Our motto and programs

“Better. Together.” is our motto, and it means that by working together, we can make things better — for our members and community. As a public agency, CalOptima was founded by the community as a County Organized Health System that offers health insurance programs for low-income children, adults, seniors and people with disabilities. As Orange County’s single largest health insurer, we provide coverage through four major programs:

 

Medi-Cal

California’s Medicaid Program for low-income children, adults, seniors and people with disabilities, offering comprehensive health care coverage

 

OneCare Connect Cal MediConnect Plan

Medicare-Medicaid Plan that combines Medicare and Medi-Cal benefits and adds worldwide emergency care, dental care, vision care and transportation to medical services at no extra cost

 

OneCare (HMO SNP)

Medicare Advantage Special Needs Plan for seniors and people with disabilities who qualify for both Medicare and Medi-Cal

 

Program of All-Inclusive Care for the Elderly

PACE for frail older adults, providing a full range of health and social services so seniors can remain living in the community

37 job(s) at CalOptima

CalOptima Orange, CA, USA
Mar 22, 2024
Full Time
Medical Case Manager (LVN) (Pre-Authorization Nurse Reviewer) Job Description Department(s): Utilization Management (Prior Authorization) Reports to: Manager, Utilization Management FLSA status: Non-Exempt Salary Grade: K - $70,000 - $114,268 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 on Thursday, April 03, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Medical Case Manager (LVN) (Pre-Authorization Nurse Reviewer) will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers. The incumbent will be responsible for prior authorization and referral related processes, including on-line responsibilities and select off-line tasks. The incumbent will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent will directly interact with provider callers and serve as a resource for their needs. Duties & Responsibilities: Medical Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Reviews requests for medical appropriateness. Verifies and processes specialty referrals, diagnostic testing, outpatient procedures, home health care services and durable medical equipment and supplies via telephone or fax using established clinical protocols to determine medical necessity. Screens requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow-ups in the utilization management system. Completes required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates. Reviews International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and existence of coverage specific to the line of business. Contacts the health networks and/or CalOptima Health's Customer Service department regarding health network enrollments. Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or verbal communication if the issue is urgent. Refers cases of possible over/under utilization to the Medical Director for proper reporting. Meets productivity and quality of work standards on an ongoing basis. Administrative Support Assists the manager with identifying areas of staff training needs and maintains current data resources. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. Current, unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required. 3 years of nursing experience required, 1 year of which must be as a Nurse Reviewer. 1 year of utilization management/prior authorization review 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. Preferred Qualifications: Active Certified Case Manager (CCM) certification. Managed care experience. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4564 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-f0c20222ebb4944b855cfc1276172545
CalOptima Orange, CA, USA
Mar 22, 2024
Sr Director, Hospital Relations and Inpatient Clinical Support CalOptima Health is seeking a highly motivated an experienced Sr Director, Hospital Relations and Inpatient Clinical Support to join our team. The Sr Director (Hospital Relations and Inpatient Clinical Support) will be responsible for leading operational effectiveness between hospitals and all CalOptima Health and health network partners. The incumbent will work collaboratively with the Executive Director, Clinical Operations and Deputy Chief Medical Officer to support and coordinate our hospital partnerships, communicating and directing protocols across the entire CalOptima Health delivery of care. The incumbent will be responsible for ensuring patient access through quality outcomes and a system approach to ensure inpatient care, transitional care services and communication amongst treatment teams. The incumbent will lead through a front-line, coordinated approach working with our hospitals, direct providers and health network partnerships to ensure exceptional direction and communication to serve CalOptima Health members. Position Information: Department: Utilization Management Salary Grade: T - $182,000 - $317,152 Work Arrangement: Partial Telework**This position is eligible for telework in California.** Duties & Responsibilities: 50% - Leadership Functions Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. 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. Facilitates improvement planning and escalation discussions with leadership including Executive Team and Chief Medical Officer as appropriate. Develops and implements effective and standardized communication strategies to facilitate seamless information flow among health care providers. Promotes a culture of accountability, excellence and continuous improvement with hospital partners through exemplary leadership practices. Participates and presents in CalOptima Health's committee meetings. 45% - Operational Functions Contributes to the development of policies and procedures that support effective collaboration for hospital teams and ambulatory care providers within the broader health care community. Collaborates with Medical Management leadership to align inpatient clinical practices with organizational goals, ensuring high-quality and patient-centered care. Develops and maintains relationships with acute care facilities to ensure seamless transitions and coordinated care for patients. Establishes and maintains a strong in-hospital presence, engaging directly with health care providers to understand their challenges and needs priorities and strategic approach to align all CalOptima Health's health networks to a coordinated and streamlined process for hospital partners. Collaborates with all internal and health network Medical Directors and proactively educates the internal UM department and health network teams as new protocols or requirements and emerge related to hospital partnerships. Develops and implements strategies for ensuring appropriate protocol communication on methods, Key Performance Indicators (KPI) and success, in information exchange to support consistent and high-quality Transitional Care Services (TCS) for all CalOptima Health members. Participates in workgroups that address both clinical and non-clinical activities related to Transitional Care services in Utilization management and Care Management. Participates in Joint Operation Meetings and Hospital Association calls to communicate protocols and report outcomes. 5% - Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in health care administration or related field required. 7 years of progressively responsible experience in the health care industry required. 5 years of Acute Care experience required. 5 years of supervisory/management experience in a hospital setting required. Experience with emergency room operations and coordination 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. Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 30% of the time or more. Preferred Qualifications: Master's degree of science in nursing, health care administration or related field.Experience as chief nursing officer at an acute care facility. Required Licensure / Certifications: Current, unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license to practice in the State of California required. Knowledge & Abilities: 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. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. 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. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. 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 & 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 2024 CalOptima Health Benefits Guide 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 April 3, 2024 at9:00 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. To apply, visit: https://jobs.caloptima.org/jobs/sr-director-hospital-relations-and-inpatient-clinical-support-505-city-parkway-california-united-states 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. Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-c3d277d0cb3de84e92a8465859632217
CalOptima Orange, CA, USA
Mar 22, 2024
