CalOptima
Orange, CA, USA
Administrative Fellow
CalOptima
Administrative Fellow
CalOptima Health is seeking a highly motivated an experienced Administrative Fellow to join our team. Under the direction of Executive Leadership (e.g., Chief Executive Officer, Chief Medical Officer, Chief Operating Officer, Chief Information Officer, Chief Financial Officer, etc.) the Administrative Fellow (Fellow) will work with key administrative personnel to gain knowledge and experience in the management of CalOptima Health, as well as the broader health care landscape. The Fellow will be assigned to select projects related to the business and operations of CalOptima Health. The Fellow will work directly with the primary preceptor to receive guidance and feedback on projects and opportunities. Over the course of the twelve (12) month fellowship, the Fellow will have the opportunity to formally meet with the CalOptima Health CalTeam senior leaders one-on-one and sit in on executive management meetings while tackling various inter-departmental projects. While working closely with the CalOptima Health CalTeam, the Fellow will need to use discretion and independent judgment in assessing situations, considering alternatives and determining appropriate courses of action. Throughout the fellowship, the Fellow will gain insight into the inner workings of a large complex health plan organization and how its work is realized in the surrounding community.
The Administrative Fellowship program is a twelve (12) month appointment with a following transition period commencing in July 2025. The program is designed to provide fellows with an educational, interactive and enriching experience that will contribute to their professional development, as well as to their understanding of CalOptima Health and health plan operations. In addition, the program will help create opportunities for fellows to enhance skills in project development, strategic implementation and operations management. Most fellows will experience a balance of project and operational work, with an emphasis on health plan operations. Learning opportunities can include but are not limited to the administrative aspects of the following specialized areas:
• Behavioral Health
• Case Management
• Claims Administration
• Equity and Community Health
• Financial Analysis
• Grievance and Appeals
• Information Technology Services
• Program for All-Inclusive Care of the Elderly (PACE)
• Enterprise Project Management Office (EPMO)
• Quality Analytics
• Quality Improvement
• Strategic Development
• Utilization Management
Position Information:
• Department: Executive Office
• Salary Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192)
• Work Arrangement: Full Office
The submission of all items is required for consideration:
• Completion of application and supplemental questions
• A resume
• A statement of interest on why you are interested in this Fellowship program (2 pages maximum)
• A writing sample from school or work (2 pages maximum)
• Two letters of recommendation (one academic and one professional)
Duties & Responsibilities:
• 95% - 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.
◦Gathers, analyzes and interprets information relating to the synthesis of recommendations, reporting, presenting development and delivery and initiating process improvements.
◦Works collaboratively with executive leadership to assist in projects related to CalOptima Health.
◦Attends all related meetings and responds to other meetings and committees as required.
◦Communicates outcomes appropriately.
◦Maintains compliance with all state and federal legal requirements, such as the Occupational Safety and Health Administration (OSHA), Health Insurance Portability and Accountability Act (HIPPA), etc.
◦Participates with executive leadership in the design, development, integration and implementation of strategic initiatives, health improvement, community outreach, mission integration, clinical research and other defined initiatives.
◦Responds to the needs of others through effective communication, mutual respect and consistent follow-through to generate trust and enhance personal effectiveness.
◦Participates in project related work teams, fosters shared problem solving and supports decisions of the work team.
• 5% - Completes other projects and duties as assigned.
Minimum Qualifications:
• Master's degree in business administration, healthcare administration, public health, nursing, public administration or relevant field required.
• Master's degree received within the past twenty-four (24) months required.
• Candidates must be U.S. Citizens or permanent residents. CalOptima Health is unable to sponsor work visas.
Preferred Qualifications:
• n/a
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, 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 2025 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 January 21, 2025 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.
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, visit: https://apptrkr.com/5960820
To apply, please visit: https://apptrkr.com/5960820
jeid-e1a618426a203948a6cf07856dfc1ac0
Full Time
Administrative Fellow
CalOptima
Administrative Fellow
CalOptima Health is seeking a highly motivated an experienced Administrative Fellow to join our team. Under the direction of Executive Leadership (e.g., Chief Executive Officer, Chief Medical Officer, Chief Operating Officer, Chief Information Officer, Chief Financial Officer, etc.) the Administrative Fellow (Fellow) will work with key administrative personnel to gain knowledge and experience in the management of CalOptima Health, as well as the broader health care landscape. The Fellow will be assigned to select projects related to the business and operations of CalOptima Health. The Fellow will work directly with the primary preceptor to receive guidance and feedback on projects and opportunities. Over the course of the twelve (12) month fellowship, the Fellow will have the opportunity to formally meet with the CalOptima Health CalTeam senior leaders one-on-one and sit in on executive management meetings while tackling various inter-departmental projects. While working closely with the CalOptima Health CalTeam, the Fellow will need to use discretion and independent judgment in assessing situations, considering alternatives and determining appropriate courses of action. Throughout the fellowship, the Fellow will gain insight into the inner workings of a large complex health plan organization and how its work is realized in the surrounding community.
