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Buyer CalOptima CalOptima Health is seeking a highly motivated Buyer to join our team. The Buyer will be responsible for procuring a variety of goods and services for use by various departments within CalOptima Health. The incumbent will work and perform under the general supervision of the supervisor. Position Information: 
<ul>
<li>Department: Procurement &amp; Vendor Management </li>
<li>Salary Grade: 306 - $58,205 - $90,217 ($27.98 - $43.3736) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Reviews and processes purchase orders from the requisition system to the Dynamics GP Purchasing module.</li>
<li>Recommends the best purchasing method using the board-approved procurement policy as a guide.</li>
<li>Researches and identifies capable vendors considering criteria such as conformity to specifications, prices, delivery times, terms, conditions and the reputation of the vendor</li>
<li>Creates, organizes, updates and maintains artwork files, contract files and scans copies of purchase orders to the purchase order repository.</li>
<li>Reviews contractual documents for completeness, accuracy, compliance with policies and procedures and presents them for management approval and signature.</li>
<li>Contacts vendors to follow up on orders and expedite or delay as needed.</li>
<li>Serves as a backup to other members of the Purchasing team as needed.</li>
<li>Updates contract management system as needed.</li>
<li>Processes credit card procurements, including monthly bill reconciliation.</li>
<li>Processes AMEX travel program, including monthly bill reconciliation.</li>
<li>Assists and trains users in other departments with purchasing systems. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 1 year of purchasing or other business experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Bachelor's degree in business administration or related field.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6374339&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 23, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6374339" target="_blank">https://jobs.caloptima.org/jobs/buyer-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-c5c613b47eab3a47a24372be6f71019e

Buyer

Community Partner (Inside Medicare Sales) CalOptima CalOptima Health is seeking a highly motivated Community Partner (Inside Medicare Sales) to join our team. The Community Partner (Inside Medicare Sales) will perform telemarketing and appointment setting tasks associated with obtaining new members in the OneCare program by making outbound calls to prospective members, participating providers, community-based organizations and government agencies. The incumbent will assist in enrolling new members, which will include the explanation of the OneCare benefits and coordination of services regarding Medicare and Medi-Cal services for individuals within these populations. The incumbent will perform outreach activities and attend cultural events and fairs within Orange County in conjunction with the Sales and Marketing departments. The incumbent will facilitate appointment setting and enrollment activities with members and OneCare Community Partners in a timely, professional and courteous manner. Position Information: 
<ul>
<li>Department: OneCare Sales &amp; Marketing </li>
<li>Salary Grade: 306 - $58,205 - $90,217 ($27.98 - $43.3736) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Provides assistance and education to potential members regarding OneCare program for enrollment purposes.</li>
<li>Prepares and conducts telemarketing presentations to potential members and community agencies.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Conducts targeted outreach and training to community-based organizations, health networks, vendors, members and providers.</li>
<li>Performs outreach to potential members and provides them with information about OneCare at cultural events and fairs. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 3 years of experience working with the needs of persons with disabilities in an enrollment capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed below may also be qualifying. </li>
<li>Valid driver's license and vehicle, an acceptable driving record and current auto insurance or other approved means of transportation, will be required for work away from the primary office 50% of the time or more.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>1 year of phone experience in a sales environment. </li>
<li>Experience in Medicare Sales as an agent or broker. </li>
<li>Experience working with people in a customer or member service capacity. </li>
<li>HMO, Medi-Cal/Medicaid and health services experience. </li>
<li>Contact informational systems experience. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>Possession of an active California Department of Insurance (DOI) license required or must be obtained within 60 calendar days from the start date of employment. </li>
<li>DOI license renewal every 2 years is required. </li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6372564&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 22, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6372564" target="_blank">https://jobs.caloptima.org/jobs/community-partner-inside-medicare-sales-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-a301c61328f60e4ea08d226efa24dee8

Community Partner (Inside Medicare Sales)