Technical Support Specialist Sr. (1st Shift Operation & Support) CalOptima Health is seeking a highly motivated an experienced Technical Support Specialist Sr. (1st Shift Operation & Support) to join our team. The Technical Support Specialist Sr will support the user community by maintaining accurate Information Systems. The incumbent will support the user community with resolving service desk support calls, providing desk side support and supporting complex enterprise support tools, and computing systems. Additional responsibilities include assisting the System Engineers and System Administrators with testing, monitoring and implementation of new technology, processes, and updates. This level assists with more complex projects and focused assignments. Position Information: Department: ITS - Infrastructure Salary Grade: I - $61,000 - $99,110/year Work Arrangement: Full Office Duties & Responsibilities: 50% - Program Support Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Provides general Service Desk phone support and Tier 1-2 desk side support for the organization, including troubleshooting and repairing computer hardware and software, Citrix, and application support. Provides support for Azure, Office 365, and various cloud services. Provides support for telco systems, such as Avaya IP Office Manager and RightFax Supports Intune Mobile Device Management (MDM) and iPhone deployment/support. Identifies, investigates, and resolves production problems involving application systems, storage allocation, device assignments. Monitors system alerts and contacts vendor for service as needed. Participates in complex project work requiring advance planning of system resources and effective communication across diverse teams. 45% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Performs basic network/system administration, security management and user account management in Active Directory (AD), Microsoft Exchange, Multi-factor authentication (MFA), Pulse Secure, CrowdStrike and Rivest Shamir Adleman (RSA). Performs Active Directory administration: disable/unlock accounts, reset passwords, and New Technology File System (NTFS) folder permissions. 5% - Other Completes other projects and duties as assigned. Minimum Qualifications High School diploma or equivalent required. 3 years of experience providing Information Technology (IT) support in an enterprise computing environment required. 3 years of progressive experience in Microsoft Office 365, Windows PC systems, Dell personal computers (PC) and Active Directory 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. Preferred Qualifications: Bachelor's degree in Information Technology, Computer Science, Business Administration, or related field. 3 years of experience in supporting executives. Required Licensure / Certifications: N/A Knowledge & Abilities: 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. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. 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. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. 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 & 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 2024 CalOptima Health Benefits Guide 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 March 27, 2024 at9:00 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. To apply, visit: https://jobs.caloptima.org/jobs/technical-support-specialist-sr-1st-shift-operation-support-505-city-parkway-california-united-states 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. Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-482f97a3ecf91f4c8e1a41789a021bd6
CalOptima Orange, CA, USA
Mar 18, 2024
Full Time
Social Worker (Care Manager) Job Description Department(s): Multipurpose Senior Services Program (MSSP) Reports to: Supervisor MSSP FLSA status: Non-Exempt Salary Grade: J - $65,000 - $106,106 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 on Thursday, October 19, 2023 at 11:59 PM. 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. 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 the Position This Social Worker (Care Manager) will assess prospective members for the various programs available. The incumbent will be responsible for developing, implementing, monitoring, modifying and documenting care plans. The incumbent will accept referrals for case management and will make recommendations for the appropriate level of care and measures needed to successfully manage care. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Collaborates with an interdisciplinary team to identify and work toward timely resolution of issues related to psychosocial needs, including assistance with financial issues, transportation and community support services. Assists in the coordination of the member's identified psychosocial needs, utilizing community resources and support when appropriate. Works with external utilization management personnel and the community in identifying members who could benefit from case management services and to actualize service plans. Provides social work consultation and education to members and their families and acts as an advocate as needed. Develops and maintains a network of current community resources and services where members can be referred for assistance. Analyzes assessments to identify individual needs and resources that are most appropriate to meet the member's needs. Monitors all services provided to members and ensures necessary and available resources are being utilized. Evaluates and anticipates members' needs, provides support, and maintains a role as the members' liaison while forecasting independence and decision-making on their part. Provides referrals based on the members' assessed needs. Partners and communicates with the members, family members, significant other(s), physicians and other health care providers to accomplish goals identified on the care plan. Participates in proactive identification of members appropriate care management. Initiates appropriate follow-up care and develops individual care management service/care plans incorporating assessment, education, resource planning and coordination of services of those patients accepted for case management. Accepts referrals for case management and serves as CalOptima Health's liaison to community agencies, organizations and State of California personnel. Maintains documentation of case management plans/interventions and statistics required to demonstrate the impact of case management or quality, cost effective care. Initiates case conferences as needed. Completes other projects and duties as assigned. Experience & Education: Master's degree in Social Work required. 2 years of experience working with the gerontology population required. Experience with behavioral health, health facility, health plans, counseling, case management, home health or hospice required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 50% of the time or more. Preferred Qualifications: Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee is required to move about the organization and to and from the office. Must be able to reach with hands and arms and must be able to lift and carry up to 25 pounds to transport laptop and other material. Employee must be able to communicate, particularly for regular phone use and face-to-face interaction. Employee must have means of transportation to and from multiple locations during a workday. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. Off-site visit environment is equivalent to a client's home. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4380 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-c7b6760def892a4890c99ad520480039
CalOptima Orange, CA, USA
Mar 14, 2024
Full Time
Medical Case Manager (Ambulatory) - Whole Child Model Job Description Department(s): Case Management Reports to: Manager, Case Management FLSA status: Non-Exempt Salary Grade: L - $77,000 - $127,094 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 on Tuesday , October 31, 2023 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager facilitates communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes. The incumbent will be responsible for providing intensive case management primarily to a pediatric population, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Duties & Responsibilities: Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Performs comprehensive, disease specific, clinical assessments of all identified cases, which includes but is not limited to, assessment of: Member's physical, functional, social and psychological status. Member's cultural and linguistic needs. Caregiver resources and available benefits. Develops and implements a member's specific care plan which includes prioritized goals. Schedules follow-up meetings with members and families to assess progress towards goals and identifies barriers to meeting goals. Communicates with member's physicians, specialists, community agencies and vendors to ensure coordination of services. Follows CalOptima Health's protocol for documenting all case interventions. Facilitates Interdisciplinary Team meetings as applicable. Collaborates with interdepartmental staff in case resolution as needed. Identifies cases needing manager, director or medical director review or input, routes accordingly and closes cases according to procedures and guidelines in a timely manner. Prepares and maintains appropriate documentation of patient care and progress within the care plan. Prepares and maintains appropriate documentation of patient care and progress within the care plan. Advocates in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. Completes other projects and duties as assigned. Experience & Education: Associate's degree in Nursing (ADN) or related field required. Current unrestricted Registered Nurse (RN) license to practice in the state of California required. 5 years of clinical experience and/or managed care experience required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree or related field. 2 years of pediatric experience. Certified Case Manager (CCM) certificate. Bilingual in English and one of CalOptima Health's defined threshold languages (Spanish, Vietnamese, Arabic, Farsi, Korean, Chinese). Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must be able to talk and hear, particularly for regular communication on the phone. Employee may at times be required to deal with significant time pressures if required to work on projects that have timeframes attached. Work Environment: Employee will have one-on-one contact with other employees in a quiet environment where hearing and listening is paramount. Employee is expected to use diplomacy and problem-solving skills to procure data and information from other sources, as well as handle incoming public inquiries. Office environment with controlled office temperatures. About our Benefits & 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 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4479 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-461113a61e1b4b48a08abe57b5af6275
