Central Health Plan of California jobs

Accepting applications through Wednesday, October 22, 2025 by 5:00 pm. This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position. We have an opportunity to join the Alliance as a Care Coordinator - D-SNP in the Care Management Department. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Medicare Care Management Manager (RN), this position: Supports the Medicare Dual Special Needs Plan (D-SNP) Care Management team with coordination of services and activities for members enrolled in D-SNP Collaborates with internal and external partners to promote efficient care coordination and support members in navigating care transitions, appointments, and referrals Contributes to the effective operation and improvement of Care Management D-SNP programs WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: The principles and practices of health care and health care systems The principles and practices of customer service The principles and practices of health education The diverse needs of the Medi-Cal and Medicare D-SNP populations Quickly learn, understand, and communicate the workings of the Alliance, particularly the Utilization Management and Complex Case Management, Community Care Coordination, ECM, and Member Services departments Ability to: Educate on care coordination for the D-SNP program and make presentations to individuals and groups Interpret, explain, and apply policies, procedures, and guidelines Clearly, completely, and independently document, summarize and resolve member's concerns and inquiries, and recognize those issues requiring escalation to a higher level Organize and prioritize work, follow up as needed, meet timelines, and ensure compliance with regulatory requirements Education and Experience: High school diploma or equivalent Three years of experience in a health care setting that involved interacting with members, patients and/or providers in meeting service needs (an Associate's degree in Health, Social Services or a related field or current certification as a Medical Assistant may substitute for one year of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Zone 1 (Monterey, San Benito and Santa Cruz) $26.33 - $42.14 USD Zone 2 (Mariposa and Merced) $23.96 - $38.35 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Job Description This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position. We have an opportunity to join the Alliance as a Senior Complex Case Manager - Pediatric (RN) on the Care Management team! WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Complex Case Management Supervisor - Pediatric (RN), this position: Develops and manages an individualized comprehensive plan of care for members referred into the assigned Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner Works with and educates members, families, providers, external agencies and internal departments on the Case Management Program and provides assistance as needed Participants in Quality Improvement studies, to continually evaluate the program's effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members Performs other duties as assigned ABOUT THE TEAM - Who is Care Management? We look to support, connect, and empower members through community-based organizations and providers, in furtherance of improving health outcomes. The Care Management Team's mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. In Care Management, we serve the Alliance by creating a bridge between the Alliance, our communities, and individual members. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance and we assist the members in connecting the dots to successfully navigate options and resources for their care. Pediatric Care Management: This unit is also about complex case management, but for our younger members. We work with the counties in line with California Children's Services Whole Child Model. THE IDEAL CANDIDATE The ideal candidate is a flexible, team-oriented critical thinker who can work independently, navigate ambiguity, and collaborate when needed to support high-quality care for our pediatric members and families. They bring an active CA RN license, solid hospital or direct patient-care experience (pediatric and/or case-management preferred), and the ability to adapt to change while exercising good judgment and knowing when to seek support. WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Thorough knowledge of the principles and practices of clinical nursing Working knowledge of the principles and practices of case management Working knowledge of care management and coordination Working knowledge of evidence-based practice guidelines in the development of care plans Ability to: Demonstrate strong critical thinking and problem-solving skills Interpret and apply policies and regulations Define issues, conduct research, interpret data, and identify and evaluate options Evaluate medical records and other health care data Organize work and manage complex priorities Education and Experience: Current unrestricted license as a Registered Nurse issued by the State of California Associate's degree in Nursing and a minimum of five years of experience in a patient care setting, including at least one year of case management experience a combination of education and relevant work experience may be qualifying A minimum of one year of the required patient care experience must be in an acute or outpatient environment, working with the Pediatric population OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz)$100,161-$160,264 USDZone 2 (Mariposa and Merced)$91,144-$145,850 USDOUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position. We have an opportunity to join the Alliance as a Regulatory Specialist in the Compliance Department. This is a primarily remote position with the expectation to meet in person with the team once per quarter in Scotts Valley, CA. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Regulatory Affairs Manager, this position: Supports and participates in the development of statutory, contractual, and regulatory filings and reporting. Supports the process through which Alliance staff intake, organize, and implement new requirements and maintain Alliance policies and procedures. Supports Regulatory Affairs Unit administrative functions Performs other duties as assigned ABOUT THE TEAM The Compliance Department helps Alliance employees understand and follow the complex rules and requirements to meet our important compliance obligations. In short, we define and support the Alliance's Culture of Compliance internally and with our external healthcare partners. The Regulatory Affairs team serves as the Alliance's primary liaison with regulators. We also identify, analyze, and implement new legal and regulatory requirements, and submit regulatory and contractual reporting and filings. THE IDEAL CANDIDATE Has experience working in healthcare regulatory processes or similar field Has an acute attention to detail and data accuracy Has experience working remotely and knows how to self-motivate while staying closely connected to their team Has excellent multitasking skills and thrives in a fast-paced environment Is efficient with their time and can meet strict deadlines for work product and governmental filings Has knowledge of the Medi-Cal, Medicare Advantage, or D-SNP programs and related regulations WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Research, analysis, and reporting methods Windows-based PC systems and Microsoft Word, Outlook, PowerPoint, and Excel State and Federal legislative and regulatory processes The principles and practices of project management Ability to: Quickly understand Alliance functions, policies, procedures, and guidelines, and Alliance roles and responsibilities related to oversight agencies Learn and apply Medicare and Medi-Cal regulations related to compliance activities Identify and research relevant legal materials, and analyze and interpret legal and contractual language Demonstrate strong analytical and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action Effectively, clearly, and independently document, summarize, and resolve moderately complex issues Manage a high volume of government relations tasks Education and Experience: Bachelor's degree in Business or Public Administration, Public Policy, Health Care Planning, or a related field and a minimum of three years of government relations or compliance experience (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz) $69,937 - $111,904 USD Zone 2 (Mariposa and Merced) $63,645 - $101,837 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position and the length of the assignment is estimated to go through 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Claims Supervisor, this position: Opens, sorts, prepares, batches, and scans claim forms and other documents Performs data entry and verifies, validates, and processes claims Assists with training of new hires in the claims control function and with cross-training other Claims Technicians I Provides support to Provider Disputes staff WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: The principles and practices of customer service General administrative procedures, standard business office practices and the operation of general office equipment, such as computer, telephone, copier, scanner and fax Ability to: Keep current with claims processing practices and procedures Read and understand medical insurance Explanation of Benefits Demonstrate strong organizational skills and attention to detail Identify issues, conduct basic research, and interpret information and data Education and Experience: High School Diploma or equivalent and a minimum or one year of administrative experience; or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Santa Cruz County Pay Range$26.41-$26.41 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position and the length of assignment is estimated to start asap and go until the end of year. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. This is a hybrid role and will require some in-office and/or in-community presence. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Quality and Health Programs Manager, this position: Leads program activities and projects for the Quality and Health Programs (QHP) Unit Coordinates initiatives and projects to advance the Alliance's health equity strategies and departmental workplans by conducting research, gathering, analyzing, and interpreting data, and recommending solutions to reduce health disparities Provides subject matter expertise and develops and conducts training related to cultural and linguistic (C&L) services, health education, and population health services for Alliance staff and Alliance network providers Ensures written member materials are designed to motivate members to modify personal health behaviors, achieve and maintain healthy lifestyles, and promote positive health behaviors, achieve and maintain healthy lifestyles, and promote positive health WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Bilingual English/Spanish or English/Hmong and of the healthcare industry. The principles and practices of health education, health promotion, and health literacy The methods of research, analysis and reporting Medi-Cal and related Title 22 regulations Ability to: Plan, organize, coordinate, and prioritize multiple tasks, coordinate activities and projects and achieve goals and timelines Identify issues, conduct research, gather, and analyze information, reach logical and sounds conclusions and offer recommendations and potential consequences Effectively, clearly, and independently document, summarize and resolve issues Education and Experience: Bachelor's degree in Public or Community Health, Human Services, Social Science or a related field and a minimum of five years of experience performing health education or health promotion in a health care setting which included some experience developing and conducting training and performing data analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying. OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Santa Cruz County Pay Range $80,197 - $104,256 USD Merced County Pay Range $72,977 - $94,870 USD Monterey County Pay Range $80,197 - $104,256 USD Mariposa County Pay Range $72,977 - $94,870 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