Programmer Analyst III Lubbock 41415BR High Performance Computing Center Position Description The Programmer Analyst III's role is to develop, test, analyze, and maintain software applications in support of business requirements. Major/Essential Functions 
<ul>
<li>Research, design, document, and modify software specifications throughout the production life cycle.</li>
<li>Supervise and/or lead the development of new systems, directing changes to existing systems and controlling the interfaces between the systems, initiating complex feasibility studies and making recommendations of the action to be taken.</li>
<li>Perform systems analysis, develops, and reviews programming code defined in project plans to meet design specifications, customer requirements, and/or applies vendor supplied upgrades.</li>
<li>Design, development, documentation, analysis, creation, testing, or modification of computer systems or programs, including prototypes, based on user or system design specifications.</li>
<li>Completes application modifications to enhance functionality, adapt to technology changes, and correct application errors.</li>
<li>Supervises and/or leads programming projects and initiatives, as assigned by management.</li>
<li>Completes other programming tasks, as assigned by management.</li>
<li>Adheres to all appropriate institutional policies (including IT Ops) and other relevant internal department policies.</li>
</ul>
 Required Qualifications Bachelor's degree with coursework in computer science, MIS, IT, or other related area plus three (3) years related full-time paid experience OR a combination of related education and/or experience. Applicants for this Security Sensitive Level II position will be subject to a criminal background check and must pass a drug and alcohol test after a conditional offer of employment has been extended, but before employment can be confirmed. Preferred Qualifications Bachelor's degree in Computer Science or a related degree field with coursework in computer science, management information systems, or information technology. 3 years of experience as a computer programmer, software engineer, or other related role. Requires analytical design skills, including process description, logic problem diagnostics, and problem-solving; programming languages; and application and database design and development concepts and standards. Employer will accept a bachelor's degree equivalency based on a combination of education and experience. Special Instructions to Applicant Minimum Hire Rate To apply, visit <a href="https://apptrkr.com/6317620" target="_blank">workattexastech.com</a> All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information or status as a protected veteran. Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-fdd102af9ca93b4bb658a7316bbd73f5

