CalOptima

Leading and managing claims operations, developing strategic plans, and ensuring compliance and efficiency in claims processing. | Requires 7+ years in claims administration, leadership experience, and relevant knowledge of healthcare claims systems and regulations. | Director, Claims Administration (Director II) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Director, Claims Administration (Director II) and help shape the future of healthcare where you'll be an integral part of our Claims Administration team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Partial Telework. • If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. The Director of Claims Administration serves as the leader and decision maker for the development and daily management of the operations and processing teams. You will be responsible for developing and implementing a strategic plan for claims operations including, planning for growth, developing claims policies and standards, budgeting, maintaining quality assurance and implementing efficiency improvements. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: • 40% - 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 for the department. • Directs all aspects of claims operations and claims processing activities and is accountable for the performance of the Claims Operations, Training, Adjustment and Customer Service teams. • Maintains policies, procedures and standards for all department activities. • Ensures adherence to Medi-Cal, Medicare and Covered California Plan policies and procedures for claims. • Leads direct reports and ensures improvement of knowledge and skill level is continuous for all department staff. • Serves as primary back up for the Director of Operations Systems Configuration. • Hires, manages, trains, supports, develops and evaluates direct reports. • Performs ongoing staff and workflow analysis; establishes plans to ensure the Claims operational teams are adequately staffed. Implements efficiency improvements such as streamlining processes and increasing claim automation. • * 55% - Program Oversight • Serves as subject matter expert in evaluating and assessing the business impact of new legislation, processes and products, and on the implementation of corporate-wide projects. • Serves as lead authority on claims processing and works with other internal department leadership on new projects and impact assessments. • Partners with other departments, whose functions directly influence claims processing activities, to ensure that performance objectives and policies are met. • Works with the Sr Director of Claims to develop and implement strategic plans involving, but not limited to, claims inventory, quality, cycle time and budget. • Assesses the impact of new business and/or technologies, identifies dependencies on other areas and works with senior leadership to ensure that operations are aligned with organizational goals. • Collaborates with the Utilization Management, Medical Management and Information Technology (IT) departments for various systems functionality. • Supplies necessary reports to the Contracting department; assists with providing claims information regarding future contracting efforts. • Provides oversight related to the review and the initiation of system updates for the Department of Health Care Services (DHCS) All Plan Letter (APL) upon issuance related to benefit, claims guidelines, procedure codes, services and fee schedule changes for Medi-Cal. • Provides oversight of the implementation and/or automation in Facets and issues notices to impacted business units. • Develops and manages the overall operations and budget to support and achieve all department and corporate initiatives and responsibilities. • Develops scope of work documents for any vendor supporting the Claims Operation department. Coordinates cross departmental projects, implements detailed project plans and champions process improvement initiatives. • * 5% - Completes other projects and duties as assigned. Do You Have What the Role Requires? • Bachelor's degree in business administration or a related field PLUS 7 years of experience in claims administration 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. • 5 years of progressive leadership experience, including direct supervision of staff required. You'll Stand Out More If You Possess the Following: • Master's degree. • Experience managing claims for a large health plan. • Experience with HMO, Medi-Cal/Medicaid, Medicare and commercial insurance or relevant government clients or public service. • Core operating system configuration and program experience. What the Regulatory Agencies Need You to Possess? • N/A Your Knowledge & Abilities to Bring to this Role: • 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. Your 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 Ways We Are Here For You • You'll enjoy competitive compensation for this role. • Our current hiring range is: Pay Grade: 321 - $181,257 - $290,011 ($87.14 - $139.4282). • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. • This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**) • A comprehensive benefits package • CalPERS pension program and additional retirement packages. • Additional benefits and perks including: • A generous PTO program • A quality work life balance • Various wellness programs • Tuition Reimbursement • Professional development opportunities • Career development opportunities • Flexible scheduling • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our 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. Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is February 17, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/director-claims-administration-director-ii-505-city-parkway-west-california-united-states jeid-a612f7957f62254a8104a1e528c690ed