CalOptima Orange, CA, USA
Mar 09, 2024
Full Time
Financial Analyst II (Decision Support) Job Description Department(s): Financial Analysis Reports to: Director IV FLSA status: Non-Exempt Salary Grade: L - $77,000 - $127,094 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 on Thursday, March 21, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Financial Analyst II (Decision Support) will be responsible for providing quantitative financial analysis for various departments within CalOptima Health. Under general supervision, the incumbent will develop financial models used to forecast medical cost trends, provide support for provider contract negotiations, assess actuarial rate development studies, participate in annual budgeting functions and provide ad-hoc analytic support as needed. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Researches, assesses and develops advanced tools, models, reports and approaches to increase accuracy and timeliness of data-driven work projects. Develops medical expense, revenue and enrollment projections to support the budget process. Develops financial models and reports to support provider contract negotiations. Develops return on investment and business case analyses for program initiatives under consideration by senior management. Provides clinical and utilization analyses to assist Medical Management with improving outcomes and quality of care for CalOptima Health members. Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse. Utilizes various software (Excel, SQL, Access, Tableau) as appropriate. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in business administration, finance, economics, actuarial sciences or related field required. 2 years of experience in a medical group, hospital or health plan setting required. Experience with managed health care or health insurance programs 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. Preferred Qualifications: Experienced user of Tableau and/or Microsoft SQL Server. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4558 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-96503e846ab4ca4eab3599cb3fd3b19a
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Supervisor, Customer Service (Call Center) Job Description Department(s): Customer Service Reports to: Manager, Customer Service FLSA status: Non-Exempt Salary Grade: I - $29.33 - $47.65 ($61,000 - $99,110) 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 on Friday, March 15, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Supervisor Customer Service (Call Center) will oversee the day-to-day operations of all call center activities, provide supervision to call center staff and provide guidance to the staff as applicable. The incumbent will resolve complex issues and handle escalated calls that a Customer Service Representative Senior or a Customer Service Representative Lead are unable to solve. The incumbent will be required to complete additional research with providers, health networks and internal CalOptima Health departments to resolve the more complex issues. Duties and Responsibilities: Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department. Sets priorities for the team to ensure task completion and performance goals are met, such as average speed of answer, abandonment rate, service level, average handle time, quality and staff schedule adherence. Identifies and resolves operational problems using defined processes, expertise and judgment. Collaborates with Customer Service managers to develop strategies to reinforce, train and disseminate information to meet operational and service performance requirements. Fosters and maintains a collaborative relationship with internal and external business partners to ensure member and provider satisfaction. Prepares requested materials for the Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA), California Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC) and Audit and Oversight audits. Oversees the exempt grievance process as it relates to Customer Service to ensure all state and federal regulations are achieved. Participates in cross-functional project teams that ultimately improve the member experience. Contributes subject matter expertise and carries out project assignments in a timely and effective manner. Facilitates the planning of the department's quarterly meetings. Assists with new hire recruitment and interviews. Monitors employee's timekeeping and schedule adherence. Holds individual monthly 1:1s with each team member to review call audits and attendance. Provides coaching, feedback and annual performance reviews, as well as formal corrective action as needed. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. 3 years of health care or call center experience required; preferably in a managed care environment or in a related area. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Preferred Qualifications: Bachelor's degree. 1 year of supervisory or lead work experience. Experience coaching staff, handling conflict resolution, implementing initiatives or projects and collaborating with other professional and non-clinical staff. HMO, Medi-Cal/Medicaid and health services experience. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Physical Demands and Work Environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee is required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms. Employee must be able to communicate, particularly for regular phone use and in meetings. Work Environment: Moderate noise levels due to call center operations. Frequent interruptions are common. Office temperatures are controlled and comfortable. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima 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 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4553 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-5023a705fb71aa4f966f17a685d09fdc
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Customer Service Representative (Bilingual Required) Job Description Department(s): Customer Service Reports to: Supervisor Customer Service FLSA status: Non-Exempt Salary Grade: C - $43,281 - $61,798 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 on Thursday, March 28, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position 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. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department. 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. Communicates, builds and maintains internal and external relationships by prompt and accurate service delivery. Identifies and communicates challenges that might arise with the use of professional judgment while adhering to departmental policies and procedures. Enters accurate and complete documentation into internal application systems regarding all concerns and/or inquiries from the member and provider interaction. Maintains departmental productivity and quality standards. Follows through on and completes all member and provider inquiries or requests during the original member and provider interaction. Serves as a resource for other team members. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. 6 months of experience in a call center capacity required. Typing speed of 35 words per minute (WPM) 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. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) required. Preferred Qualifications: 6 months of Medi-Cal/Medicaid or health services experience. Physical Demands and Work Environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Moderate noise levels due to call center operations. Frequent interruptions are common. Office temperatures are controlled and comfortable. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4556 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-0daca2de3ebd5743941ee48f0e57a9b5