The Administrative Fellowship program is a twelve (12) month appointment with a following transition period commencing in July 2025. The program is designed to provide fellows with an educational, interactive and enriching experience that will contribute to their professional development, as well as to their understanding of CalOptima Health and health plan operations. In addition, the program will help create opportunities for fellows to enhance skills in project development, strategic implementation and operations management. Most fellows will experience a balance of project and operational work, with an emphasis on health plan operations. Learning opportunities can include but are not limited to the administrative aspects of the following specialized areas:
• Behavioral Health
• Case Management
• Claims Administration
• Equity and Community Health
• Financial Analysis
• Grievance and Appeals
• Information Technology Services
• Program for All-Inclusive Care of the Elderly (PACE)
• Enterprise Project Management Office (EPMO)
• Quality Analytics
• Quality Improvement
• Strategic Development
• Utilization Management
Position Information:
• Department: Executive Office
• Salary Grade: 309 - $68,015 - $108,824 ($32.70 - $52.3192)
• Work Arrangement: Full Office
The submission of all items is required for consideration:
• Completion of application and supplemental questions
• A resume
• A statement of interest on why you are interested in this Fellowship program (2 pages maximum)
• A writing sample from school or work (2 pages maximum)
• Two letters of recommendation (one academic and one professional)
Duties & Responsibilities:
• 95% - 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.
◦Gathers, analyzes and interprets information relating to the synthesis of recommendations, reporting, presenting development and delivery and initiating process improvements.
◦Works collaboratively with executive leadership to assist in projects related to CalOptima Health.
◦Attends all related meetings and responds to other meetings and committees as required.
◦Communicates outcomes appropriately.
◦Maintains compliance with all state and federal legal requirements, such as the Occupational Safety and Health Administration (OSHA), Health Insurance Portability and Accountability Act (HIPPA), etc.
◦Participates with executive leadership in the design, development, integration and implementation of strategic initiatives, health improvement, community outreach, mission integration, clinical research and other defined initiatives.
◦Responds to the needs of others through effective communication, mutual respect and consistent follow-through to generate trust and enhance personal effectiveness.
◦Participates in project related work teams, fosters shared problem solving and supports decisions of the work team.
• 5% - Completes other projects and duties as assigned.
Minimum Qualifications:
• Master's degree in business administration, healthcare administration, public health, nursing, public administration or relevant field required.
• Master's degree received within the past twenty-four (24) months required.
• Candidates must be U.S. Citizens or permanent residents. CalOptima Health is unable to sponsor work visas.
Preferred Qualifications:
• n/a
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, 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 2025 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 January 21, 2025 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.
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, visit: https://apptrkr.com/5960820
To apply, please visit: https://apptrkr.com/5960820
jeid-e1a618426a203948a6cf07856dfc1ac0
CalOptima
Orange, CA, USA
Contracts Database Administrator, Sr. (Business Analyst, Sr.)
CalOptima
CalOptima Health is seeking a highly motivated an experienced Contracts Database Administrator, Sr. (Business Analyst, Sr.) to join our team. The Contracts Database Administrator, Sr. will be responsible for initiating, overseeing and maintaining the department's contract management system. The incumbent will code and/or program templates, and add custom prompts, alternative terms and exhibits to all contract templates. The incumbent will build custom forms to capture contract data, rates, payment terms, provider types, sub-specialties, services/products and metadata. The incumbent will maintain updates to pre-approved templates, be responsible for maintenance of the template and language library and oversee the end-to-end contract life cycle system management processes. The incumbent will administer regular and ad-hoc reporting, oversee deployment of bulk contracts, support the return of outstanding contracts and perform user acceptance testing after system updates. The incumbent will provide training to end users, assist Information Technology Systems (ITS) with system enhancements and support requests from leadership and/or the board of directors and as required by the Department of Health Care Services (DHCS).