Programmer Analyst III

Manager Grievance &amp; Appeals (Provider Services) CalOptima CalOptima Health is seeking a highly motivated an experienced Manager, Grievance &amp; Appeals (Provider Services) to join our team. The Manager Grievance &amp; Appeals (Provider Services) will provide daily oversight and technical management for provider services, including provider disputes, provider grievances and provider appeal to ensure compliance with state, federal and accreditation standards applicable to CalOptima Health. The incumbent will work with CalOptima Health management staff and other affiliated health networks with a close interface to the program and process, including areas such as Utilization Management, Claims Administration, Delegation Oversight, Quality Improvement and health network relations. The incumbent will research complex claims problems, isolate root causes and partner with various entities for resolution. The incumbent will communicate with all levels of internal staff, regulatory agencies, health networks, providers, vendors, community-based organizations and medical groups. Position Information: 
<ul>
<li>Department: GA - Provider Disputes </li>
<li>Salary Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>50% - Program Oversight
<ul>
<li>Identifies and analyzes trends, collaborates with the Director to provide trends and makes recommendations for improvement.</li>
<li>Stays current on the local, state and federal health care environment, identifying issues that may impact CalOptima Health's programs as they relate to claims, provider disputes, grievances and provider appeals.</li>
<li>Develops, implements, maintains and reviews the adequacy of the CalOptima Health provider grievance systems, reporting, policies and functions to achieve stated goals, including, but not limited to, complaint resolution and timely responsiveness for all lines of business, to ensure compliance with all relevant regulatory requirements pertaining to provider disputes.</li>
<li>Works with the Audit and Oversight department and key departments to ensure internal departments and external partners (e.g., health networks and delegates) are up to date with regulatory, departmental and organizational changes impacting the grievance and appeals processes.</li>
<li>Ensures timely and effective data collection, summarization, integration and reporting, including, but not limited to, productivity, status and trend reports for specific committees such as the Quality Improvement Committee, Grievance and Appeals Committee, Quality Assurance Committee of the Board of Directors and other ad hoc reporting as required.</li>
<li>Serves as CalOptima Health's primary point of contact and subject matter expert related to provider services (disputes, grievances and appeals).</li>
<li>Participates in Department of Managed Healthcare (DMHC), Department of Health Care Services (DHCS) and Centers for Medicare and Medicaid (CMS) audits related to area of responsibility for all CalOptima Health programs. </li>
</ul>
</li>
<li>45% - Leadership
<ul>
<li>Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.</li>
<li>Manages, hires, mentors and develops department staff.</li>
<li>Oversees the development and maintenance of internal policies and procedures and desktops to ensure compliance with all state and federal regulations for multiple lines of business.</li>
<li>Manages and makes recommendations on the development and maintenance of an effective dispute, appeals and grievance process and systems consistent with CalOptima Health policies and stated goals, including, but not limited to mechanisms to monitor provider disputes, grievances and appeals involving Legal, DMHC, DHCS, Independent Medical Review, Medi-Cal State Hearings, Office of Administrative Hearings and Appeals, CMS and external review agencies for CMS.</li>
<li>Partners with the management to ensure appropriate training and auditing tools are developed and maintained for the department. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, nursing, healthcare administration or related field PLUS 3 years of health care management experience in a related area of responsibility (provider disputes and appeals, claims administration, appeals and grievances) required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>3 years of leadership experience required. </li>
<li>Experience in health maintenance organization, Medi-Cal/Medicaid, Medicare Advantage, Medicare Part D, Special Needs Plans, Medicare-Medicaid Plans and/or the Program of All-Inclusive Care for the Elderly required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Experience with process improvement implementation.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6357344&amp;targetURL=https://alliantbenefits.cld.bz/24caloptimacabenguide" target="_blank">2024 CalOptima Health Benefits Guide</a> and our <a href="https://apptrkr.com/get_redirect.php?id=6357344&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 16, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6357344" target="_blank">https://jobs.caloptima.org/jobs/manager-grievance-appeals-provider-services-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-cf7b2c04c4b10840a8654602344b5194

Manager Grievance & Appeals (Provider Services)