We have an opportunity to join the Alliance as a Quality Improvement Nurse PQI (RN) in the QI and Population Health Department. WHAT YOU'LL BE RESPONSIBLE FOR Develops, manages, and measures a comprehensive healthcare strategy in alignment with Department of Health Care Services (DHCS) standards of care and in collaboration with internal stakeholders and network providers to promote best evidence-based practices and improve member health outcomes Evaluates patient safety and quality issues and communicates findings to internal stakeholders, network providers and community partners WHAT YOU'LL NEED TO BE SUCCESSFUL Desirable Qualifications Experience in process improvement, practice coaching, or health care quality improvement Experience performing PQI activities Working knowledge of managed care, the Medi-Cal program, and related policy Working knowledge of the methods of conducting and interpreting quantitative and qualitative analysis Some knowledge of NCQA HEDIS abstracting guidelines Some knowledge of CPT and ICD coding principles To read the full position description and list of requirements, click here. Knowledge of: The principles and practices of clinical nursing Medical practice operations and healthcare delivery systems Ability to: Participate in and support internal and external audits Identify issues, conduct research, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action Analyze information and data and prepare oral and written reports Education and Experience: Current, unrestricted license as a Registered Nurse issued by the State of California Bachelor's degree in Nursing and a minimum of three years of experience as a Registered Nurse in acute care or primary care with an emphasis on preventative care (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz) $91,055.76 - $145,704 USD Zone 2 (Mariposa and Merced) $82,857.88 - $132,579.20 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

We have an opportunity to join the Alliance as a Senior Payer Analytics Consultant in the Payment Strategy Department. WHAT YOU'LL BE RESPONSIBLE FOR Performs complex managed care payer financial modeling and analysis to evaluate the feasibility of payer reimbursement methodologies Conducts complex financial analysis to support successful payer reimbursement outcomes Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives Provides subject matter expertise and assists with providing orientation, mentoring, and training to subordinate Payer Analytics Consultants ABOUT THE TEAM The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs. THE IDEAL CANDIDATE An experienced analytical and collaborative professional, with direct experience with complex medical payor modeling Technically strong, with skill in provider reimbursement modeling, payment structure design and reimbursement strategies A collaborative and professional communication style, building productive relationships supporting multiple stakeholders Experience with Medicare and/or Medi-Cal (Medicaid) a plus WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: Methods and techniques of financial modeling and analysis Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers Various types of health insurance payers, including Medicare, Medicaid, and commercial plans Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider type Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), and ICD 9/10 Ability to: Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action Translate data into understandable information and deliver solutions that improve business processes Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs Assist with the orientation, training, and mentoring of other staff, as assigned Education and Experience: Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field Minimum of five years of experience performing financial healthcare reimbursement analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz) $110,160 - $176,259 USD Zone 2 (Mariposa and Merced) $100,246 - $160,410 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Accepting applications through Wednesday, October 22, 2025 by 5:00 pm. We have an opportunity to join the Alliance as a Care Coordination Social Worker - D-SNP (LCSW) in the Care Management Department. WHAT YOU'LL BE RESPONSIBLE FOR Develops and manages an individualized intervention plan for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Care Coordination program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner Works in conjunction with the interdisciplinary Care Coordination team to facilitate quality outcomes across the continuum by educating members, caregivers, providers, external agencies, and internal teams and providing assistance in navigating the managed care system Participates in program evaluation and quality improvement efforts to ensure D-SNP program effectiveness and compliance with regulatory requirements WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: The principles and practices of case management and coordination, including assessment, care/treatment planning, discharge planning. and documentation The availability and means of utilizing community resources for special services Reporting methods for cases of abuse or neglect Community resources and behavioral health systems The needs of older adults, individuals with disabilities, and/or those with complex medical or psychosocial needs Ability to: Effectively interview members to determine their strengths, problems prognosis, functional status, goals, and need for specific services and resources, and to establish short-term and long-term goals Assess psychosocial needs and conduct culturally competent interviews Use proactive customer services skills in responding to complex and demanding situations Advocate on behalf of the individual member to assure quality of care and attainment of appropriate goals Education and Experience: Possession and continued maintenance, in good standing, of a Licensed Clinical Social Worker (LCSW) license issued by the State of California Master's Degree in Social Work or related field and two years of social service experience in an acute care, community-based, or managed care environment which included developing and managing member-centered care plans; or an equivalent combination of education and work experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Zone 1 (Monterey, San Benito and Santa Cruz) $91,056 - $145,704 USD Zone 2 (Mariposa and Merced) $82,858 - $132,579 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position, and the length of the assignment is estimated to be 3+ months from January 2026 to March 2026. The length of the assignment is always dependent on business need, and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. This is a hybrid role requiring weekly on-site presence at our Merced office 1-4 days per week, depending on business needs. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Member Services Supervisor, you will: Act as the frontline customer service representative within the Member Services Department, providing assistance to members and providers primarily by phone Facilitate and coordinate non-medical transportation benefits for members Perform other duties as assigned ABOUT THE TEAM Our Member Services teams work together to empower members to understand Alliance services and provide resources that meet medical, cultural, and social needs to improve member health and well-being. We are the voice of the Alliance. We view our members' healthcare from their perspective and provide direct support by sharing benefit information and helping break down barriers to care. When a member calls, we're the ones who pick up the phone. We provide information that educates and empowers our members to be advocates for themselves and their health care. And we do it with heart! WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Required: Bilingual Hmong/English Principles and practices of customer service Windows-based PC system and Microsoft Word, Outlook, Excel, and database systems Conflict resolution techniques Ability to: Answer telephone calls promptly and minimize delays that may lead to missed calls Understand and communicate the complex operations and processes of the Alliance, particularly those related to Member Services and Care Management Translate healthcare-related terminology and complex processes into simple language and step-by-step instructions when communicating with members and providers Utilize a variety of computer systems, including the Alliance systems and external web sites and databases Demonstrate strong organizational skills and attention to detail Education and Experience: High school diploma or equivalent Minimum of two years of customer service experience in member services, health care, public assistance or human services or in a customer service or call center environment (an Associate's degree may substitute for one year of the required experience); or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Merced County Pay Range$24-$27 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position and the length of the assignment is estimated to go from January 6, 2026 to June 30, 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. We have an opportunity to join the Alliance as a Grievance Coordinator in the Member Services Department. This position will require in office presence either in our Merced or Scotts Valley office (hybrid). WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Grievance Supervisor, this position: Assists in the administration and resolution of low complexity cases in support of the Alliance Grievance function Performs administrative duties to track, organize, monitor, and follow up on case work Participates in departmental and cross-departmental trainings, workgroups, and operational improvement activities Performs other duties as assigned ABOUT THE TEAM Grievance work involves complex coordination, investigation and specific resolution(s) within regulatory timeframes. Areas of Grievance work include: Appeals: A member complaint involving an adverse benefit determination by an Alliance Utilization Management (UM) decision. Member Grievances (Complaints): An oral or written statement submitted by a member or a member's authorized representative expressing dissatisfaction with any aspect of the Alliance's health care plan. Expedited Appeals/ Grievances: A complaint or Appeal involving an imminent and serious threat to the health of the member, as determined by an Alliance Medical Director that includes, but is not limited to, severe pain, potential loss of life, limb or major bodily function. State Fair Hearings: The process whereby a member enrolled in Medi-Cal requests the Department of Social Services (DSS) and its Administrative Law Division to resolve Plan decisions that deny, modify or delay health care services or affect Medi-Cal benefits. Inquiries: A question or request for information or assistance by a member that does not reflect the member's dissatisfaction with any aspect of the Alliance's health care plan. Complex Member Billing Issues or Member Reimbursements: When an Alliance member receives a bill from a medical provider for covered services or paid out of pocket for covered Medi-Cal services. WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Principles and practices of managed healthcare, healthcare Coverage and benefit structures, principles of coordination of benefits, and medical billings Title 22 and Title 28 utilization management and grievance regulations The diverse needs of the Medi-Cal population Customer service principles and practices Ability to: Understand and communicate the complex operations and processes of the Alliance, particularly the Utilization Management, Care Management, and Member Services departments Use the Alliance's internal tracking systems Draft professional correspondence Learn and utilize computer systems and verbally communicate the program's mission, vision, and roles Education and Experience: Associate's degree in health, social services or a related field and one year of experience in a managed health care setting, health plan, or provider office interacting with members, patients, or providers and receiving complaints, preferably related to healthcare administration or public assistance; or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Santa Cruz County Pay Range$24.61-$32 USDMerced County Pay Range$22.40-$29.12 USD OUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Job Description *This is a hybrid position with the expectation to work in our service area(s) 2-3 days per month. The Alliance service area includes Santa Cruz, Monterey, Merced, San Benito, and Mariposa counties. We have an opportunity to join the Alliance as the Medicare Medical Director (MD). WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Chief Medical Officer, this position: Acts as the Alliance's Medicare Dual Eligible Special Needs Plan (D-SNP) clinical subject matter expert Provides specialized clinical D-SNP leadership within a variety of Health Services functional areas Develops and improves relationships with internal and external stakeholders, including the professional medical community, and maintains and enhances communications with similar Health Plan organizations Participates in all aspects of regulatory compliance related to D-SNP and Health Services functions THE IDEAL CANDIDATE Enjoys a fast-paced, demanding environment that requires critical thinking