Qureos Mentor

Caloptima

<div><div>Program Specialist, Community Relations 
 
CalOptima</div> 

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 Program Specialist, Community Relations and help shape the future of healthcare where you'll be an integral part of our Community Relations 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.
 
<ul><li>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.
</li></ul> 
Under general supervision, the Program Specialist will support the Community Relations department management team in a wide variety of duties. You will work closely with the department manager to support CalOptima Health initiatives through community engagement, program development and implementation of special projects, large-scale events and meetings with key stakeholders. You will coordinate administrative support for special events, projects and meetings led by CalOptima Health and key community stakeholders. You will support team members with their outreach and educational activities and will interface and work collaboratively with internal staff, members and community stakeholders. You will support internal staff members, respond to requests for meetings and presentations and participate in community events. Together, we are building a stronger, more equitable health system.
 
 
Your Contributions To the Team:
 
<ul><li>95% - Program Support
<ul><li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Coordinates email and telephone requests from internal departments and external stakeholders.</li>
<li>Serves as a resource to appropriate department contacts.</li>
<li>Oversees and tracks the department's inventory for outreach and educational materials and supplies.</li>
<li>Serves as the primary point of contact for Community Relations' communications platform, Constant Contact; develops content and updates information as needed.</li>
<li>Acts as a liaison between Community Relations and various internal departments to coordinate participation and provides support with internal and external events and meetings.</li>
<li>Collects data, identifies pertinent information and prepares reports and presentations.</li>
<li>Provides support for specific and ongoing projects, including generating logs, coordinating calendars and managing mailings, while applying general business practices, policies and procedures.</li>
<li>Redirects escalated provider concerns or addresses them directly as appropriate.</li>
Maintains confidential and sensitive information and files regarding management projects and policy. 
<li>
 
 
</li></ul></li><li>5% - Other
<ul><li>Completes other projects and duties as assigned.</li>
</ul></li></ul> 
Do You Have What the Role Requires? 
<ul>
<li>Bachelor's degree in public health, health administration or related field PLUS 1 year of experience in community or public relations and/or project management 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. 
</li>
<li>Have access to means of transportation for work away from the primary office approximately 10% of the time required.</li>
</ul> 
You'll Stand Out More If You Possess the Following: 
<ul>
<li>N/A</li>
</ul> 
What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul> 
Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>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.
</li><li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul> 
Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul> 
Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul><li>Our current hiring range is: Pay Grade: 305 - $55,966 - $83,949 ($26.91 - $40.3601).
<ul><li>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. 
</li>
</ul></li></ul></li><li>This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)
</li><li>A comprehensive benefits package
</li><li>CalPERS pension program and additional retirement packages.
</li><li>Additional benefits and perks including:
<ul><li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul></li></ul> 
Our Work Environment: 
 
If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul> 
If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul> 
If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
</li><li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul> 
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 April 1st, 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/program-specialist-community-relations-505-city-parkway-west-california-united-states-4a636d20-e5cf-4d00-ae9f-cbe3f3510358 
 
jeid-8c92d84c87c4ac42adafca5c6892bed2</div>

Program Specialist, Community Relations

<div><div>Sr. Accounts Payable Clerk (Accounting Clerk Sr) 
 
CalOptima</div> 

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 Sr. Accounts Payable Clerk (Accounting Clerk Sr) and help shape the future of healthcare where you'll be an integral part of our Accounting 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.
 
<ul><li>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.
</li></ul> 
Under general direction, the Accounting Clerk Sr will be responsible for performing general accounting and administrative support duties for various specialties, including accounts payable and account reconciliations. You will coordinate work with external vendors and various departments within CalOptima Health to ensure that payments are processed timely, accurately and efficiently. Together, we are building a stronger, more equitable health system.
 
 
Your Contributions To the Team:
 
<ul><li>95% - Accounting Support
<ul><li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Reviews and resolves complex issues and exceptions on vendor and provider-related invoices.</li>
<li>Provides training, including cross-training, to staff across various functions of programs and processes.</li>
<li>Provides guidance to vendors/providers regarding policies, procedures and directives.</li>
<li>Completes payments and controls expenses by receiving, processing, verifying and reconciling invoices.</li>
<li>Reviews incoming vendor invoices received via e-mail or mail and verifies that all approved invoices have proper signatures and accurate invoice details.</li>
<li>Processes escheat and health network capitation payments.</li>
<li>Inputs and processes vendor invoices and electronic funds transfer files via the accounting system and confirms receipt of the automated clearing house confirmation email.</li>
<li>Notifies business owners and buyers when a purchase order lacks funding to process invoices.</li>
<li>Assists with Microsoft 365 stop pay and check re-issues and coordinates new vendor setups or updates.</li>
<li>Researches and makes recommendations on how to resolve complex customer service problems.</li>
<li>Collaborates with stores, vendors and internal departments to research issues and implement corrective actions.</li>
<li>Verifies vendor accounts by reconciling monthly statements and related transactions.</li>
<li>Researches and responds to business owners and vendors with payment status inquiries.</li>
Provides support with all internal and external audit requests. 
<li>
 
 
</li></ul></li><li>5% - Other
<ul><li>Completes other projects and duties as assigned.</li>
</ul></li></ul> 
Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 3 years of experience in accounts payable or related experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul> 
You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate's degree in business administration or related field.
 