Accountant 2 - Sponsored Programs Administration Job ID: 276117 Location: Augusta University Full/Part Time: Full Time Regular/Temporary: * About Us Augusta University is Georgia's innovation center for education and health care, training the next generation of innovators, leaders, and healthcare providers in classrooms and clinics on four campuses in Augusta and locations across the state. More than 10,500 students choose Augusta for educational opportunities at the center of Georgia's cybersecurity hub and experiential learning that blends arts and application, humanities, and the health sciences. Augusta is home to Georgia's only public academic health center, where groundbreaking research is creating a healthier, more prosperous Georgia, and world-class clinicians are bringing the medicine of tomorrow to patient care today. Our<a href="https://apptrkr.com/get_redirect.php?id=6332110&amp;targetURL=https://www.augusta.edu/about/mission.php" target="_blank"> mission and values</a> make Augusta University an institution like no other. The<a href="https://apptrkr.com/get_redirect.php?id=6332110&amp;targetURL=https://www.usg.edu/hr/orientation/welcome_to_the_board_of_regents_university_system_office" target="_blank"> University System of Georgia</a> is comprised of our 26 institutions of higher education and learning as well as the System Office. Our USG Statement of Core Values are Integrity, Excellence, Accountability, and Respect. These values serve as the foundation for all that we do as an organization, and each USG community member is responsible for demonstrating and upholding these standards. More details on the USG Statement of Core Values and Code of Conduct are available in USG Board Policy 8.2.18.1.2 and can be found online at <a href="https://apptrkr.com/get_redirect.php?id=6332110&amp;targetURL=https://www.usg.edu/policymanual/section8/C224/#p8.2.18_personnel_conduct" target="_blank">https://www.usg.edu/policymanual/section8/C224/#p8.2.18_personnel_conduct.</a> Additionally, USG supports Freedom of Expression as stated in Board Policy 6.5 Freedom of Expression and Academic Freedom found online at <a href="https://apptrkr.com/get_redirect.php?id=6332110&amp;targetURL=https://www.usg.edu/policymanual/section6/C2653" target="_blank">https://www.usg.edu/policymanual/section6/C2653</a>. Location Augusta University - Our Health Sciences Campus: 1120 15th Street, Augusta, GA 30912 Our Summerville Campus: 2500 Walton Way, Augusta, GA 30904 College/Department Information The Division of Sponsored Programs Administration and the Augusta University Research Institute serve as a central unit to coordinate and support Augusta University's Internal and External Sponsored Projects. The Division aims to identify, support, and advance opportunities for research, training, teaching, and scholarly activities by managing the entire lifecycle of sponsored project ' from proposal and grant development and submission to contract preparation, award management, and project close out management. The DSPA seeks to advance extramural support programs for the institution by providing administrative, informational, and logistical assistance to faculty and staff, while ensuring compliance with pertinent policies and regulations of the institution, extramural sponsors, and federal oversight agencies. Job Summary This position is responsible for monitoring assigned sponsored accounts, educating department administrators/principal investigators concerning compliance issues, and assisting them in managing the sponsored funds in accordance with state and federal regulations. Responsibilities The duties include, but are not limited to: Prepare financial reports for various sponsored programs. Help educate administrators and faculty about compliance for federal and state regulations for various sponsored programs. Work collaboratively with various offices to ensure terms and conditions of each sponsored program are met. Invoice sponsoring agencies and track accounts receivable. Monitor sponsored programs to determine that expenditures are in compliance with agency requirements and terms of the award. Establish and maintain budgets for sponsored programs. Review and authorize transfers (expenditure and budget) for sponsored accounts. Perform all other related duties as assigned and necessary for managing sponsored programs. Required Qualifications Bachelor's degree from an accredited college or university in Accounting, Finance or related field with a demonstrated emphasis in accounting coursework and a minimum of two years of related work experience. Preferred Qualifications Experience with Excel Knowledge, Skills, &amp; Abilities Knowledge of accounting, Excel including formulas and pivot tables to achieve management and understanding of large amounts of financial data. Proficient in Microsoft Office and other computer software/databases. SKILLS Excellent interpersonal, written, and verbal communication skills. Detail-oriented with strong organizational, prioritization, analytical, multi-tasking, and problem-solving skills. ABILITIES Ability to maintain confidentiality, follow written processes, use multiple databases include financial systems, to reconcile accounts, and to recommend solutions to discrepancies as well as continue to monitor accounts and systems ongoing Shift/Salary/Benefits Shift: Days; Monday - Friday (Work outside of normal business hours may be required) Salary Minimum: $45,400 annually Pay Band: B8 Salary to be commensurate with qualifications of the selected candidate within the established range (generally minimum-midpoint) of the position Recruitment Period: Until Filled Augusta University offers a variety of benefits to full-time benefits-eligible employees and some of our half-time (or more) employees. Benefits that may be elected could include health insurance, dental insurance, life insurance, Teachers Retirement System (or Optional Retirement Plan), as well as earned vacation time, sick leave, and 13 paid holidays. Also, our full-time employees who have been employed with us successfully for more than 6 months can be considered for the Tuition Assistance Program. Consider applying with us today! Conditions of Employment All selected candidates are required to successfully pass a Background Check review prior to starting with Augusta University. If applicable for the specific position based on the duties: the candidate will also need to have a credit check completed for Positions of Trust and or approved departmental Purchase Card usage. Motor vehicle reports are required for positions that are required to drive an Augusta University vehicle. For Faculty Hires: Final candidates will be required to provide proof of completed academic degree(s) as well as post-secondary coursework in the form of original transcript(s). Those candidates trained by a foreign institution will also be required to provide an educational/credential evaluation. All employees are responsible for ensuring the confidentiality, availability, and integrity of sensitive [patient, student, employee, financial, business, etc.] information by exercising sound judgment and adhering to cybersecurity and privacy policies during their employment and beyond. Other Information This position is also responsible for promoting a customer-friendly environment and providing superior service to our patients, students, faculty, and employees. "Augusta University is a patient-and family-centered care institution, where employees partner every day with patients and families for success." Augusta University is a tobacco-free environment, and the use of any tobacco products on any part of the campus, both inside and outside, is strictly prohibited. Equal Employment Opportunity Augusta University is proud to be an equal opportunity employer, welcoming applicants from underrepresented groups, including individuals with disabilities and veterans. How To Apply Consider applying with us today! Search for Job ID: 276117 <a href="https://apptrkr.com/get_redirect.php?id=6332110&amp;targetURL=https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.augusta.edu%2Fhr%2Fjobs%2F&amp;data=05%7C01%7Capril.godfrey%40usg.edu%7C631396d91c524c74497208da7017d89b%7C4711f877fb3a4f11aaab3c496800c23d%7C0%7C0%7C637945544983568848%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=Uh0MAMlBT003th6nRVp3vYHiWxjSyEessQd6O14aRR4%3D&amp;reserved=0" target="_blank">https://www.augusta.edu/hr/jobs/</a> Select University Faculty &amp; Staff &gt; External Applicants if you are a candidate from outside the university Select University Faculty &amp; Staff &gt; Internal Applicants if you are a current university employee If you need further assistance, please contact us at 706-721-9365 To apply, visit <a href="https://apptrkr.com/6332110" target="_blank">https://careers.hprod.onehcm.usg.edu/psp/careers/CAREERS/HRMS/c/HRS_HRAM_FL.HRS_CG_SEARCH_FL.GBL?Page=HRS_APP_JBPST_FL&amp;Action=U&amp;FOCUS=Applicant&amp;SiteId=12000&amp;JobOpeningId=276117&amp;PostingSeq=1</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-d6ab50f33dc40d4799dd7cd5a3aa8c84