to develop and implement effective solutions in a timely manner Is dedicated to caring for Medicare and/or Medicaid patients while addressing the social determinants of health Works with a broad and diverse group of stakeholders to problem solve and build cutting-edge programs Has the latitude to think broadly, make operational and strategic decisions, and oversee the implementation and continuous process improvement related to key internal and external priorities WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: The needs of the Medicare population and/or Medicare Plan administration The Medicare D-SNP program and related regulations, CMS D-SNP STARS Rating System, and managed care Medical programs administration, quality improvement, and/or informatics Data collection and management practices, as related to utilization and quality of medical care Promoting and applying change management principles Ability to: Provide clinical oversight and leadership of the Medicare D-SNP program Analyze issues and think critically to ensure success in leading system change, make informed operational and strategic decisions, and oversee implementation and continuous process improvement related to key internal and external priorities Audit, analyze, and assess medical records and other health care data Interpret regulations, legal and contractual language, policies, and procedures Education and Experience: Doctor of Medicine, current license to practice medicine issued by the State of California, Board certification in a specialty recognized by the American Board of Medical Specialties, and a minimum of three years of experience as an attending physician with the Medicare population or three years of experience as an attending physician which included a minimum of two years of Medicare Plan administration experience; or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz)$296,164-$473,866 USDZone 2 (Mariposa and Merced)$269,500-$431,205 USDOUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Job Description We have an opportunity to join the Alliance as a Payer Analytics Consultant in the Payment Strategy Department. There are two positions that can be filled as a Payer Analytics Consultant or Senior Payer Analytics Consultant level. This position can be filled remotely for those living in California. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Payment Strategy Director, this position: Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies Conducts moderately complex financial analysis to support successful payer reimbursement outcomes Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives ABOUT THE TEAM The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs. THE IDEAL CANDIDATE Technically strong, with proven experience in payer financial modeling, provider payment methodologies, payment structure design, and reimbursement strategy development. Analytical and detail-oriented, skilled in data interpretation, trend analysis, and scenario modeling to inform decision-making and optimize payment accuracy. Collaborative and solutions-focused, working effectively across departments - including finance, provider network management, operations, and clinical teams - to align analytics with business goals. A clear and professional communicator, able to explain complex financial and analytical concepts to both technical and non-technical audiences. Relationship-driven, fostering productive partnerships with internal stakeholders and external partners to support shared priorities and ensure alignment. Curious and improvement-minded, continuously seeking opportunities to enhance data quality, streamline processes, and support innovative payment strategies. WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems Methods and techniques of financial modeling and analysis Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau Ability to: Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action Translate data into understandable information and deliver solutions that improve business processes Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs Interpret and apply rules, regulations, policies, procedures, and guides Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders Education and Experience: Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field A minimum of three years of experience performing financial healthcare reimbursement analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz)$97,920-$156,686 USDZone 2 (Mariposa and Merced)$89,108-$142,584 USDOUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position, and the length of the assignment is estimated to be 3+ months from January 2026 to March 2026. The length of the assignment is always dependent on business need, and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. This is a hybrid role requiring weekly on-site presence at our Merced office 1-4 days per week, depending on business needs. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Member Services Supervisor, you will: * Act as the frontline customer service representative within the Member Services Department, providing assistance to members and providers primarily by phone * Facilitate and coordinate non-medical transportation benefits for members * Perform other duties as assigned ABOUT THE TEAM Our Member Services teams work together to empower members to understand Alliance services and provide resources that meet medical, cultural, and social needs to improve member health and well-being. We are the voice of the Alliance. We view our members' healthcare from their perspective and provide direct support by sharing benefit information and helping break down barriers to care. When a member calls, we're the ones who pick up the phone. We provide information that educates and empowers our members to be advocates for themselves and their health care. And we do it with heart! WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. * Knowledge of: * Required: Bilingual Hmong/English * Principles and practices of customer service * Windows-based PC system and Microsoft Word, Outlook, Excel, and database systems * Conflict resolution techniques * Ability to: * Answer telephone calls promptly and minimize delays that may lead to missed calls * Understand and communicate the complex operations and processes of the Alliance, particularly those related to Member Services and Care Management * Translate healthcare-related terminology and complex processes into