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Program Manager, Sr. (Provider Operation) Job Description Department(s): Provider Data Management Services Reports to: Director II FLSA status: Exempt Salary Grade: M - $85,000 - $141,086 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 on Monday, March 18, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position Under the guidance and leadership of the Director of Provider Data Management Services, the Program Manager Sr (Provider Operation) will lead the program development and continuous operation within the Provider Data Management Services department, including the Network Adequacy, provider life cycle operations and regulatory programs impacting the department. The incumbent will be responsible for the end to end of development, implementation and monitoring of their assigned program. The incumbent will develop project work plans, research, organize, and synthesize critical data and information to support strategic decision-making. The incumbent will also be responsible for preparing presentations, briefing documents and data reports and presenting findings to management. The incumbent will facilitate meetings, workgroups and committees to communicate updates within the organization and issue resolution. The incumbent will be expected to work independently. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Formulates and proposes recommendations and options to address new requirements and organization needs with moderate guidance. Ensures assigned programs meet regulatory requirements and operational needs, works with internal departments and external stakeholders to complete deliverables and meet program Key Performance Indicators. Participates in compliance and operational meetings and attends external info sessions to stay informed. Leads the planning, implementation and management of various initiatives and activities in collaboration with management and other CalOptima Health departments. Executes compliance and policy requirements as mandated, works within the department to ensure timely and accurate implementation. Owns assigned program, serves as subject matter expert and conducts ongoing review and analysis to ensure compliance, efficiency and overall success. Supports vendor management activities and works with vendors and leadership to ensure continuous alignment with business needs and strategies. Tracks and monitors the impact and success of programs. Produces documentation, summaries, impact analysis and reports for department operations, audits and responses to regulators. Coordinates workgroup and committee meetings as needed. Presents regular and organized program updates to all staff levels and regulators. Stays current on the local, state and federal health care environment to identify public policy and market trends that may impact CalOptima Health's provider programs and/or mission. Completes other projects or duties as assigned. Experience & Education: Bachelor's degree required. 5 years of experience in program development, including using data-driven decision making in program planning and implementation required. 2 years of experience working with policies/regulatory requirements (i.e. impact analysis, report submission, requirements documentation, etc.) required. 1 year of experience working with data analytics/reporting 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. Preferred Qualifications: Project Management certificate. 1 year of experience and aptitude for working in a highly matrixed, mission-driven organization. Experience working with vendors/vendor management. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4555 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-29200d6a98785d4998fc9574aace5fac
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Program Manager (Quality Improvement) Job Description Department(s): Quality Improvement Reports to: Director II FLSA status: Non-Exempt Salary Grade: L - $77,000 - $127,094 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 on Monday, December 11, 2023 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Program Manager (Quality Improvement) will provide oversight, coordination and staff support to the Quality Improvement (QI) department in the areas of National Committee for Quality Assurance (NCQA) Accreditation, as well as quality requirements for the Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS). The incumbent will lead CalOptima Health's Health Plan and Health Equity accreditation efforts to ensure CalOptima Health achieves its renewal accreditation. Specifically, the incumbent will work to enhance and strengthen CalOptima Health's quality infrastructure, including program, policy, contract compliance and statutory and regulatory obligations with NCQA, DHCS and CMS. The incumbent will require the ability to complete a variety of detailed analyses, including the impact of accreditation and policy changes from the NCQA, the State of California and the federal government, communicating these changes with QI leadership and affected areas. The incumbent will lead and manage projects and other assignments in the QI department, including those relating to the quality program, workplan and evaluation. The incumbent will interact with CalOptima Health's leadership, state and federal regulatory agencies, as needed. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Leads CalOptima Health through the NCQA Health Plan and Health Equity accreditation process and renewals and provides leadership to all business areas to ensure standards are known and met. Leads and facilitates NCQA regulatory audits and audit readiness activities for QI department. Stays current on NCQA accreditation standards as well as local, state and federal health care environment; identifies issues and communicates areas that may impact CalOptima Health's QI programs. Ensures all NCQA related policies are reviewed and updated, as needed, annually. Work directly with regulatory and compliance to ensure submissions are reviewed timely and with legal review. Engages and collaborates with all external NCQA and regulatory related vendors/organizations, including but not limited to NCQA and NCQA Consultants, to ensure standards are known and met and accreditation surveys are submitted accurately and timely. Initiates and maintains contact with key business owners to ensure proper submission of required documentation for the accreditation and renewal survey and regulatory audits. Designs and develops process improvements for the QI department to ensure annual QI program, workplan and evaluation is monitored and executed as planned. Represents QI at various CalOptima Health committee meetings such as the Quality Improvement Health Equity Committee (QIHEC) and its related subcommittees, as well as the Health Network Forum and the Joint Operation Meetings with health networks. Designs and develops process improvements for the QI department as the one-stop shop for regulatory information. Manages the accurate and timely submission of regulatory filings and reporting requirements on an ongoing basis. Works with all CalOptima Health departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message. Researches national, state and local health policy issues that may impact CalOptima Health's mission, vision and strategic goals. Leads and facilitates the NCQA Steering Committee Meeting. Represents QI department in various internal and external meetings. Provides QI program support to QI managers and other team members, assuring PQI, Credentialing, FSR and PARS processes are compliant with regulatory or audit and accreditation requirements. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in a Health Care or related field required. 3 years of experience working with health care delivery systems and/or in a public agency serving the related population or equivalent required. 3 years of experience successfully managing and achieving NCQA accreditation for a health plan or equivalent required. 2 years of experience within managed care and quality management or equivalent required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Preferred Qualifications: 2 years of experience with outreach and public speaking/public relations. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization and to travel to offsite locations. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case while traveling, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Occasional travel to off-site locations is required. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4457 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-0eb1f22ec0118a4689f8f80a770ed9b3
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Medical Authorization Assistant (LTC) Job Description Department(s): Long Term Care (LTC) Reports to: Manager Long Term Support Services FLSA status: Non-Exempt Salary Grade: C - $43,281 - $61,798 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 on Monday, December 18, 2023 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Medical Authorization Assistant will provide office and case management support services by serving as a contact between members, physicians, nursing home facilities, community-based organizations, providers and CalOptima Health staff. The incumbent will complete initial intake of information, assist with authorization functions and gather information. The incumbent will perform under the direction of the licensed Medical Case Managers, Social Workers, Program Mangers and department managers. The incumbent will perform medical administrative and/or routine tasks specific to the assigned program and may also perform office support functions. The incumbent will provide effective and efficient communication with the utmost courtesy in every interaction with our CalOptima Health members, employees and other customers. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Receives cases via mail, fax, phone or electronically and enters data for new case information into the medical management systems. Conducts individual interviews with CalOptima Health members and/or providers to obtain intake information and gather data. Works with the Medical Case Manager to authorize requested services according to department guidelines and verifies eligibility through the state systems. Contacts the health networks and/or CalOptima Health's Customer Service department regarding health network enrollments, changes in address and primary care provider. Assists in gathering medical records, obtaining appropriate coding for diagnosis and procedures and follows up on phone calls. Documents all contacts and case information in the appropriate medical management system using the standard charting format. Performs data entry into the appropriate databases for monitoring and tracking, trending of cases and other relevant databases as needed. Generates monthly and other required reports from the databases as requested by the Medical Case Manager and/or health networks. Sends letters to providers and members. Answers calls and provides customer service to providers and members, provides care coordination and refers the callers to the correct department. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. 2 years of experience in a health care or managed 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 is also qualifying. Preferred Qualifications: Certified Medical Assistant (CMA) certification. Experience working with the needs of seniors or persons with disabilities (SPD) in a customer/member service capacity. Previous medical billing or coding experience. Utilization management experience. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese). Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as and work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4465 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-2a95d2052f5c664587deda91b35af312