Position Information:
• Department: Contracting • Salary Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947) • Work Arrangement: Partial Telework
**This position is eligible for telework in California.**
Duties & Responsibilities:
• 25% - 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. • Serves as subject matter expert to ITS and other departments for overall database configuration and reporting. • Develops and maintains the department's required regulatory reports, metrics and completion factors (returned contracts/amendments). • Provides cross training and mentors support staff on system development and template management.
• 70% - Contract Management System (CMS)
• Oversees, manages and maintains the department's contracts database, codes and/or programs documents, administers bulk distribution of contracts and amendments and maintains template updates and history. • Manages contract templates and incorporates appropriate styles, autonumbering, font/font size, pagination and standard headers and footers. • Reviews new templates for consistency, language alignment and configuration. • Develops custom forms that populate contracts, payment terms, provider types, cover letters, routing forms and metadata. • Develops supporting documents (exhibits) to complement contract templates. • Develops contract activity trend reports processed through CMS monthly, quarterly and annual basis. • Provides training to end users on contract creation, language revisions, the approval process and general reporting. • Develops back-end quality control reports to monitor data entry requirements and integrity. • Oversees end-to-end system management, validates system upgrades and ensures business needs are met.
• 5% - Completes other projects and duties as assigned.
Minimum Qualifications:
• Bachelor's degree in healthcare administration, business administration, computer science or a related field required.
• 3 years of experience working with a contract management application required.
• 2 years of experience as a business data analyst in the healthcare industry or a managed care environment, preferably with Medicare and Medi-Cal experience required.
• 2 years of programming experience with Transact SQL (MS SQL Server) 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:
• n/a
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 https://alliantbenefits.cld.bz/24caloptimacabenguide regarding our comprehensive benefits and wellness package.
IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 11, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.
Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://apptrkr.com/5512442
Full Time
Contracts Database Administrator, Sr. (Business Analyst, Sr.)
CalOptima
CalOptima Health is seeking a highly motivated an experienced Contracts Database Administrator, Sr. (Business Analyst, Sr.) to join our team. The Contracts Database Administrator, Sr. will be responsible for initiating, overseeing and maintaining the department's contract management system. The incumbent will code and/or program templates, and add custom prompts, alternative terms and exhibits to all contract templates. The incumbent will build custom forms to capture contract data, rates, payment terms, provider types, sub-specialties, services/products and metadata. The incumbent will maintain updates to pre-approved templates, be responsible for maintenance of the template and language library and oversee the end-to-end contract life cycle system management processes. The incumbent will administer regular and ad-hoc reporting, oversee deployment of bulk contracts, support the return of outstanding contracts and perform user acceptance testing after system updates. The incumbent will provide training to end users, assist Information Technology Systems (ITS) with system enhancements and support requests from leadership and/or the board of directors and as required by the Department of Health Care Services (DHCS).
Position Information:
• Department: Contracting • Salary Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947) • Work Arrangement: Partial Telework
**This position is eligible for telework in California.**
Duties & Responsibilities:
• 25% - 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. • Serves as subject matter expert to ITS and other departments for overall database configuration and reporting. • Develops and maintains the department's required regulatory reports, metrics and completion factors (returned contracts/amendments). • Provides cross training and mentors support staff on system development and template management.
• 70% - Contract Management System (CMS)
• Oversees, manages and maintains the department's contracts database, codes and/or programs documents, administers bulk distribution of contracts and amendments and maintains template updates and history. • Manages contract templates and incorporates appropriate styles, autonumbering, font/font size, pagination and standard headers and footers. • Reviews new templates for consistency, language alignment and configuration. • Develops custom forms that populate contracts, payment terms, provider types, cover letters, routing forms and metadata. • Develops supporting documents (exhibits) to complement contract templates. • Develops contract activity trend reports processed through CMS monthly, quarterly and annual basis. • Provides training to end users on contract creation, language revisions, the approval process and general reporting. • Develops back-end quality control reports to monitor data entry requirements and integrity. • Oversees end-to-end system management, validates system upgrades and ensures business needs are met.
• 5% - Completes other projects and duties as assigned.
Minimum Qualifications:
• Bachelor's degree in healthcare administration, business administration, computer science or a related field required.
• 3 years of experience working with a contract management application required.
• 2 years of experience as a business data analyst in the healthcare industry or a managed care environment, preferably with Medicare and Medi-Cal experience required.
• 2 years of programming experience with Transact SQL (MS SQL Server) 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:
• n/a
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 https://alliantbenefits.cld.bz/24caloptimacabenguide regarding our comprehensive benefits and wellness package.
IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is July 11, 2024 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.
Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://apptrkr.com/5512442