Accountant 2 - Sponsored Programs Administration

Customer Service Representative CalOptima CalOptima Health is seeking a highly motivated Customer Service Representative to join our team. The Customer Service Representative (CSR) will be the first line of contact for CalOptima Health's members and providers. The incumbent will assist members and providers with questions and/or complaints related to the Medi-Cal programs for Orange County. The incumbent will provide information regarding eligibility, enrollment, benefits and services to CalOptima Health's eligible members and providers. Position Information: 
<ul>
<li>Department: Customer Service </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Office </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>80% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Maintains departmental productivity and quality standards.</li>
<li>Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction.</li>
<li>Serves as a resource for other team members. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas including eligibility, enrollment, claims or authorization status, benefit interpretation and referrals/authorizations for medical care in-person or telephonically.</li>
<li>Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction.</li>
<li>Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery.</li>
<li>Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High School diploma or equivalent PLUS 6 months of experience in a call center capacity required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>Typing speed of 35 words per minute (WPM) required.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>6 months of Medi-Cal/Medicaid or health services experience.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6337909&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 15, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6337909" target="_blank">https://jobs.caloptima.org/jobs/customer-service-representative-505-city-parkway-west-california-united-states-7d5bf04b-390c-46e1-91cb-12f6a1dd6e9a</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-fa21bddb4c4a0240925cf86da2f60f27