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Program Specialist (BHI) Job Description Department(s): Behavioral Health Integration Reports to: Manager Behavioral Health FLSA status: Non-Exempt Salary Grade: E - $48,000 - $72,292 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 on Thursday, March 14, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Program Specialist (Behavioral Health) will support various projects and initiatives, as well as assist in the coordination of key strategies to effectively enhance the delivery of behavioral health (BH) services. Primary responsibilities include, but are not limited to, participating in and supporting BH workgroups, activities and projects focused on implementing targeted quality initiatives designed to improve access to care, awareness and understanding of BH services. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Reviews, monitors and tracks quality performance data related to, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS) and member and provider experience and access to care against internal and external benchmarks to identify performance gaps and identify opportunities for improvement in a timely manner. Assists with creating and updating project plans, develops and maintains process flows, maintains project related materials (ex., action plans, intervention logs, tracking and trending) and completes other project related tasks as needed. Creates, develops and edits member and provider communication pieces. Prepares and provides coverage for health fairs, continuing education events, material requests and educational sessions. Attends and supports cross-functional quality improvement work teams responsible for the identification, implementation and evaluation of BH quality improvement projects, activities and reports. Conducts comprehensive research on BH topics, interventions and best practices. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in public health, health policy, health care, public policy administration or related field required. 2 years of experience in a managed care organization required; preferably in behavioral health, quality, population health and/or health equity. 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. Have access to means of transportation for work away from the primary office approximately 20% of the time required. Preferred Qualifications: Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization and to travel to offsite locations. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case while traveling, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Occasional travel to off-site locations is required. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4552 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-8f4137bf44c1ac429f2ec81cfec34f79
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Registered Dietitian (PACE) Job Description Department(s): Program for All-Inclusive Care for the Elderly (PACE) Reports to: Supervisor Dietary Services (PACE) FLSA status: Non-Exempt Salary Grade: K - $70,000 - $117,268 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 on Thursday, March 14, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Registered Dietitian will be responsible for providing nutrition care, education and food services to CalOptima Health's PACE participants. The incumbent will evaluate the participant's nutritional status, develop and implement nutritional care plans, assess nutrient requirements and recommend nutritional prescriptions. The incumbent will be responsible for assessing the participant's nutritional care, communicating nutritional data and providing information to the primary care staff and other interdisciplinary team members. Position Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Collects participant data and completes required forms with responses according to department and industry standards, identifies participant's overt nutritional problems/needs, including proper intake and diet texture and sets reasonable priorities. Identifies problems requiring further referral and/or follow-up, assesses participants' responses and satisfaction with nutrition services. Develops a plan of care based on the nutritional therapeutic process and Academy of Nutrition and Dietetics (AND) standards, which incorporates the plans of other disciplines and continuing care needs, including the participant/family in developing or revising the nutrition plan of care and makes referrals to interdisciplinary support services. Completes initial/annual and periodic assessments prior to the scheduled team meetings, communicates participant changes to team members and coordinates care with Registered Dietitians at outside dialysis centers and skilled nursing facilities as required for continuity of care. Provides in-services and group education classes to participants, families/caregivers, residential care facilities, PACE staff and contractors regarding nutritional requirements and special dietary regimens as prescribed by the physician or Registered Dietitian. Documents all nutrition interventions and recommendations accurately and within departmental time requirements into participant's charts. Reviews daily diet list as assigned and assists in meal service delivery to participants attending day health center. Monitors and records participant's nutritional intake as planned and recommends variation to nutritional plan with appropriate rationale. Monitors participant's weight and notes significant changes to recommend dietary changes as appropriate. Reviews diet orders in charts to ensure appropriateness and updates the supervisor with any changes. Recognizes department problems and takes responsibility for documentation, demonstrates active participation in Quality Initiative processes and proactively reports any deficiencies or issues with food service vendor(s), other contracted vendors or environmental health issues to the supervisor. Stays current with knowledge and expertise regarding industry standards in nutrition. Participates as an active member of the interdisciplinary team, attends staff meetings and takes part in participant care planning as assigned. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in nutrition from an American Dietetic Association (ADA) accredited institution required. Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) certification by the Commission on Dietetic Registration required. 2 years of work experience as a Registered Dietitian required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. CPR and First-Aid Certification required or must be obtained within six (6) months of date of hire. Preferred Qualifications: Certified Diabetes Educator (CDE) status. 1 year of experience working with the frail or elderly population. Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical Demand Infrequent 0-9% Occasional 10-33% Frequent 34-65% Continuous 66% + of day Description of physical demand Move/Transport/ Position X Assists/supports participants from a seated to standing position for up to 75 lb. & for ambulation for up to 100 feet at a time. Assists with food service (i.e., pushing cart loaded with 25 lb. of food product). Position/Install/ Remove X Reaches for tools in kitchen/work area that are above shoulder level &/or picks up items lower than knee level. Moves/Traverses X Moves throughout the PACE Center to meet with participants & staff. Positions Self X Positions self at participant-level to communicate or at various levels to inspect kitchen appliances. Operates/Uses/ Prepares/ Inspects X Uses a computer & other essential office equipment. Detects/Determines/ Identifies/Recognizes/ Observes/Inspects/ Assesses X Assesses status of kitchen & food preparation/service. Assesses nutritional intake of participants. Communication X Communicates with participants, families & staff about nutrition. Must be able to exchange accurate information regarding participant care. Work Environment: Employee must be able to work effectively within an interdisciplinary team model, interfacing and collaborating with a wide range of clinical and social services disciplines who work together to manage the PACE members' care. The work setting is in an Adult Day Health Center and primary care clinic environment with moderate noise levels and controlled office temperatures. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4551 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-dfc06aa863ea894ea191c686bfc33ee9