simple language and step-by-step instructions when communicating with members and providers * Utilize a variety of computer systems, including the Alliance systems and external web sites and databases * Demonstrate strong organizational skills and attention to detail * Education and Experience: * High school diploma or equivalent * Minimum of two years of customer service experience in member services, health care, public assistance or human services or in a customer service or call center environment (an Associate's degree may substitute for one year of the required experience); or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying OTHER INFORMATION * We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. * While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. * In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. * This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Merced County Pay Range $24-$27 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. * Medical, Dental and Vision Plans * Ample Paid Time Off * 12 Paid Holidays per year * 401(a) Retirement Plan * 457 Deferred Compensation Plan * Robust Health and Wellness Program * Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position and the length of assignment is estimated to go from December 2025 through July 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Medicare Care Management Manager (RN), this position: Develops and manages an individualized intervention plan for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Care Coordination program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner Works in conjunction with the interdisciplinary Care Coordination team to facilitate quality outcomes across the continuum by educating members, caregivers, providers, external agencies, and internal teams and providing assistance in navigating the managed care system Participates in program evaluation and quality improvement efforts to ensure D-SNP program effectiveness and compliance with regulatory requirements WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: The principles and practices of case management and coordination, including assessment, care/treatment planning, discharge planning. and documentation The availability and means of utilizing community resources for special services Reporting methods for cases of abuse or neglect Community resources and behavioral health systems The needs of older adults, individuals with disabilities, and/or those with complex medical or psychosocial needs Ability to: Effectively interview members to determine their strengths, problems prognosis, functional status, goals, and need for specific services and resources, and to establish short-term and long-term goals Assess psychosocial needs and conduct culturally competent interviews Use proactive customer services skills in responding to complex and demanding situations Advocate on behalf of the individual member to assure quality of care and attainment of appropriate goals Education and Experience: Possession and continued maintenance, in good standing, of a Licensed Clinical Social Worker (LCSW) license issued by the State of California Master's Degree in Social Work or related field and two years of social service experience in an acute care, community-based, or managed care environment which included developing and managing member-centered care plans; or an equivalent combination of education and work experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Zone 1 (Monterey, San Benito and Santa Cruz)$43.78-$56.91 USDZone 2 (Mariposa and Merced)$39.84-$51.79 USDOUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Job Description This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position. We have an opportunity to join the Alliance as a Senior Complex Case Manager - Pediatric (RN) on the Care Management team! WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Complex Case Management Supervisor - Pediatric (RN), this position: Develops and manages an individualized comprehensive plan of care for members referred into the assigned Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner Works with and educates members, families, providers, external agencies and internal departments on the Case Management Program and provides assistance as needed Participants in Quality Improvement studies, to continually evaluate the program's effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members Performs other duties as assigned ABOUT THE TEAM - Who is Care Management? We look to support, connect, and empower members through community-based organizations and providers, in furtherance of improving health outcomes. The Care Management Team's mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. In Care Management, we serve the Alliance by creating a bridge between the Alliance, our communities, and individual members. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance and we assist the members in connecting the dots to successfully navigate options and resources for their care. Pediatric Care Management: This unit is also about complex case management, but for our younger members. We work with the counties in line with California Children's Services Whole Child Model. THE IDEAL CANDIDATE The ideal candidate is a flexible, team-oriented critical thinker who can work independently, navigate ambiguity, and collaborate when needed to support high-quality care for our pediatric members and families. They bring an active CA RN license, solid hospital or direct patient-care experience (pediatric and/or case-management preferred), and the ability to adapt to change while exercising good judgment and knowing when to seek support. WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Thorough knowledge of the principles and practices of clinical nursing Working knowledge of the principles and practices of case management Working knowledge of care management and coordination Working knowledge of evidence-based practice guidelines in the development of care plans Ability to: Demonstrate strong critical thinking and problem-solving skills Interpret and apply policies and regulations Define issues, conduct research, interpret data, and identify and evaluate options Evaluate medical records and other health care data Organize work and manage complex priorities Education and Experience: Current unrestricted license as a Registered Nurse issued by the State of California Associate's degree in Nursing and a minimum of five years of experience in a patient care setting, including at least one year of case management experience a combination of education and relevant work experience may be qualifying A minimum of one year of the required patient care experience must be in an acute or outpatient environment, working with the Pediatric population OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz)$100,161-$160,264 USDZone 2 (Mariposa and Merced)$91,144-$145,850 USDOUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

