and implementation of:&nbsp;
Department Operations, including:
<ul>
<li>Team dashboards, benchmarks, KPIs,and progress toward strategic plan goals</li>
<li>Gift processing and donor services,including timely and accurate acknowledgments and other compliancethat ensure positive donor connections</li>
<li>Department timelines for campaigns,events, cross-department operations, team meetings</li>
<li>Department database and technology,including CRM (Salesforce), donation processing (current: Classy),additional campaign tools, equipment, shared file systems</li>
<li>Financial reporting, reconciliation,and compliance, coordinating the Development and Financedepartments</li>
<li>Tracking department deliverables,including fulfillment, partner benefits, key statistics</li>
</ul>
Annual Giving, including:
<ul>
<li>Annual plan for the annualgiving/scaled income stream (focus: individuals), includingstrategy, goal tracking, team workplans</li>
<li>Campaign management coordinated withthe Communications team, including strategy, timelines, production(eg. mail), reporting</li>
<li>Digital fundraising and stewardshipwith the Communications team, including regular analytics reviews,testing, acquisition, visibility tracking</li>
<li>Pipeline strategy, processes, andtools to manage prospects and increase support, coordinating withMajor Gifts Officer</li>
<li>Special projects to increase theorganization’s visibility to build a donor base, such as affiliategroups and third-party validator websites</li>
<li>Regular reporting on budgetbenchmarks and cashflow</li>
<li>Analytics and content for performancereports to leadership and the Board of Directors, includingbenchmarking to industry standards</li>
<li>Income forecasting and data-informedgrowth strategies for future years&nbsp;</li>
</ul>
Staff Supervision and Administration, including:
<ul>
<li>Supervise two: Development OperationsSupervisor (database specialist) and Coordinator&nbsp;</li>
<li>Contract management</li>
<li>Ongoing learning for processimprovements that incorporate best practices, inspire teamperformance</li>
<li>Organization-wide initiatives asneeded</li>
</ul>

Associate Director, Operations & Annual Giving

Director Premium Billing and Member Enrollment (Director II) CalOptima Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Director Premium Billing and Member Enrollment (Director II) 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. CalOptima Health is looking for a strategic thinker with a proven track record of leading a high-performing team to establish and manage the Enrollment and Billing function related to Health Insurance Exchange/Marketplace/Covered California product operations. As the Director, you'll serve in a leadership role to define and scale up their own team, roadmap, implement, and manage operationalization of this capability at CalOptima Health, and drive closing the people, process, and technological gaps between current state and future state operations to support enrollment and billing capabilities for the Covered California line of business. This role will be critical in standing up and continuing to successfully execute seamless enrollment, accurate billing, and regulatory compliance for the product line expansion. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>45% - 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>Directs, hires and trains department managers and staff.</li>
<li>Reviews and develops the performance of department staff and sets monthly or quarterly goals.</li>
<li>Serves as the key point of contact and advisor for executive leadership when making strategic decisions impacting the operations of the Enrollment and Billing function at CalOptima Health.</li>
<li>Develops and executes the 12-18-month roadmap to operationalize Enrollment and Billing capabilities for Covered California line of business - integrating with existing Medi-Cal workflows (where applicable), defining new operational processes, and configuring existing and/or new systems to support Covered California line of business.</li>
<li>Builds out and leads Enrollment and Billing function at CalOptima Health (i.e., recruiting, coaching, and retaining team, setting up governance structure, collaborating cross-functionally with other CalOptima Health functions to identify teams' dependencies, etc.).</li>
<li>Oversees the timely and accurate completion of Covered California enrollment capabilities inclusive of ingestion and processing of 834 enrollment files, plan changes, cancellations, and grace-period management per Covered California rules. </li>
</ul>
</li>
<li>50% - Program Oversight
<ul>
<li>Implements and oversees end-to-end premium billing capability -including invoice generation, member payments, financial reconciliation (including subsidies) and refunds-ensuring regulatory compliance.</li>
<li>Reconciles membership and premium data with Covered California and internally at CalOptima Health to support regulatory requirements and data accuracy internally on a cyclical basis.</li>
<li>Manages the end-to-end enrollment and billing processing and reconciliation for the off-exchange population.</li>
<li>Oversees integration and management of the enrollment and billing capabilities that third party vendors and delegated health network are responsible and accountable for.</li>
<li>Leads vendor and technology selection for vended capabilities and oversees implementation and integration with the organization's processes and technologies.</li>
<li>Leads the development of processes and configuration of core admin system to support implementation and ongoing optimization of the premium billing capability at CalOptima - inclusive of partnering with CalOptima Health's Information Technology teams (and potentially vendor teams), overseeing system and data integrations, etc.</li>
<li>Develops and manages the annual departmental budget. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in business, health administration, finance, or related field PLUS 7 years in health-plan operations with at least 5 years in health insurance exchange/marketplace and/or commercial Individual and Family Plan (IFP) enrollment and billing required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>3 years of progressive management/leadership experience required.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Knowledge and prior experience at a health plan leading enrollment and billing functions for an exchange or commercial product. </li>
<li>Specific experience with Covered California.</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: 321 - $181,257 - $290,011 ($87.14 - $139.4282). 
<ul>
<li>The base pay offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office </li>
</ul>
 A <a href="https://apptrkr.com/get_redirect.php?id=6691212&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> 
<ul>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is October 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/6691212" target="_blank">https://jobs.caloptima.org/jobs/director-premium-billing-and-member-enrollment-director-ii-505-city-parkway-west-california-united-states-eec0bbc1-1619-4a08-8efb-318193291fd1</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-9e5db22bed600f45bd7f3251e28bfe46

Director Premium Billing and Member Enrollment (Director II)

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

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