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Medical Case Manager (LTSS) Job Description Department(s): Long Term Care Reports to: Supervisor, Long Term Support Services FLSA status: Non-Exempt Salary Grade: L - $77,000 - $127,094 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 on Thursday , February 29, 2023 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Medical Case Manager (LTSS) is part of an advanced specialty collaborative practice, responsible for case management, care coordination, authorization and utilization management of the assigned population of focus (Community Adult Based Services (CBAS), CalAIM, complex discharge and long term care (LTC) members residing in nursing facilities under custodial care) including members in the OneCare Programs, Medi-Cal only members or members living in the intermediate care facilities under regional center guidelines. The incumbent will perform utilization functions and authorizations, provide coordination of care and ongoing case management services for CalOptima Health members discharging from LTC facilities. Discharge planning may include services for CalAIM, LTC and CBAS. The incumbent will review and determine medical eligibility based on approved criteria/guidelines, National Committee for Quality Assurance (NCQA) standards, Medicare, Medi-Cal and CDA guidelines and will facilitate communication and coordination among all participants of the health care team and the member to ensure services are provided to promote quality cost-effective outcomes. The incumbent will provide intensive case management in a collaborative process that includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. The incumbent will be the subject matter expert and acts as a liaison to Orange County based community agencies, CalAIM program and providers, CBAS centers, In-Home Support Services (IHSS) liaisons, skilled nursing facilities, members and providers. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Applies utilization management, authorizations and case management/nursing processes that include assessment, care planning collaboration, advocacy, implementation/intervention, monitoring and evaluation of a member's status. Performs and/or reviews clinical assessments by using CalAIM, CalOptima Health and DHCS approved standardized tools such as Pre-Admission Screening and Resident Review (PASRR), Minimum Data Set (MDS), CBAS Eligibility Determination Tool (CEDT), Health Risk Assessment (HRA), Individual Plans of Care, etc. Participates in hospital rounds. Collaborates with hospitals on complex discharges. Communicates timely with CalAIM providers and members to coordinate and initiate Community Support (CS) services and (ECM) Enhanced Case Management. Completes all documentation accurately and appropriately for data entry into the utilization management or care management system at the time of the telephone call or fax to include any authorization updates. Reviews and evaluates proposed services utilizing medical criteria, established policies and procedures, Title 22, Medicare and/or Medi-Cal guidelines. This includes review of submitted medical documentation. Determines the appropriate action regarding the service being requested for approval, modification or denial and refers to the Medical Director for review when necessary. Initiates contact with patient, family and treating physicians as needed to obtain additional information or to introduce the role of CalAIM and case management. Analyzes all requests with the objective of monitoring utilization of services, which includes medical appropriateness and identify potentially high cost, complex cases for high level case management intervention. For short-term cases, conducts a thorough and objective assessment of the member's current physical, psychosocial and environmental status and gathers all information pertinent to the case. Develops, implements and monitors a care plan through the interdisciplinary team process in conjunction with the individual member and family in internal and external settings across the continuum of care. Assesses member's status and progress routinely; if progress is static or regressive, determines reason and proactively encourages appropriate referrals to a higher level of case management or makes appropriate adjustments in the care plan, providers and/or services to promote better outcomes. Reports cost analysis, quality of care and/or quality of life improvements as measured against the case management goals. Establishes means of communication and collaboration with CalAIM providers, other team members, physicians, CBAS centers, IHSS liaisons, community agencies, health networks, skilled nursing facilities and administrators. Prepares and maintains appropriate documentation of patient care and progress within the care plan. Acts as an advocate in the member's best interest for necessary funding, treatment alternatives, timelines and coordination of care and frequent evaluations of progress and goals. Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem-solving complex cases. Documents case notes and rationale for all decisions in the Medical Management System (i.e., JIVA, CCMS system, Altruista Guiding Care, etc). Conducts assessments by collecting in-depth information about a member's situation, identifies high-risk needs, issues and resources and gathers all information pertinent to the case to write referrals for any gaps in services. Plans and determines specific objectives, goals and actions as identified through the assessment process and makes recommendations to nursing facilities for the care of the patients. Implements by conducting specific interventions, including referring members to outside resources and/or community agencies that will result in meeting the goals established in the care plan. Supports implementation of the care plan through an interdisciplinary team process in conjunction with the member, family and all participants of the health care team. Monitors established measurable goals and routinely assesses the member's status and progress to proactively make appropriate recommendations for adjustments in the care plan, providers and/or services to promote better outcomes. Performs utilization review of services requested for members in case management by reviewing all pertinent medical records for medical necessity, applying medical review protocols and criteria and meeting the timeframes per the Utilization Management policies and procedures. Assists the Manager, Long-Term Support Services in identifying areas of needed staff training and in maintaining current data resources. Maintains confidentiality of the member's medical information. Completes other projects and duties as assigned. Experience & Education: Associate degree in nursing (ADN) required. Current, unrestricted Registered Nurse (RN) license to practice in the state of California required. 3 years of clinical experience with the health needs of the population served 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. A valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office approximately 50% of the time. Preferred Qualifications: Bachelor's degree in nursing (BSN). 2 years of experience in Long Term Care, Community Health, Managed Care Medi-Cal, Medicare programs. Active Commission for Case Manager (CCM) certification. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of the job, employee may need to move about the organization. Employee is required to participate in provider workshops, CME events and conferences. Employee must be able to communicate, particularly for regular phone use, in meetings and face-to-face interaction. Employee must have means of transportation for offsite travel to nursing facilities approximately 95% of the time. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. Off-site locations are equivalent to a typical physician's office, hospital, or other ancillary provider. About our Benefits & 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 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4544 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-bf96b920096d6349b56d14901c0245fb
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Personal Care Coordinator (Bright Steps) Bilingual Job Description Department(s): Population Health Management Reports to: Manager Population Health Management FLSA status: Non-Exempt Salary Grade: C - $43,281 - $61,798 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 on Thursday , February 29, 2023 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Personal Care Coordinator (Bright Steps) will coordinate activities aligned with the Certified Perinatal Services Program (CPSP) and support CalOptima Health moms with trimester specific, postpartum assessments and infant assessments. The incumbent will ensure communication of the member's assessment and care plan with the member and the health care team. The incumbent will identify barriers to member's care and assist in improving these barriers for all levels of care. The incumbent will work closely with the health care team to ensure member access to timely services and coordination of care. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Provides outreach to members to coordinate completion of trimester specific assessments, including postpartum following CPSP protocols. Conducts telephonic assessments. Collaborates with the health care team to ensure timely communication of member's clinical information. Maintains documentation of member's case, care plan and communication with the health care team within CalOptima Health's medical management system and ensures appropriate documentation of all interventions. Identifies the need for referrals and coordinates with community resources or behavioral health services as needed. Facilitates warm transfers in accordance with the member's needs when appropriate and notifies member's care team of key event triggers. Guides members in understanding and accessing the benefits they are entitled to under Medi-Cal. Maintains compliance with established departmental productivity guidelines. Provides productivity metrics reports to supervisor as needed. Works with CalOptima Health staff from other departments to expedite the resolution of member concerns. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. 1 year of experience working with maternal and child health programs required. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) 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. Preferred Qualifications: Certification from California Board of Medical Assistant or American Registry of Medical Assistants. 2 years of experience working with maternal and infant health programs Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4545 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-09771a0885eeda4a98220eb20a9d3cc5