*This is a hybrid position with the expectation to work in our service area(s) 2-3 days per week. The Alliance service area includes Santa Cruz, Monterey, Merced, San Benito, and Mariposa counties. We have an opportunity to join the Alliance as the Medicare Medical Director (MD). WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Chief Medical Officer, this position: Acts as the Alliance's Medicare Dual Eligible Special Needs Plan (D-SNP) clinical subject matter expert Provides specialized clinical D-SNP leadership within a variety of Health Services functional areas Develops and improves relationships with internal and external stakeholders, including the professional medical community, and maintains and enhances communications with similar Health Plan organizations Participates in all aspects of regulatory compliance related to D-SNP and Health Services functions THE IDEAL CANDIDATE Enjoys a fast-paced, demanding environment that requires critical thinking to develop and implement effective solutions in a timely manner Is dedicated to caring for Medicare and/or Medicaid patients while addressing the social determinants of health Works with a broad and diverse group of stakeholders to problem solve and build cutting-edge programs Has the latitude to think broadly, make operational and strategic decisions, and oversee the implementation and continuous process improvement related to key internal and external priorities WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: The needs of the Medicare population and/or Medicare Plan administration The Medicare D-SNP program and related regulations, CMS D-SNP STARS Rating System, and managed care Medical programs administration, quality improvement, and/or informatics Data collection and management practices, as related to utilization and quality of medical care Promoting and applying change management principles Ability to: Provide clinical oversight and leadership of the Medicare D-SNP program Analyze issues and think critically to ensure success in leading system change, make informed operational and strategic decisions, and oversee implementation and continuous process improvement related to key internal and external priorities Audit, analyze, and assess medical records and other health care data Interpret regulations, legal and contractual language, policies, and procedures Education and Experience: Doctor of Medicine, current license to practice medicine issued by the State of California, Board certification in a specialty recognized by the American Board of Medical Specialties, and a minimum of three years of experience as an attending physician with the Medicare population or three years of experience as an attending physician which included a minimum of two years of Medicare Plan administration experience; or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz) $296,164 - $473,866 USD Zone 2 (Mariposa and Merced) $269,500 - $431,205 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Job Description We have an opportunity to join the Alliance as a Payer Analytics Consultant in the Payment Strategy Department. There are two positions that can be filled as a Payer Analytics Consultant or Senior Payer Analytics Consultant level. This position can be filled remotely for those living in California. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Payment Strategy Director, this position: Designs and validates managed care payer models and performs moderately complex analysis to evaluate the feasibility of payer reimbursement methodologies Conducts moderately complex financial analysis to support successful payer reimbursement outcomes Coordinates and collaborates with internal and external stakeholders to achieve payer reimbursement objectives ABOUT THE TEAM The Payment Strategy department ensures the Alliance's payments to our network are adequate to our revenue. We also work to advance our payment methodology in order to achieve the best quality healthcare while reducing costs. THE IDEAL CANDIDATE Technically strong, with proven experience in payer financial modeling, provider payment methodologies, payment structure design, and reimbursement strategy development. Analytical and detail-oriented, skilled in data interpretation, trend analysis, and scenario modeling to inform decision-making and optimize payment accuracy. Collaborative and solutions-focused, working effectively across departments - including finance, provider network management, operations, and clinical teams - to align analytics with business goals. A clear and professional communicator, able to explain complex financial and analytical concepts to both technical and non-technical audiences. Relationship-driven, fostering productive partnerships with internal stakeholders and external partners to support shared priorities and ensure alignment. Curious and improvement-minded, continuously seeking opportunities to enhance data quality, streamline processes, and support innovative payment strategies. WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Windows based PC systems and Microsoft Word, Outlook, PowerPoint, Access, Visual Basic, and Excel (including pivot tables), and database systems Methods and techniques of financial modeling and analysis Principles and practices of provider reimbursement methodologies, pricing, and fee schedules for all provider types, including hospital, physician, and ancillary providers Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types National standards for fee-for-service and value-based provider reimbursement methodologies, including risk-sharing models Data modeling techniques and business analytical and data mining tools, including SQL, and data visualization tools, such as Tableau Ability to: Collect, interpret, and evaluate data, detect patterns, brainstorm solutions, consider multiple factors when making decisions, and project consequences of recommendations Demonstrate strong analytical, critical