Lead strategic planning and growth initiatives, manage projects with senior leadership collaboration, develop and maintain strategic plans and reports, and conduct market analysis to support organizational growth. | Bachelor's degree with 8+ years in healthcare strategy, research, or consulting, strong strategic planning and project management skills, and ability to work with executive leadership. | Project Manager, Strategic Planning & Growth Advisor (Project Manager IV) CalOptima Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Project Manager, Strategic Planning & Growth Advisor (Project Manager IV) and help shape the future of healthcare where you'll be an integral part of our Strategic Development team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. As the Strategic Planning & Growth Advisor, you'll be responsible for strategic alignment and integration across programs and projects in support of Strategic Development department's process and administrative efficiency. Working closely with the Director, you'll be responsible for the management of the CalOptima Health's Strategic Plan and implementation. Additionally, you'll collaborate with business owners, finance, compliance and senior leadership to develop strategic planning processes, annual planning, reporting, and process improvement. Finally, you'll also support executive leadership in the development of market analyses and growth strategies. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: • 45% - Strategic Planning and Growth Strategy Development • 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 strategic planning activities and collaborates with executive leadership throughout the process to ensure alignment with organizational priorities and successful planning and implementation. • Maintains the Strategic Plan for CalOptima Health, including quarterly reporting to the Board, annual performance goal setting for the organization, and annual planning in partnership with Finance to ensure alignment on strategic goals across the organization. • Supports executive leadership in the development of growth strategies across all CalOptima Health lines of business. • Conducts market analysis to assess competitive landscape, growth opportunities, gaps, and areas for improvement to drive growth. Fosters ongoing relationships and mutually beneficial partnerships with CalOptima Health to facilitate implementation of the Strategic Plan. • * 50% - Project Management/Program Oversight • Leads projects related to growth strategies and initiatives, including convening stakeholders, reporting to leadership, and developing presentations and other documentation to support program execution and oversight. • Ensures that the strategic planning and annual planning processes deliver the right outcomes by developing and monitoring quantifiable values and key performance indicators to track progress toward business objectives and proactively identifying and resolving issues for improvement. • Develops monthly and quarterly progress Strategic Plan reports for the Board and executive leadership. • Serves as a point of contact and contributes to organizational initiatives and projects providing input to align strategies with business unit goals and objectives. Continually partners with line of business leaders to identify market trends, opportunities, and monitor market dynamics to inform strategy development and implementation. • * 5% - Other • Completes other projects and duties as assigned. Do You Have What the Role Requires? • Bachelor's degree PLUS 8 or more years of work experience that includes experience in health care strategy, research, or consulting; 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. • Demonstrated knowledge and experience with strategic planning, strategy, market analysis, or strategic initiatives. You'll Stand Out More If You Possess the Following: • Master's degree. • Demonstrated experience with leading strategic projects with visibility at the senior leadership/executive level. • Client service or management consulting experience. What the Regulatory Agencies Need You to Possess? • n/a Your Knowledge & Abilities to Bring to this Role: • 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. Your 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 Ways We Are Here For You • You'll enjoy competitive compensation for this role. • Our current hiring range is: Pay Grade: 316 - $120,881 - $193,410 ($58.12 - $92.9856). • The base pay offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors. • This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**) • A comprehensive benefits package • CalPERS pension program and additional retirement packages. • Additional benefits and perks including: • A generous PTO program • A quality work life balance • Various wellness programs • Tuition Reimbursement • Professional development opportunities • Career development opportunities • Flexible scheduling • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our 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. Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is October 8, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/project-manager-strategic-planning-growth-advisor-project-manager-iv-505-city-parkway-west-california-united-states jeid-71c22de7c24fdf49b108e70e02e6bbd7

Assist the communications team with writing/editing projects, support meetings and media efforts, and complete department-assigned projects under supervision. | Enrollment in a college or university program and ability to work independently with good communication and organizational skills. | Intern (Communications) CalOptima Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Intern (Communications) and help shape the future of healthcare where you'll be an integral part of our Communications team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Your goal and purpose and objective of this internship (Communications) is to gain work experience in the field prior to graduating. You have an opportunity to utilize and apply the skills and knowledge learned in the classroom setting and apply it in the workforce. You will be primarily responsible for handling department assigned projects, given a moderate degree of independence. The incumbent will frequently meet with supervisors to go over the status and progress of assignments. Under the general oversight of the Communications department leadership, you will assist the editorial team with a variety of writing/editing projects, including social media, the monthly staff e-newsletter and the monthly community e-newsletter. You will also provide support for the monthly all-hands Zoom meeting, media efforts (photos at press conferences, etc.) and other communication department support as needed. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: • 95% - Department 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. • Assists with department assigned projects. • Meets deadlines and completes sub-tasks of assigned projects. Participates in meetings with the supervisor to go over status and progress of work. • * 5% - Completes other projects and duties as assigned. Do You Have What the Role Requires? • High school diploma or equivalent PLUS enrollment in a college or university two- or four-year degree program, an accredited vocational institution or a graduate program required. The submission of ALL items are required for consideration for Fall 2025: • Completion of application • Resume • A statement of interest on why you are interested in this internship position (2 pages maximum). • Two (2) letters of recommendation (one academic, one professional) will be required upon confirmation of minimum qualifications. You'll Stand Out More If You Possess the Following: • N/A What the Regulatory Agencies Need You to Possess? • N/A Your Knowledge & Abilities to Bring to this Role: • 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. Your 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 Ways We Are Here For You • You'll enjoy competitive compensation for this role. • Our current hiring range is: Pay Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500). • The base pay offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors. • A comprehensive benefits package • CalPERS pension program and additional retirement packages. • Additional benefits and perks including: • A generous PTO program • A quality work life balance • Various wellness programs • Tuition Reimbursement • Professional development opportunities • Career development opportunities • Flexible scheduling • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our 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. Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is October 2, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/intern-communications-505-city-parkway-west-california-united-states jeid-bff3721cd3d5ac48a341d67ed9cfd49b

Lead IT strategy and operations for clinical systems supporting Utilization Management, Care Management, and Grievance & Appeals, managing teams, budgets, vendor relations, and driving continuous service improvement. | Bachelor's degree plus 7 years IT leadership in multiple health plans, experience influencing clinical business management, managing large teams and budgets, and deep knowledge of clinical IT systems and vendor marketplace. | Director, Information Technology Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV) CalOptima Director, Information Technology - Clinical, (Utilization Management, Care Management, and Grievance & Appeals) Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Director, Information Technology - Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV) and help shape the future of healthcare where you'll be an integral part of our IT - Applications Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: • 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. • Leads the development of IT strategy and technical roadmap and ensures its integration with overall IT and CalOptima Health strategies. • Works with the department's leadership team on the project portfolio and governance required to prioritize resources, including budget. • Acts as a trusted advisor and builds and maintains relationships with other internal and external IT and business leaders to develop a clear understanding of business needs. Ensures cost-effective delivery of IT services to meet those needs and can respond with the agility required to address changing business priorities. • Develops and adheres to the annual operating and capital budgets and expenditures for infrastructure to ensure consistency with the departmental and organizational strategic objectives and remain within budget. Manages labor forecasting in support of project cost accounting. • Champions innovative efforts in experimenting with new solutions to take advantage of business opportunities. • Stays abreast of leading-edge and innovative solutions to the recruitment, development and retention of the IT workforce. • Drives the adoption and commitment to continual service improvement. • 45% - Program Oversight • Provides strategic direction and oversight for the design, development, operation and support of systems that fulfill the needs of the business, including a deep understanding of the marketplace and technology's role in supporting the assigned systems. • Defines, develops, and manages a comprehensive and integrated architecture for assigned systems based on best-practice processes, disciplines and toolsets. • Operates within the established governance process to ensure that services can continue to be delivered in line with the agreed-upon business outcomes and timelines. • Delivers effective service management through the definition and adoption of a governance practice that uses key performance indicators (KPIs) and metrics to track and measure the quality of service. Continually monitors metrics and the integration of them with key accountabilities to ensure consistency of approach and continual service improvement. • Participates in the assessment of external and internal technology capabilities required to achieve desired competitive positioning. • Maintains knowledge of new technologies and platforms and provides direction on what emerging technologies should be assimilated, integrated, and introduced, ensuring that technology capabilities respond to and support the needs of the business. • Negotiates with vendor and supplier partners to enable cost-effective and innovative contracts and solutions to achieve business goals and ensure receipt of full support in line with service agreements. • 5% - Other • Completes other projects and duties as assigned. Do You Have What the Role Requires? • Bachelor's degree in computer science, information systems or other related field PLUS 7 years of experience within information technology leadership 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. • 7 years of experience in an IT leader role at multiple health plans