Central Health Plan of California jobs - 29 jobs

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. ABOUT THIS TEMP POSITION This is a temporary position and the length of assignment is estimated to go through December 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 Risk Adjustment Director, this position: Acts as the clinical coding subject matter expert and lead coding resource across the organization Acts as a resource and provides education to providers on clinical coding standards Coordinates and leads the Alliance Coding Workgroup ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strong background in clinical coding and documentation education with current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) Demonstrated experience in supporting the development and implementation of clinical documentation improvement (CDI) programs Excellent communication skills with the ability to clearly explain complex regulatory or clinical coding concepts to diverse audiences Meticulous attention to detail with a strong foundation in auditing practices Experience leading cross functional workgroups WHAT YOU'LL NEED TO BE SUCCESSFUL Knowledge of: Medical coding languages, concepts, guidelines, methodologies, and regulations related to all sites of service, including knowledge of ICD-10, CPT, and HCPCS coding systems Principles and practices of training, including training content development for providers and staff The relationship between diagnosis documentation and risk adjustment payment models CMS Hierarchical Condition Categories (HCC) Risk Adjustment program, methodology, and impact to value-based contracts Principles and practices of internal data auditing Electronic Medical Record (EMR) coding standards Medicare and Medi-Cal coding policies The principles and practices of conducting and responding to audits The principles and practices of project management Ability to: Act as a subject matter expert and technical resource and explain policies, regulations, terms, and procedures related to area of responsibility Accurately assign clinical codes and act as the final decision maker regarding clinical code assignments Conduct research, gather and interpret information and data, identify issues of concern, make logical recommendations for action, and present findings in a clear and organized manner Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines Interpret and apply policies, standards, and guidelines Make presentations and facilitate and lead meetings and workgroups Develop training materials and conduct internal and external training Foster effective working relationships and communicate clearly and effectively with external and internal stakeholders and individuals at all levels of the organization Education and Experience: Current certification as a Certified Coding Specialist (CCS) issued by the American Health Information Management Association and as a Certified Risk Adjustment Coder (CRC) issued by the American Academy of Professional Coders Bachelor's degree in Health Care, Business, Nursing, or a related field A minimum of eight years of experience including a minimum of three years of clinical experience and a minimum of eight years of risk adjustment coding experience which included provider education responsibilities (an Associate's degree and an additional two years of experience may substitute for the Bachelor's degree); 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). Zone 1 (Monterey, San Benito and Santa Cruz)$67-$72 USDZone 2 (Mariposa and Merced)$62-$67 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 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 Fraud Waste Abuse (FWA) Specialist II (also known as a Program Integrity Specialist II) in the Compliance Department. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Program Integrity Manager, this position: Conducts medium- to high-complexity investigations into alleged fraud, waste, and abuse (FWA) referred to or identified by the Alliance FWA Prevention (FWAP) Program and/or Special Investigations Unit (SIU) Assists with the administration of medium- to high-complexity Program Integrity activities Supports the execution and oversight of moderate- to high-complexity privacy-related compliance activities Performs other duties as assigned ABOUT THE TEAM The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization's integrity and members' access to quality healthcare. We are the team that helps 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. We perform internal audits and monitoring to help us maintain a compliance program that is always up-to-date with ever-evolving compliance rules and obligations. We also handle and investigate internal concerns related to HIPAA, fraud, waste, and abuse, and conduct prevention and detection activities. THE IDEAL CANDIDATE Has experience conducting investigations into alleged fraud, waste and abuse (FWA)in a managed care or healthcare environment Is knowledgeable of HIPAA regulations and committed to maintaining data privacy and security Is proficient in Microsoft Office, especially Word and Excel 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 the ability to manage multiple projects at once in adeadline-driven environment Has knowledge of the Medi-Cal and Medicare Advantage 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 General health care compliance and privacy principles, quality improvement practices, and related audit techniques Proficiency with Windows-based PC systems and Microsoft Word, Outlook, PowerPoint and Excel (including pivot tables), and Adobe Acrobat Ability to: Quickly understand Alliance functions and roles and responsibilities related to oversight agencies and learn and apply policies, procedures, and guidelines, including Medi-Cal and Medicare guidelines Conduct thorough investigations and produce well-documented and accurate conclusions and recommendations Develop, implement, and monitor corrective action plans with guidance from the Program Integrity Specialist III or Program Integrity Manager Understand and interpret provider contracts and provider payment system processes Identify and research relevant legal materials, analyze and interpret legal and contractual language Education and Experience: Bachelor's degree in Healthcare Administration, Public Health Administration, Criminal Justice, Finance, or a related field and a minimum of three years of program integrity, auditing, quality improvement, or compliance-related experience in the healthcare industry (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 USDZone 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.