</li><li>5 years of experience in accounts payable or related experience. 
</li>
<li>Experience with Great Plains accounting software, enterprise resource planning (ERP) and/or claims software.</li>
</ul> 
What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul> 
Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>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.
</li><li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul> 
Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul> 
Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul><li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077).
<ul><li>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. 
</li>
</ul></li></ul></li><li>This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)
</li><li>A comprehensive benefits package
</li><li>CalPERS pension program and additional retirement packages.
</li><li>Additional benefits and perks including:
<ul><li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul></li></ul> 
Our Work Environment: 
 
If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul> 
If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul> 
If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
</li><li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul> 
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 April 1, 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/sr-accounts-payable-clerk-accounting-clerk-sr-505-city-parkway-west-california-united-states 
 
jeid-1fc71e23ac265446844d5c8bed0197fd</div>

Sr. Accounts Payable Clerk (Accounting Clerk Sr)

<div><div>Grievance Resolution Specialist Sr (Provider Resolution) 
 
CalOptima</div> 

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 Grievance Resolution Specialist Sr (Provider Resolution) and help shape the future of healthcare where you'll be an integral part of our Grievance &amp; Appeals 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 Telework.
 
<ul><li>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.
</li></ul> 
You will coordinate the overall process of complaint resolution, responding to all verbal and written complaints from members and providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, pharmacy and vision decisions. You will have frequent external contact with members and families, health care providers, organizations and regulators. In addition, you will frequently interact with internal contacts in Claims Administration, Customer Service, Provider Relations, Contracting, Pharmacy Management, Third-Party Administrators, Medical Management, health networks and other resources to identify the factors necessary for optimal resolution of complaints. You will be responsible for processing complex cases requiring additional research or problem-solving. You will process 1st and 2nd Level provider appeals in accordance with Department of Health Care Services (DHCS) and Centers for Medicare &amp; Medicaid Services (CMS) guidelines and regulations. Together, we are building a stronger, more equitable health system.
 
 
Your Contributions To the Team:
 
<ul><li>75% - Program Support
<ul><li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Develops and maintains adequate information systems to assure timely and effective data collection, summarization, integration and reporting, including case creation, management and events/activity tracking.</li>
<li>Ensures compliance with CalOptima Health's Grievance Policy and timely case resolution, initiates and coordinates referrals to the Quality Improvement department as necessary and facilitates response to members according to policy.</li>
<li>Handles escalated issues from providers, as well as internal and external customers.</li>
<li>Gathers pertinent information regarding complaints, including member or provider concerns, claims payments, billing reimbursements, supporting information related to initial decisions, new information supporting complaints and supplemental information required to evaluate complaints and regulatory requirements.</li>
<li>Coordinates and participates in case discussions with operational experts to result in a final case disposition.</li>
<li>Reviews government claim cases and determines resolution and recommendation based on researched claims, Provider Dispute Resolution (PDR) and 2nd Level appeal analyses.</li>
<li>Evaluates case details related to member or provider complaints and makes appropriate decisions based on information provided and research conducted.</li>
<li>Provides a summary of GARS cases requested by Legal Affairs or other departments.</li>
<li>Provides subject matter expertise and trains new and existing staff as needed.</li>
<li>Assists with case assignment, assumes cases assignments per business needs and monitors the daily operations for member and provider complaints, ensuring compliance with the implementation of the decision.</li>
<li>Contacts appropriate parties to request and obtain missing information and supporting documentation or provides education.</li>
<li>Oversees resolution letters for accuracy of information and appropriate decisions.</li>
<li>Meets performance measurement goals for GARS.</li>
Supports with provider appeals audits by reviewing findings, gathering and organizing requested materials and completing rebuttals. 
<li>
 
 
</li></ul></li><li>20% - Administrative Support
<ul><li>Participates in meetings regarding case assignment issues and collaborates with cross-department teams to maintain current knowledge of organizational processes and guidelines to effectively resolve cases.</li>
<li>Reads and interprets provider contracts, Division of Financial Responsibility (DOFR), policies, procedures and instructions.</li>
<li>Responds to routine provider inquiries via phone and assists with provider appeals resolution inquiries.</li>
<li>Tracks and trends provider appeals and claims issues.</li>
Supports all department initiatives in improving overall efficiency. 
<li>
 
 
</li></ul></li><li>5% - Completes other projects and duties as assigned.
</li></ul> 
Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 3 years of experience with Provider Non-Contracted Medicare Post-Service appeals and denials 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. 
</li>
<li>3 years of experience with PDR in Medicare and Medi-Cal in Professional, Institutional, Outpatient, Ancillary, Coordination of Benefits and Government Cases required.
 
</li><li>Experience with Medicare or Medi-Cal provider appeals and denials process required. 
</li>
<li>Experience in health care practice standards, for both government and commercial plans required. 
</li>
<li>Experience with claims administration required.</li>
</ul> 
You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate's degree in health care administration or related field. 
</li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).</li>
</ul> 
What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul> 
Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>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.
</li><li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>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.</li>
</ul> 
Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul> 
Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul><li>Our current hiring range is: Pay Grade: 306 - $58,205 - $90,217 ($27.98 - $43.3736).
<ul><li>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. 
</li>
</ul></li></ul></li><li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
</li><li>A comprehensive benefits package
</li><li>CalPERS pension program and additional retirement packages.
</li><li>Additional benefits and perks including:
<ul><li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul></li></ul> 
Our Work Environment: 
 
If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul> 
If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul> 
If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
</li><li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul> 
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 April 1, 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/grievance-resolution-specialist-sr-provider-resolution-505-city-parkway-west-california-united-states 
 
jeid-9f97bae4154ec349812fc00e682610dd</div>

Grievance Resolution Specialist Sr (Provider Resolution)

Join Caloptima and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Caloptima

About Company

Program Specialist, Community Relations

Sr. Accounts Payable Clerk (Accounting Clerk Sr)

Grievance Resolution Specialist Sr (Provider Resolution)