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Member Liaison Specialist (Bilingual, Customer Service) Job Description Department(s): Member Liaison Program Reports to: Supervisor, Member Liaison Program FLSA status: Non-Exempt Salary Grade: D - $21.15 - $32.51 ($44,000 - $67,628) 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 on Tuesday, March 05, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Member Liaison Specialist (Customer Service) will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of 21 who participate in the Whole-Child Model program. The incumbent will serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution. Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines. Coordinates members' health care and social service needs both within and outside the health network and CalOptima Health during the original interaction. Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program. Guides members in understanding and accessing the benefits under the Whole-Child Model program. Maintains documentation of member cases within the FACETS system. Initiates referrals to internal and external care management departments and government agencies. Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes and helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services. Collaborates with interdepartmental staff in call resolution as needed. Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines. Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. 2 years of experience as a call center agent or customer/member services representative in health care required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese) required. Preferred Qualifications: 2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity. Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Must be able to focus and function in a high pace, moderate noise level work environment. Office temperatures are controlled and comfortable. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. . Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4547 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-53ffdd17646a1547bdd359b106fa95e7
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Manager, Utilization Management (UM Oversight & Clinical Administration) Job Description Department(s): Utilization Management (Delegate Monitoring) Reports to: Director, Utilization Management FLSA status: Exempt Salary Grade: P - $117,000 - $192,390 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 on Tuesday , March 5, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Manager, Utilization Management (UM Oversight & Clinical Administration) will provide direct management and coordination activities for Utilization Management (UM) program compliance and delegated health network oversight, to ensure that service and compliance standards are met, and operations are consistent with all regulatory requirements, accreditation standards and CalOptima Health's policies and procedures. The incumbent will be responsible for staying updated on regulatory requirements from All Plan Letters (APLs), CCS Number Letters (NLs) and regulatory changes for the management of and to ensure adherence to CalOptima Health's internal UM department and external health network's UM operations. The incumbent will work closely with key internal and external stakeholders relevant to the UM (outpatient and inpatient) program and delivery of care across CalOptima Health. Duties & Responsibilities: Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. 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. Manages the day-to-day activities of the Clinical Administrative and Oversight team in UM to ensure compliance with regulatory requirements, accreditation standards and CalOptima Health's policies. Interviews, onboards, trains, manages, motivates, supports and evaluates staff. Develops clinical and documentation tools for education and oversight of the UM Operational team and sets performance standards for the Clinical Administrative and Oversight team. Establishes and maintains priorities and strategic approach to meet internal and external deadlines for regulatory and programmatic procedures to support UM team compliance. Collaborates with the Medical Director and Director of UM to ensure appropriate monitoring of the internal UM team and delegated health network performance and proactively educates the internal UM department and Health Network teams as new requirements and regulatory changes emerge. Researches and informs health network delegates and CalOptima Health's internal UM teams of any regulatory or programmatic changes in requirements. Participates in workgroups that address both clinical and non-clinical internal activities in which CalOptima Health must demonstrate improvement to meet its contractual requirements with the Center for Medicare and Medicaid (CMS), California Department of Health Care Services (DHCS), California Managed Risk Medical Insurance Board (MRMIB), Department of Managed Health Care (DMHC) and any other applicable entity. Facilitates improvement teams as assigned by the director and/or senior staff. Participates and attends CalOptima Health's Delegation Oversight Committee (DOC) meetings and Internal Audit meetings. Presents monitoring findings at the Utilization Management Committee (UMC) and other committees as requested. Ensures all reviews for medical appropriateness use the established criteria to determine the medical necessity of the request. Demonstrates support of CalOptima Health's goals and priorities with attention to managing department monitoring activities that are cost-effective in terms of resources, materials and time. Leads the annual review and revision of CalOptima Health's policies and procedures and UM department desktop procedures as required by benefit plan changes guidance from CMS and DHCS and department process improvement workflow updates. Assists the Director of Utilization Management in all areas of the department, as requested, to ensure department and organizational goals are met. Completes other projects and duties as assigned. Experience & Education: Current, unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license to practice in the state of California is required. 5 years in the health care industry required 5 years of varied clinical experience (e.g., acute care, home care) required. 3 years of supervisory/management experience in utilization management activities required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Valid driver's license and vehicle or other approved means of transportation, an acceptable driving record and current auto insurance will be required for work away from the primary office 30% of the time or more. Preferred Qualifications: Bachelor's degree in health care administration or related field. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of the job, employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers for typing on the computer and using the mouse. Employee must be able to communicate, particularly for regular phone use, in meetings, and face-to-face interaction. This position is required to work to project timelines, and at times may deal with significant time pressures. Work Environment: Typical office environment with minimal noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4548 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-3f28c313a237944ea9c85ba3c82ca07d
