Medi-Cal & CalAIM Program Specialist
CalOptima, Orange, CA, United States
Medi-Cal & CalAIM Program Specialist
CalOptima
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 Medi‑Cal & CalAIM Program Specialist and help shape the future of healthcare where you will be an integral part of our Medi‑Cal & CalAIM team, striving for excellence while we serve our members with dignity, respect and collaboration with providers, community partners and local stakeholders. This position is approved as Full Office.
If telework is approved, you are required to work within the State of California only. If partial telework is allowed, you are also required to work at the Main Office in Orange, CA at least two days per week.
Responsibilities
Program Support (80%)
Participate in a mission‑driven culture of high‑quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assist the department in carrying out responsibilities and collaborate with others to support short‑ and long‑term goals and priorities.
Work with cross‑functional teams to support the implementation, monitoring and evaluation of CalAIM services, activities and reports.
Assist in developing and updating program materials that support effective implementation.
Assist with developing auditing tools, conducting audits of contracted providers and providing recommendations for compliance and quality improvement plans.
Collect and analyze data related to the health outcomes and service utilization of JI members and prepare reports for management and stakeholders on program impact.
Communicate with external partners, providers and stakeholders to ensure accurate program updates, reminders and relevant information are distributed timely.
Coordinate regulatory reporting for assigned programs and prepare memos, documents, reports and forms as needed.
Enter data into CalOptima Connect portal and other CalOptima Health information systems as needed.
Collaborate with CalOptima Health’s Facilities and Information Technology departments to support the needs of the Street Medicine Program.
Prepare monthly and quarterly data related to the Street Medicine and JI initiatives.
Provide support for Care Traffic Control, including training new users, monitoring tickets, tracking weekly data uploads and auditing the system.
Support correctional facilities, pre‑release care managers and enhanced care management (ECM) providers to coordinate care for members as needed.
Provide information on topics such as pre‑release care manager and ECM provider assignment, Managed Care Plan (MCP) policy, prior authorization, community supports, non‑emergency medical transportation, primary care provider assignment and network providers.
Ensure smooth assignment of ECM providers to eligible JI members.
Support the department in the training and monitoring of JI ECM providers.
Monitor activities of JI ECM providers to ensure compliance with policy guide.
Stay updated about Department of Health Care Services (DHCS) CalAIM program requirements and outcomes.
Support the achievement of CalOptima Health’s vision and goals for its Street Medicine Program as defined in the Street Medicine Operations Manual.
Administrative Support (10%)
Coordinate department calendars and schedules, including scheduling appointments, preparing meeting materials, taking minutes, coordinating travel, meetings and events.
Provide administrative support for specific and/or ongoing projects, such as generating reports, collecting data and maintaining project tracking logs.
Maintain confidential and sensitive information and files regarding management projects, policies and personnel while ensuring appropriate follow‑up.
Respond to Street Medicine referral calls and direct inquiries to the appropriate provider, offering support via phone and electronic communication during regular business hours; ensure all incoming questions are addressed within one business day.
Coordinate and monitor email communication with external partners for the JI initiative.
Other (5%)
Complete other projects and duties as assigned.
Qualifications
Required
Bachelor’s degree in health policy, health care economics, public policy, public health, sociology, psychology, social work or a related field PLUS one year of experience in program development, implementation and operations or related experience in a managed health care organization.
Access to means of transportation for work away from the primary office approximately 20% of the time required.
Preferred
Three years of experience working with health care delivery systems and/or in a public agency/organization serving Medi‑Cal, Medicare or other underserved populations.
Two years of experience working with community‑based organizations.
Bilingual in English and one of CalOptima Health’s threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).
Knowledge & Abilities
Develop rapport and maintain effective working relationships with CalOptima Health’s leadership, 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 execute tasks efficiently.
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 (Microsoft Office: Word, Outlook, Excel, PowerPoint) and job‑specific applications/systems to produce correspondence, charts, spreadsheets and other information applicable to the position.
Physical Requirements
Ability to visually read information from computer screens, forms and other printed materials.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication via telephone and face‑to‑face interactions.
Manual dexterity for typing, writing, standing and reaching; flexibility and body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lift and move objects, patients and/or equipment 10 to 25 pounds.
Ways We Are Here For You
Competitive compensation: Pay Grade 305 ($55,966 – $83,949).
Full Office (eligible for telework within California only).
CalPERS pension program and additional retirement packages.
Generous PTO program.
Quality work‑life balance.
Various wellness programs.
Tuition reimbursement.
Professional development opportunities.
Career development opportunities.
Flexible scheduling.
Work Environment
Work is typically indoors and sedentary, subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions in the 500/505 Building or remote locations. The noise level is usually moderate.
At PACE, work is indoors in a clinical setting serving the frail and elderly, with potential for harmful or hazardous conditions; noise level is moderate to loud.
In the community, work is indoors and sedentary with occasional outdoor work in varied temperatures; potential for harmful or hazardous conditions; noise level is moderate to loud.
Equal Opportunity
CalOptima Health is an equal‑opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health prohibits unlawful discrimination against any employee or applicant based on race, religion, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status, or other characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246‑8400.
