Medi-Cal & CalAIM Program Specialist - Irvine - CalOptima

    CalOptima
    CalOptima Irvine

    1 day ago

    Description
    Medi‐Cal & CalAIM Program Specialist
    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

    Medi‐Cal & CalAIM Program Specialist

    and help shape the future of healthcare where you'll be an integral part of our

    Medi‐Cal & CalAIM


    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

    Full Office .

    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 Program Specialist (Medi‐Cal & CalAIM) will provide comprehensive support for CalOptima Health's Street Medicine Program and Justice‐Involved (JI) Reentry Initiative while contributing to broader Medi‐Cal and CalAIM projects.

    You will be responsible for administrative responsibilities, service coordination and program monitoring to ensure effective operations and improved member outcomes.

    TYou will also work closely with internal teams, contracted providers and community partners to facilitate seamless care delivery and program success.

    Together, we are building a stronger, more equitable health system.

    Your Contributions To the Team:
    80% ‐ 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 department in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.

    Works with cross‐functional teams to support the implementation, monitoring and evaluation of CalAIM services, activities and reports.
    Assists in developing and updating program materials that support effective program implementation.
    Assists with developing auditing tools, conducting audits of contracted providers and providing recommendations for compliance and quality improvement plans.

    Collects and analyzes data related to the health outcomes and service utilization of JI members and prepares reports for management and stakeholders on the impact of programs and services.

    Communicates with external partners, providers and stakeholders to ensure accurate program updates, reminders and relevant information are distributed in a timely manner.

    Coordinates regulatory reporting for assigned programs and prepares memos, documents, reports and forms as needed.
    Enters data into CalOptima Connect portal and other CalOptima Health information systems as needed.
    Collaborates with CalOptima Health's Facilities and Information Technology departments to support the needs of the Street Medicine Program.
    Prepares monthly and quarterly data related to the Street Medicine and JI initiatives.

    Provides support for Care Traffic Control, including training new users, monitoring tickets, tracking weekly data uploads and auditing the system.

    Supports correctional facilities, pre‐release care managers and enhanced care management (ECM) providers to coordinate care for members as needed.

    Provides information on topics, including pre‐release care manager and ECM provider assignment, managed care plan (MCP) policy pertaining to the JI population of focus (POF), prior authorization, MCP services such as community supports and non‐emergency medical transportation, primary care provider (PCP) assignment and network providers.

    Ensures smooth assignment of ECM providers to eligible JI members.
    Supports the department in the training and monitoring of JI ECM providers.
    Monitors activities of JI ECM providers to ensure compliance with policy guide.
    Stays updated about Department of Health Care Services (DHCS) CalAIM program requirements and outcomes.

    Supports the achievement of CalOptima Health's vision and goals for its Street Medicine Program as defined in the Street Medicine Operations Manual.

    10% ‐ Administrative Support


    Coordinates department calendars and schedules as assigned, including scheduling appointments, preparing meeting materials, taking minutes, coordinating travel, meetings and events, evaluating needs and scheduling meeting arrangements.

    Provides administrative support for specific and/or ongoing projects, such as generating reports, collecting data and maintaining project tracking logs.
    Maintains confidential and sensitive information and files regarding management projects, policies and personnel while ensuring appropriate follow‐up.

    Responds to Street Medicine referral calls and directs inquiries to the appropriate provider, while offering support via phone and electronic communication during regular business hours.

    Ensures all incoming questions are addressed within one business day.
    Coordinates and monitors email communication with external partners for the JI initiative.

    5% ‐ Other

    Completes other projects and duties as assigned.

    Do You Have What the Role Requires?

    Bachelor's degree in health policy, health care economics, public policy, public health, sociology, psychology, social work or a related field PLUS 1 year of experience in program development, implementation and operations or related experience in a managed health care organization 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 20% of the time required.


    You'll Stand Out More If You Possess the Following:3 years of experience working with health care delivery systems and/or in a public agency/organization serving Medi‐Cal, Medicare or any other under resourced populations.

    2 years of experience working with community‐based organizations.

    Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

    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
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