Customer Service Representative

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

Library Technician, Senior

Claims Examiner CalOptima CalOptima Health is seeking a highly motivated Claims Examiner to join our team. The Claims Examiner will be responsible for analyzing and validating claim data elements and claims processing. The incumbent will be responsible for adhering to the regulatory and internal processing guidelines in conjunction with CalOptima Health policies and procedures related to claims adjudication. Position Information: 
<ul>
<li>Department: Claims Administration </li>
<li>Salary Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500) </li>
<li>Work Arrangement: Full Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>85% - Claims Support
<ul>
<li>Performs thorough review of pending claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services.</li>
<li>Processes non-institutional claim types.</li>
<li>Corrects system generated errors manually prior to final claims adjudication.</li>
<li>Processes claims based upon CalOptima Health contractual agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and CalOptima Health policies and procedures.</li>
<li>Analyzes and validates Medi-Cal pricing; researches, adjusts and adjudicates claims; reviews services for accurate charges and utilizes current billing code sets, including International Classification Diseases (ICD10) codes, Current Procedural Terminology (CPT) codes and/or authorization guidelines as reference.</li>
<li>Validates eligibility and other possible health insurance coverage on the claim.</li>
<li>Alerts manager or supervisor of more complex issues that arise.</li>
<li>Processes claim exception reports as assigned. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>High school diploma or equivalent PLUS 1 year of related claims processing experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Experience processing online claims in a managed care environment. </li>
<li>Experience processing Medi-Cal claims.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6329575&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 11, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6329575" target="_blank">https://jobs.caloptima.org/jobs/claims-examiner-505-city-parkway-west-california-united-states-fd7ed77a-73a4-4bd2-9f12-47d82ac1ed30</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-a4cc42329aeb0d40b1127d796b9ce31e

Claims Examiner

Interdisciplinary Team Lead (Program Specialist) CalOptima CalOptima Health is seeking a highly motivated Program Specialist (Interdisciplinary Team Lead) to join our team. The Program Specialist (Interdisciplinary Team Lead) will be responsible for supporting the Manager PACE Center by holding primary responsibility for scheduling meetings and follow ups with the Interdisciplinary Teams (IDT), documenting attendance, recording decision-making, and managing authorizations for multiple IDT. The incumbent will interact with various clinical and non-clinical staff to coordinate participant care. Position Information: 
<ul>
<li>Department: PACE- Clinic </li>
<li>Salary Grade: 305 - $55,966 - $83,949 ($26.91 - $40.3601) </li>
<li>Work Arrangement: Full Office **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<ul>
<li>95% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Coordinates calendars, meeting space, equipment and schedules to support IDT functions.</li>
<li>Serves as a scribe to all IDTs by tracking authorizations, service delivery requests and care coordination authorizations that are approved by the IDT.</li>
<li>Tracks and communicates to the Quality Improvement team the status of service delivery requests, including approved, denied or modified to ensure compliance with regulatory requirements.</li>
<li>Tracks and communicates the status of initial, semi-annual and annual assessments for all members of the IDT on behalf of the manager.</li>
<li>Assigns and tracks completion of PACE participant care plan approval.</li>
<li>Ensures completion of required documentation in electronic health records within 30-day requirement.</li>
<li>Serves as a liaison between manager and members of IDT and follows up on the progress of projects and activities assigned to other staff.</li>
<li>Determines the priority of matters of attention for the manager and redirects to supervisor, staff or handles matters directly as appropriate.</li>
<li>Provides back-up support to the Administrative Assistant by taking IDT minutes.</li>
<li>Maintains accurate and timely documentation in participant electronic health records.</li>
<li>Provides administrative support for specific and/or ongoing projects, such as regulatory audits by generating reports, logs, calendars and mailings as appropriate.</li>
<li>Attends and participates in in-services, staff meetings and case conferences as indicated. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, health care administration, public health, public policy or related field PLUS 2 years of administrative experience in a health care setting required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>1 year of experience working with the frail or elderly population required with relevant experience within the last 3 years required. </li>
<li>CPR and First-Aid Certification required or must be obtained within six (6) months of date of hire.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>N/A</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>N/A</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6322849&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 8, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6322849" target="_blank">https://jobs.caloptima.org/jobs/interdisciplinary-team-lead-program-specialist-pace-garden-grove-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-57516b5c0f361d49a2dff80b78f313ae

Interdisciplinary Team Lead (Program Specialist)