#J-18808-Ljbffr
CalOptima
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 Medi‑Cal & CalAIM Program Specialist and help shape the future of healthcare where you will be an integral part of our Medi‑Cal & CalAIM team, striving for excellence while we serve our members with dignity, respect and collaboration with providers, community partners and local stakeholders. This position is approved as Full Office.
If telework is approved, you are required to work within the State of California only. If partial telework is allowed, you are also required to work at the Main Office in Orange, CA at least two days per week.
Responsibilities
Program Support (80%)
Participate in a mission‑driven culture of high‑quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assist the department in carrying out responsibilities and collaborate with others to support short‑ and long‑term goals and priorities.
Work with cross‑functional teams to support the implementation, monitoring and evaluation of CalAIM services, activities and reports.
Assist in developing and updating program materials that support effective implementation.
Assist with developing auditing tools, conducting audits of contracted providers and providing recommendations for compliance and quality improvement plans.
Collect and analyze data related to the health outcomes and service utilization of JI members and prepare reports for management and stakeholders on program impact.
Communicate with external partners, providers and stakeholders to ensure accurate program updates, reminders and relevant information are distributed timely.
Coordinate regulatory reporting for assigned programs and prepare memos, documents, reports and forms as needed.
Enter data into CalOptima Connect portal and other CalOptima Health information systems as needed.
Collaborate with CalOptima Health’s Facilities and Information Technology departments to support the needs of the Street Medicine Program.
Prepare monthly and quarterly data related to the Street Medicine and JI initiatives.
Provide support for Care Traffic Control, including training new users, monitoring tickets, tracking weekly data uploads and auditing the system.
Support correctional facilities, pre‑release care managers and enhanced care management (ECM) providers to coordinate care for members as needed.
Provide information on topics such as pre‑release care manager and ECM provider assignment, Managed Care Plan (MCP) policy, prior authorization, community supports, non‑emergency medical transportation, primary care provider assignment and network providers.
Ensure smooth assignment of ECM providers to eligible JI members.
Support the department in the training and monitoring of JI ECM providers.
Monitor activities of JI ECM providers to ensure compliance with policy guide.
Stay updated about Department of Health Care Services (DHCS) CalAIM program requirements and outcomes.
Support the achievement of CalOptima Health’s vision and goals for its Street Medicine Program as defined in the Street Medicine Operations Manual.
Administrative Support (10%)
Coordinate department calendars and schedules, including scheduling appointments, preparing meeting materials, taking minutes, coordinating travel, meetings and events.
Provide administrative support for specific and/or ongoing projects, such as generating reports, collecting data and maintaining project tracking logs.
Maintain confidential and sensitive information and files regarding management projects, policies and personnel while ensuring appropriate follow‑up.
Respond to Street Medicine referral calls and direct inquiries to the appropriate provider, offering support via phone and electronic communication during regular business hours; ensure all incoming questions are addressed within one business day.
Coordinate and monitor email communication with external partners for the JI initiative.
Other (5%)
Complete other projects and duties as assigned.
Qualifications
Required
Bachelor’s degree in health policy, health care economics, public policy, public health, sociology, psychology, social work or a related field PLUS one year of experience in program development, implementation and operations or related experience in a managed health care organization.
Access to means of transportation for work away from the primary office approximately 20% of the time required.
Preferred
Three years of experience working with health care delivery systems and/or in a public agency/organization serving Medi‑Cal, Medicare or other underserved populations.
Two years of experience working with community‑based organizations.
Bilingual in English and one of CalOptima Health’s threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).
Knowledge & Abilities
Develop rapport and maintain effective working relationships with CalOptima Health’s leadership, 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 execute tasks efficiently.
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 (Microsoft Office: Word, Outlook, Excel, PowerPoint) and job‑specific applications/systems to produce correspondence, charts, spreadsheets and other information applicable to the position.
Physical Requirements
Ability to visually read information from computer screens, forms and other printed materials.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication via telephone and face‑to‑face interactions.
Manual dexterity for typing, writing, standing and reaching; flexibility and body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lift and move objects, patients and/or equipment 10 to 25 pounds.
Ways We Are Here For You
Competitive compensation: Pay Grade 305 ($55,966 – $83,949).
Full Office (eligible for telework within California only).
CalPERS pension program and additional retirement packages.
Generous PTO program.
Quality work‑life balance.
Various wellness programs.
Tuition reimbursement.
Professional development opportunities.
Career development opportunities.
Flexible scheduling.
Work Environment
Work is typically indoors and sedentary, subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions in the 500/505 Building or remote locations. The noise level is usually moderate.
At PACE, work is indoors in a clinical setting serving the frail and elderly, with potential for harmful or hazardous conditions; noise level is moderate to loud.
In the community, work is indoors and sedentary with occasional outdoor work in varied temperatures; potential for harmful or hazardous conditions; noise level is moderate to loud.
Equal Opportunity
CalOptima Health is an equal‑opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health prohibits unlawful discrimination against any employee or applicant based on race, religion, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status, or other characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246‑8400.
#J-18808-Ljbffr