Job Description OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. *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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. ABOUT THIS TEMP POSITION This is a temporary position and the length of assignment is estimated to go through December 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 position can be filled remotely for those residing in California or for those residing within the Pacific Standard Time zones. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Risk Adjustment Director, this position: Acts as the clinical coding subject matter expert and lead coding resource across the organization Acts as a resource and provides education to providers on clinical coding standards Coordinates and leads the Alliance Coding Workgroup ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuringaccuratecoding,appropriate reimbursementand data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners tooptimizerisk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strong background in clinical coding and documentation education with current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) Demonstrated experience in supporting the development and implementation of clinical documentation improvement (CDI) programs Excellent communication skills with the ability to clearly explain complex regulatory or clinical coding concepts to diverse audiences Meticulous attention to detail with a strong foundation in auditing practices Experience leading cross functional workgroups WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Medical coding languages, concepts, guidelines, methodologies, and regulations related to all sites of service, including knowledge of ICD-10, CPT, and HCPCS coding systems The relationship between diagnosis documentation and risk adjustment payment models CMS Hierarchical Condition Categories (HCC) Risk Adjustment program, methodology, and impact to value-based contracts Principles and practices of internal data auditing Medicare and Medi-Cal coding policies Ability to: Act as a subject matter expert and technical resource and explain policies, regulations, terms, and procedures related to area of responsibility Accurately assign clinical codes and act as the final decision maker regarding clinical code assignments Conduct research, gather and interpret information and data, identify issues of concern, make logical recommendations for action, and present findings in a clear and organized manner Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines Make presentations and facilitate and lead meetings and workgroups Education and Experience: Current unrestricted license as a Registered Nurse or Licensed Vocational Nurse issued by the State of California Current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) issued by the American Health Information Management Association Bachelor's degree in Nursing, Health Care, or a related field A minimum of eight years of experience including a minimum of three years of clinical experience and a minimum of five years of CDI (clinical documentation integrity) experience with emphasis on Medi-Cal and Medicare requirements in a managed care environment which included provider education responsibilities (an Associate's degree and an additional two years of experience may substitute for the Bachelor's degree); 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). Zone 1 (Monterey, San Benito and Santa Cruz)$70-$75 USDZone 2 (Mariposa and Merced)$67-$72 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. ABOUT THIS TEMP POSITION This is a temporary position and the length of assignment is estimated to go from February 2026 to 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. This position is a full-time, 40 hour week position, Monday through Friday, 8:00 am to 5:00 pm and requires presence on-site in our Santa Cruz County Office located in Scotts Valley, California. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Administrative Services Manager, this position: Prepares and executes print service requests Performs mailing, shipping, and receiving activities Acts as back up to the reception function WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: The operation and basic maintenance of printing machines, including large volume printers, folders, inserters, and address printers General office procedures and standard office equipment The principles and practices of customer service Windows based PC systems, Microsoft Word, Outlook, and Excel Ability to: Organize tasks, coordinate projects and meet deadlines Learn and utilize office equipment, mail processing, equipment, computer systems, and software related to areas of assignment Use general office business machines including multi-line telephone system, photocopy machines, fax machines Learn and apply postal regulations and procedures which apply to Alliance mailing processes Process large volume of mail efficiently and ensure accurate and timely delivery Plan, organize and coordinate work to meet scheduled mail delivery routes Education and Experience: High school diploma or equivalent Three years of general office experience which included a minimum of one year performing printing services related functions (an Associate's degree may substitute for one year of the non-specialty require 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$22-$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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 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. This position can be filled remotely for those residing in California or for those residing within the Pacific Standard Time zones. We have an opportunity to join the Alliance as a Risk Adjustment Program Manager in the Risk Adjustment Department. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Risk Adjustment Director, this position: Develops, manages, implements, and supports Risk Adjustment programs and manages Risk Adjustment Department activities Manages small- to large-scale projects that advance business outcomes to achieve strategic objectives Acts as a risk adjustment subject matter expert and resource ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strength in building, scaling, and managing risk adjustment programs within healthcare settings Skilled in provider education and engagement, from material creation to meeting facilitation, as well as addressing challenges to accurate clinical documentation Proven ability to build strong partnerships with internal stakeholders across clinical, operational and technical teams to achieve shared goals. Self-directed and proactive, with the ability to manage priorities and drive projects forward Excellent presentation and communications skills, delivering clear and compelling updates and training diverse audiences Strong commitment to compliance, clinical integrity and ethical risk capture practices Medicare and Medi-Cal experience a plus 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 Principles and practices of risk adjustment program management Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types Application and utilization of data and analytics to drive critical financial decisions Principles and practices of project management Ability to: Analyze and evaluate data and trends and apply the results to the development of risk adjustment strategies and tactics Act as a subject matter expert and provide guidance regarding the most complex risk adjustment activities to all levels of staff across the organization Manage the development and implementation of projects, systems, programs, policies, procedures, and workflows Manage multiple projects simultaneously, organize work, and achieve goals and timelines Provide leadership and facilitate meetings Education and Experience: Bachelor's Degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a related field A minimum of eight years of progressively responsible experience in healthcare finance or analytics, which included a minimum of three years of experience managing or supporting risk adjustment programs (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 USDZone 2 (Mariposa and Merced)$100,246-$160,410 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.