Sr Manager, Fraud, Waste and Abuse (Investigations) (Sr Manager I) CalOptima CalOptima Health is seeking a highly motivated Sr Manager, Fraud, Waste and Abuse (Investigations) (Sr Manager I) to join our team. The Sr Manager I for Fraud, Waste and Abuse (FWA) will be responsible for leading the team of CalOptima Health investigators to detect, investigate and mitigate FWA issues. The incumbent will ensure investigations are handled effectively and in a timely manner and will engage with regulatory agencies. The incumbent will partner with the director in long-term strategy planning to accomplish the department's goals and mission to enhance the program and payment integrity of the organization. Position Information: 
<ul>
<li>Department: Office of Compliance </li>
<li>Salary Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856) </li>
<li>Work Arrangement: Partial Telework **This position is eligible for telework in California.** </li>
</ul>
 Duties &amp; Responsibilities: 
<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>Hires, manages, trains, supports, develops and evaluates direct reports.</li>
<li>Directs work assignments, measures results and initiates personnel actions.</li>
<li>Ensures that team members are trained and equipped with the necessary skills and resources.</li>
<li>Collaborates with the director in departmental budgeting activities.</li>
<li>Oversees the planning, scoping and execution of audits and the development of audit tools; ensures alignment with organizational goals and regulatory requirements.</li>
<li>Oversees the planning, scoping and execution of investigations and the development of investigative tools; ensures alignment with organizational goals and regulatory requirements.</li>
<li>Assists the director on development of the annual FWA risk assessment and Anti-Fraud, Waste and Abuse Plan.</li>
<li>Assists department leadership in the management of critical business risks by communicating best practices, promoting process improvement, and monitoring remediation activities. </li>
</ul>
</li>
<li>35% - Program Oversight
<ul>
<li>Provides expertise and guidance to staff, management and other department areas on sensitive and complicated program integrity concerns, oversight and referrals.</li>
<li>Creates and manages effective monitoring of ongoing investigations, including quality control, timeliness and business relations to continually evaluate FWA related activities.</li>
<li>Performs reviews of investigations for sufficiency of content and documentation and escalates where appropriate.</li>
<li>Prepares timely and accurate reporting on investigations, including scope, activities, methodologies, observations, deficiencies, recommendations and remediation activities.</li>
<li>Presents investigative reports including findings, risks and recommendations to senior management.</li>
<li>Collaborates with business areas to enhance systems, workflows and internal controls.</li>
<li>Identifies benchmarking standards (leading practices) for identifying potential control gaps and/or opportunities for improving efficiency and compliance.</li>
<li>Proposes recommendations for enhancing operational efficiency and identifying other areas of improvement.</li>
<li>Provides excellent customer service by addressing concerns promptly and delivering actionable, professional insights. </li>
</ul>
</li>
<li>15% - Investigative Activities
<ul>
<li>Performs investigation activities for complex cases.</li>
<li>Partners with staff in performing investigations of difficult cases. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned. </li>
</ul>
</li>
</ul>
 Minimum Qualifications: 
<ul>
<li>Bachelor's degree in business administration, accounting, health information management, or another related field PLUS 5 years of relevant work experience in health care investigations required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. </li>
<li>5 years of managerial experience within a managed care health plan in audits or investigations, or as an outside consultant engaged to perform audit work for a managed care health plan required. </li>
<li>Have access to means of transportation for work away from the primary office approximately 15% of the time.</li>
</ul>
 Preferred Qualifications: 
<ul>
<li>Master's degree.</li>
</ul>
 Required Licensure / Certifications: 
<ul>
<li>Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI) or similar certification completion, currently pursuing a related certification or has completed more than half of the requirements towards a certification.</li>
</ul>
 Knowledge &amp; Abilities: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 About CalOptima Health: CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay! About our Benefits &amp; Wellness options: At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the <a href="https://apptrkr.com/get_redirect.php?id=6305723&amp;targetURL=https://alliantbenefits.cld.bz/25caloptimacabenguide" target="_blank">2025 CalOptima Health Benefits Guide</a> regarding our comprehensive benefits and wellness package. IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 30, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet. Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6305723" target="_blank">https://jobs.caloptima.org/jobs/sr-manager-fraud-waste-and-abuse-investigations-sr-manager-i-505-city-parkway-west-california-united-states</a> Copyright ©2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-7b45ba9efc4d8747a6f8e14e16e01d8e

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