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Medical Authorization Assistant (Prior Authorization) Job Description Department(s): Utilization Management (Prior Authorization) Reports to: Supervisor Utilization Management FLSA status: Non-Exempt Salary Grade: C - $43,281 - $61,798 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 on Thursday, February 22, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Medical Authorization Assistant (Prior Authorization) will provide office and referral management services and serve as a contact between members, physicians, providers and CalOptima Health staff. The incumbent will process initial intake of information, assist with authorization functions and gather information. The incumbent will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers. The incumbent monitor tasks related to CalOptima Health's prior authorization and referral process. Additionally, the incumbent will be responsible for applying CalOptima Health's medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent will directly interact with provider callers, acting as a resource for their needs. The incumbent will operate under the direction of the licensed nurse. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Receives referral requests via fax, phone or electronically and enters new service request information into the authorization system. Collects additional information from CalOptima Health members and providers to complete referral information. Authorizes requested services according to CalOptima Health's authorization guidelines, performing data entry into the authorization system and verifying eligibility. Contacts the health networks and CalOptima Health Customer Service regarding health network enrollments. Assists the Medical Case Managers in gathering medical records, obtains appropriate coding for diagnosis and procedures and follows up on phone calls as directed by the authorization nurse. Documents all contacts and case information in the system using the standard charting format. Performs data entry into the appropriate databases for monitoring, tracking and trending of events and other relevant databases as needed. Completes other projects and duties as assigned. Experience & Education: High School diploma or equivalent required. 2 years of experience in a health care or managed 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. Preferred Qualifications: Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese). Prior Authorization and Utilization Management process experience. Physical Demands and Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4540 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-decd5e67ba024a44abee262b40dbc74c
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Program/Policy Analyst (Government Affairs) Job Description Department(s): Government Affairs Reports to: Sr Manager III FLSA status: Non-Exempt Salary Grade: I - $61,000 - $99,110 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 on Monday, November 27, 2023 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Program/Policy Analyst (Government Affairs) will be responsible for identifying, monitoring and analyzing state and federal legislation and recommending appropriate actions to advance CalOptima Health's legislative, regulatory and budgetary agenda. The incumbent will interact with CalOptima Health's staff and leadership to assess potential policy impacts. The incumbent will help ensure that CalOptima Health's strategic goals and objectives are communicated to legislative offices and that CalOptima Health's strong reputation is upheld. The incumbent serves on projects and other assignments in the Government Affairs department relating to policy initiatives and priorities. The incumbent will be responsible for coordinating and communicating advocacy opportunities, policy positions, meetings and events related to CalOptima Health's industry associations. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Tracks, analyzes and reports on key bills and budget developments throughout the federal and state legislative sessions, including maintaining a legislative tracking matrix and drafting legislative memos. Compiles programmatic and policy updates and briefs for internal and external communication to CalOptima Health's Board of Directors, executives and elected officials. Supports Government Affairs leadership in crafting and executing CalOptima Health's legislative and regulatory agenda. Interacts with and assists in managing CalOptima Health's relationships with health care industry associations. Recognizes the top challenges facing the organization, providers, members and the community. Completes other projects and duties as assigned. Experience & Education: Bachelor's degree in Political Science, Public Policy, Health Administration or related field required. 2 years of work experience in legislative analysis in public policy, public administration, health care or managed care policy required. An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying. Have access to means of transportation for work away from the primary office approximately 10% of the time. Physical Demands & Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: While performing duties of job, employee may be required to move about the organization and to travel to offsite locations. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case while traveling, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting. Occasional travel to off-site locations is required. Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4440 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-e716bf9c5181294193ecf07edae94d20
CalOptima Orange, CA, USA
Mar 08, 2024
Full Time
Program Manager (Population Health Management Strategic Initiatives) Job Description Department(s): Population Health Management - Strategic Initiatives Reports to: Manager, Population Health Management - Strategic Initiatives FLSA status: Non-Exempt Salary Grade: L - $77,000 - $127,094 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 on Wednesday, February 28, 2024 at 11:59 PM. 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. About CalOptima Health Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health! About the Position The Program Manager (PM) - Population Health Management (PHM) Strategic Initiatives plays a vital role in the program design, development, implementation and support of PHM initiatives, pilots and programs related to the National Committee for Quality Assurance (NCQA) Health Plan and Health Equity Accreditations, Department of Health Care Services (DHCS) PHM Strategy and Roadmap and CalOptima Health's Board of Directors' PHM priorities. Goals may include helping to close racial/ethnic disparities for identified populations, achieve greater health equity, improve care management and provider resources, as well as assisting with data collection, analysis and reporting. The incumbent will be responsible for coordination, implementation, execution and completion of tasks supporting new program development and the re-design of existing programs. The incumbent will manage cross-functional projects and other assignments in the PHM department, including those related to department efficiency to ensure department strategic objectives and initiatives are met. The incumbent will interact with CalOptima Health's executives and department management, legal counsel, state and federal regulatory agencies and community stakeholders. The incumbent will also support other CalOptima Health staff on related projects. Duties & Responsibilities: Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Leads program development, implementation of activities and oversight for various PHM programs and project plans including innovative pilots consistent with the DHCS PHM strategy and CalOptima Health's Board of Directors' priorities. Implements activities supporting the Health Equity enterprise-wide efforts for NCQA, DHCS, Centers for Medicare & Medicaid Services (CMS) and other regulatory agencies as they align with priorities set by leadership. This could include, but is not limited to, supporting CalOptima Health's Health Equity strategic priorities, collaborating with the Orange County Health Care Agency on their Community Health Assessment and Community Health Improvement Plan processes and supporting community stakeholders' health equity efforts that align with PHM priorities. Assists in the write up and bookmarking of documents used for NCQA Health Equity accreditation and other regulatory agency reporting submissions. Coordinates identification and management of data and works with Information Technology Services (ITS), Finance, Enterprise Analytics and Quality Analytics departments to obtain relevant data to strategize and plan. Keeps current on the local, state and federal health care environment, identifying issues that may impact CalOptima Health's medical management programs focused on health equity and social determinants of health. Assists with tracking and reporting of Health Equity and SDOH Strategic Plan priorities and tactics. Develops recommendations and proposals for leadership consideration. Completes other projects and duties as assigned. Experience and Education: Bachelor's degree in public health, healthcare administration or related field required. 3 years of experience in program development, including strategic planning for a start-up program, program implementation and evaluation of evidenced-based programs, preferably in the health care industry or a managed care environment, 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. Preferred Qualifications: Master's degree in public health, health administration or related field. 1 year of experience and aptitude for working in a highly matrixed, mission-driven organization. Physical Demands & Work Environment: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: Employee must be able to sit for extended periods of time and work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Employee must be able to communicate, particularly for frequent phone use, in meetings and to conduct presentations. Employee must have means of transportation for offsite travel to a local meeting venue as needed. Work Environment: Typical office environment with moderate noise levels and controlled office temperatures. About our Benefits & 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. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options. 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 employment 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 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. Job Location: Orange, California Position Type: To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4542 Copyright 2022 Jobelephant.com Inc. All rights reserved. Posted by the FREE value-added recruitment advertising agency jeid-d8b24384402c134ba4b6f49f63077496