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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. We have an opportunity to join the Alliance as the Health Services Executive Director overseeing the Alliance Health Services Departments of Quality Improvement and Population Health (QI/PH), Utilization Management (UM), Care Management (CM), Health Services Operations, and Pharmacy. *This position can be based in any of our service areas and may include occasional in-office or local travel - generally no more than twice per week. Our service areas include Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Chief Medical Officer, this position: Provides strategic management, leadership, and accountability for the Alliance Health Services Departments of Quality Improvement and Population Health (QI/PH), Utilization Management (UM), Care Management (CM), Health Services Operations, and Pharmacy to achieve Alliance strategic plan objectives and outcomes Provides senior leadership in new business plans, policies, programs and projects to ensure high quality results Organizes and integrates Health Services departmental operations, systems, and programs to ensure policies, procedures, and execution are in alignment with contractual obligations, Health Plan initiatives, and strategic goals Participates in strategic planning and goal setting for the Alliance ABOUT THE TEAM All of our departments within the Health Services Division maintain a proactive stance when it comes to promoting access to effective, quality care in our service areas. Our commitment is reflected in our mission statement, which affirms that Health Services embodies the Alliance vision through: Equitable, optimized healthcare with meaningful impact through responsive, community-focused innovation; and Establishing trust through transparent clinical leadership, sustainable solutions, and shared accountability. We recognize that each Alliance member is an individual with their own health care needs. Those needs can range from preventative check-ups to prescriptions to case management and more - and often a combination of these factors. At the same time, we track the overall health of our communities from a bird's-eye view and, when necessary, take action in concert with local providers and agencies. THE IDEAL CANDIDATE A visionary leader and effective delegator, able to set direction and empower others to deliver results. Brings deep operational experience across the areas of quality improvement and population healthcare management, utilization management, health services operations, and pharmacy. Acts with independence and sound judgment, executing confidently while knowing when to escalate to executive leadership. Trusted and respected, cultivating credibility and strong relationships across all levels of the organization and within the broader community - including providers, partner agencies and members. Rolls up their sleeves when needed, working shoulder to shoulder with teams to problem-solve and move initiatives forward. Community-minded and empathetic, fostering a sense of belonging and shared purpose; offering steady support when teams face challenges. Serves as a connector and coach, linking strategy with execution and mentoring managers to perform at their best. Uses data to drive decisions 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 managed care Thorough knowledge of the principles and practices of utilization management, care management, quality improvement and population health The clinical practices related to license as an MD, Pharm.D., or RN Title 22, Knox Keene, Medicaid, Medicare, entitlement programs, and related regulations The principles and practices of supervision and training Promoting and applying change management principles The principles and practices of program development and project management National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Centers for Medicare and Medicaid Services (CMS) requirements and standards Ability to: Direct, manage, supervise, mentor, train and evaluate the work of staff and assist department directors in doing so Promote an atmosphere of teamwork and cooperation, convey the mission and values of the organization, and motivate staff to achieve goals and objectives Develop, plan, organize and direct programs and activities that are complex in nature and regional in scope Review and assess overall division function, including the core work, goals and structure of each department, and oversee the directors' development and implementation of short- and long-term planning to achieve strategic plans and completion of an annual department assessment Provide leadership, facilitate meetings, and partner with and guide directors, managers and employees in the resolution of issues Demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk Education and Experience (RN): Current and unrestricted license as a Registered Nurse issued by the state of California Bachelor's Degree in Nursing, Public Health, Health Administration, Behavioral Health, Social Science, or a related field and a minimum of ten years of experience in healthcare which included a minimum of five years of experience in a leadership position responsible for running core health plan operations across utilization management and care management functional areas in a managed care setting, as well as the development and implementation of strategic programs, policies and practices in support of the overall operational mission, goals and objectives (a Master's degree may substitute for two years of the general healthcare experience); or an equivalent combination of education and experience may be qualifying. OR Education and Experience (Pharm.D.): Current unrestricted license as a Pharmacist issued by the state of California Pharmacy Doctorate (Pharm.D.) and a minimum of six years of experience in healthcare which included a minimum of five years of experience in a leadership position responsible for running core health plan operations across utilization management and care management functional areas in a managed care setting, as well as the development and implementation of strategic programs, policies and practices in support of the overall operational mission, goals and objectives; or an equivalent combination of education and experience may be qualifying. OR Education and Experience (MD): Doctor of Medicine, current license to practice medicine issued by the state of California, and a minimum of five years of experience in a leadership position responsible for running core health plan operations across utilization management and care management functional areas in a managed care setting, as well as the development and implementation of strategic programs, policies and practices in support of the overall operational mission, goals and objectives; 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)$236,931-$379,101 USDZone 2 (Mariposa and Merced)$215,600-$344,968 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. ABOUT THIS TEMP POSITION This is a temporary position and the length of assignment is estimated to the end of the year with an opportunity for extension. 