thinking, and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action Translate data into understandable information and deliver solutions that improve business processes Act as a technical resource, provide guidance related to area of assignment, and explain related regulations, processes, and programs Interpret and apply rules, regulations, policies, procedures, and guides Work collaboratively with individuals at all levels of the organization while supporting multiple stakeholders Education and Experience: Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, or a related field A minimum of three years of experience performing financial healthcare reimbursement analysis (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area Zone 1 (Monterey, San Benito and Santa Cruz)$97,920-$156,686 USDZone 2 (Mariposa and Merced)$89,108-$142,584 USDOUR BENEFITS Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations And many more ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet. At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position and the length of assignment is estimated to go from October 2025 to December 2025. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Member Services Supervisor, you will: Act as the frontline customer service representative within the Member Services Department, providing assistance to members and providers Facilitate and coordinate non-medical transportation benefits for members ABOUT THE TEAM Our Member Services teams work together to empower members to understand Alliance services and provide resources that meet medical, cultural, and social needs to improve member health and well-being. We are the voice of the Alliance. We view our members' healthcare from their perspective and provide direct support by sharing benefit information and helping break down barriers to care. When a member calls, we're the ones who pick up the phone. We provide information that educates and empowers our members to be advocates for themselves and their health care. And we do it with heart! WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Required: Bilingual Spanish/English Principles and practices of customer service Windows-based PC system and Microsoft Word, Outlook, Excel and database systems Conflict resolution techniques Ability to: Answer telephone calls promptly and minimize delays that may lead to missed calls Understand and communicate the complex operations and processes of the Alliance, particularly those related to Member Services and Care Management Translate healthcare-related terminology and complex processes into simple language and step-by-step instructions when communicating with members and providers Utilize a variety of computer systems, including the Alliance systems and external web sites and databases Demonstrate strong organizational skills and attention to detail Education and Experience: High school diploma or equivalent Minimum of two years of customer service experience in member services, health care, public assistance or human services or in a customer service or call center environment (an Associate's degree may substitute for one year of the required experience); or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying OTHER INFORMATION We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (this is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Santa Cruz County Pay Range $26.41 - $35.80 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

This is a temporary position and the length of assignment is estimated to go from September through December 2025. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Medicare Care Management Manager (RN), this position: Develops and manages an individualized intervention plan for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Care Coordination program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner Works in conjunction with the interdisciplinary Care Coordination team to facilitate quality outcomes across the continuum by educating members, caregivers, providers, external agencies, and internal teams and providing assistance in navigating the managed care system Participates in program evaluation and quality improvement efforts to ensure D-SNP program effectiveness and compliance with regulatory requirements WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description, and list of requirements click here. Knowledge of: The principles and practices of case management and coordination, including assessment, care/treatment planning, discharge planning. and documentation The availability and means of utilizing community resources for special services Reporting methods for cases of abuse or neglect Community resources and behavioral health systems The needs of older adults, individuals with disabilities, and/or those with complex medical or psychosocial needs Ability to: Effectively interview members to determine their strengths, problems prognosis, functional status, goals, and need for specific services and resources, and to establish short-term and long-term goals Assess psychosocial needs and conduct culturally competent interviews Use proactive customer services skills in responding to complex and demanding situations Advocate on behalf of the individual member to assure quality of care and attainment of appropriate goals Education and Experience: Possession and continued maintenance, in good standing, of a Licensed Clinical Social Worker (LCSW) license issued by the State of California Master's Degree in Social Work or related field and two years of social service experience in an acute care, community-based, or managed care environment which included developing and managing member-centered care plans; or an equivalent combination of education and work experience may be qualifying OTHER INFORMATION We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed). Temporary employees on assignment at the Alliance will be connected to a staffing agency with separate benefit options. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Zone 1 (Monterey, San Benito and Santa Cruz) $43.78 - $56.91 USD Zone 2 (Mariposa and Merced) $39.84 - $51.79 USD OUR BENEFITS Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance. Medical, Dental and Vision Plans Ample Paid Time Off 12 Paid Holidays per year 401(a) Retirement Plan 457 Deferred Compensation Plan Robust Health and Wellness Program Onsite EV Charging Stations ABOUT US We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.