required. • 7 years of experience influencing clinical business management and key stakeholders effectively across the organization required. • Experience with technology and business processes required to support Utilization Management, Care Management, EMR, and other clinical tools are required. • Experience in leading IT transformational initiatives in dynamic environments required. • Experience managing staff of 20+ required. • Experience managing large-scale consulting/contracting engagements required. • Experience managing operational and project budgets (including project cost accounting) required. • Experience with the technology implications of a delegated provider model required. • Experience leading the implementation of Utilization and Care Management vendor systems and an extensive knowledge of best-in-class integrations required and optimal reporting/analytics. • Comprehensive knowledge of the Utilization and Care Management technology vendor marketplace and the ability to compare and contrast vendors and benefits delivered. • Experience crafting business cases including meticulous cost estimates and quantifiable benefits. You'll Stand Out More If You Possess the Following: • Experience leading a team responsible for ZeOmega's Jiva (Utilization Management and Care Management). • Clinical credentials. What the Regulatory Agencies Need You to Possess? • N/A Your Knowledge & Abilities to Bring to this Role: • 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. Your 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 Ways We Are Here For You • You'll enjoy competitive compensation for this particular role: • Pay Grade: 323 - $204,199 - $326,717 ($98.17 - $157.0756) • This position is approved for Partial Telework. (If the position is listed as Telework, it is eligible within California) • A comprehensive benefits package • CalPERS pension program and additional retirement packages. • Additional benefits and perks including: • A generous PTO program • A quality work life balance • Various wellness programs • Tuition Reimbursement • Professional development opportunities • Career development opportunities • Flexible scheduling • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our 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. Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is September 25, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/director-information-technology-clinical-utilization-management-care-management-and-grievance-appeals-director-iv-505-city-parkway-west-california-united-states jeid-8636253b2abb214384031835c499a1ba

Manage and support public policy programs including legislative analysis, advocacy strategy development, and collaboration with internal and external stakeholders to advance healthcare policy goals. | Bachelor's degree in related field plus 4 years of experience in public policy, government affairs, or healthcare policy, with ability to work independently and manage multiple projects. | Sr. Program Manager, Public Policy (Program Manager Sr) CalOptima Sr. Program Manager, Public Policy Join Us - Where Your Talent Meets Opportunity. We're Better Together The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Sr. Program Manager, Public Policy (Program Manager Sr) and help shape the future of healthcare where you'll be an integral part of our Government Affairs team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: • 95% - Public Policy Program 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. • Tracks, evaluates concurrent initiatives ensuring all projects meet success parameters and targets. • Develops initial workplan for assigned projects and assignments, and manages the scope, schedule, and quality of the project. • Develops workflows, procedures and/or policies and recommends changes to ensure timely, efficient and effective results. • Researches various health care policy topics, providing strategic advice and analysis for department leadership, executives, board of directors and key external strategic partners. • Follows and analyzes key bills and budget developments throughout the federal and state legislative sessions. • Develops specific legislative advocacy strategies, official positions and materials to promote and preserve CalOptima's legislative priorities and serves as a subject matter expert in this area. • 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 community. • * 5% - Other • Completes other projects and duties as assigned. Do You Have What the Role Requires? • Bachelor's degree in political science, public policy, health administration or related field required PLUS 4 years of work experience in public policy, government affairs, legislative analysis, health care policy 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 may also be qualifying. • Have access to means of transportation for work away from the primary office approximately 10% of the time. You'll Stand Out More If You Possess the Following: • n/a What the Regulatory Agencies Need You to Possess? • n/a Your Knowledge & Abilities to Bring to this Role: • 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. Your 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 Ways We Are Here For You • You'll enjoy competitive compensation for this particular role: • Pay Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192) • This position is approved for Partial Telework. (**If the position is Telework, it is eligible in California**) • A comprehensive benefits package • CalPERS pension program and additional retirement packages. • Additional benefits and perks including: • A generous PTO program • A quality work life balance • Various wellness programs • Tuition Reimbursement • Professional development opportunities • Career development opportunities • Flexible scheduling • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our 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 harmfuInternal Websitel 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. Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is September 22, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: https://jobs.caloptima.org/jobs/sr-program-manager-public-policy-program-manager-sr-505-city-parkway-west-california-united-states jeid-bb728cebd900814bb1804c19836dc729