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 Clinical Safety Supervisor, this position: 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 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 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 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. 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). 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) $50 - $57 USD Zone 2 (Mariposa and Merced) $45 - $52 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 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 Fraud Waste Abuse (FWA) Specialist II (also known as a Program Integrity Specialist II) in the Compliance Department. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Program Integrity Manager, this position: Conducts medium- to high-complexity investigations into alleged fraud, waste, and abuse (FWA) referred to or identified by the Alliance FWA Prevention (FWAP) Program and/or Special Investigations Unit (SIU) Assists with the administration of medium- to high-complexity Program Integrity activities Supports the execution and oversight of moderate- to high-complexity privacy-related compliance activities Performs other duties as assigned ABOUT THE TEAM The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization's integrity and members' access to quality healthcare. We are the team that helps 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. We perform internal audits and monitoring to help us maintain a compliance program that is always up-to-date with ever-evolving compliance rules and obligations. We also handle and investigate internal concerns related to HIPAA, fraud, waste, and abuse, and conduct prevention and detection activities. THE IDEAL CANDIDATE Has experience conducting investigations into alleged fraud, waste and abuse (FWA)in a managed care or healthcare environment Is knowledgeable of HIPAA regulations and committed to maintaining data privacy and security Is proficient in Microsoft Office, especially Word and Excel 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 the ability to manage multiple projects at once in adeadline-driven environment Has knowledge of the Medi-Cal and Medicare Advantage 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 General health care compliance and privacy principles, quality improvement practices, and related audit techniques Proficiency with Windows-based PC systems and Microsoft Word, Outlook, PowerPoint and Excel (including pivot tables), and Adobe Acrobat Ability to: Quickly understand Alliance functions and roles and responsibilities related to oversight agencies and learn and apply policies, procedures, and guidelines, including Medi-Cal and Medicare guidelines Conduct thorough investigations and produce well-documented and accurate conclusions and recommendations Develop, implement, and monitor corrective action plans with guidance from the Program Integrity Specialist III or Program Integrity Manager Understand and interpret provider contracts and provider payment system processes Identify and research relevant legal materials, analyze and interpret legal and contractual language Education and Experience: Bachelor's degree in Healthcare Administration, Public Health Administration, Criminal Justice, Finance, or a related field and a minimum of three years of program integrity, auditing, quality improvement, or compliance-related experience in the healthcare industry (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 USDZone 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.

Job Description OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. *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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. ABOUT THIS TEMP POSITION This is a temporary position and the length of assignment is estimated to go through December 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 position can be filled remotely for those residing in California or for those residing within the Pacific Standard Time zones. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Risk Adjustment Director, this position: Acts as the clinical coding subject matter expert and lead coding resource across the organization Acts as a resource and provides education to providers on clinical coding standards Coordinates and leads the Alliance Coding Workgroup ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuringaccuratecoding,appropriate reimbursementand data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners tooptimizerisk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strong background in clinical coding and documentation education with current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) Demonstrated experience in supporting the development and implementation of clinical documentation improvement (CDI) programs Excellent communication skills with the ability to clearly explain complex regulatory or clinical coding concepts to diverse audiences Meticulous attention to detail with a strong foundation in auditing practices Experience leading cross functional workgroups WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Medical coding languages, concepts, guidelines, methodologies, and regulations related to all sites of service, including knowledge of ICD-10, CPT, and HCPCS coding systems The relationship between diagnosis documentation and risk adjustment payment models CMS Hierarchical Condition Categories (HCC) Risk Adjustment program, methodology, and impact to value-based contracts Principles and practices of internal data auditing Medicare and Medi-Cal coding policies Ability to: Act as a subject matter expert and technical resource and explain policies, regulations, terms, and procedures related to area of responsibility Accurately assign clinical codes and act as the final decision maker regarding clinical code assignments Conduct research, gather and interpret information and data, identify issues of concern, make logical recommendations for action, and present findings in a clear and organized manner Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines Make presentations and facilitate and lead meetings and workgroups Education and Experience: Current unrestricted license as a Registered Nurse or Licensed Vocational Nurse issued by the State of California Current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) issued by the American Health Information Management Association Bachelor's degree in Nursing, Health Care, or a related field A minimum of eight years of experience including a minimum of three years of clinical experience and a minimum of five years of CDI (clinical documentation integrity) experience with emphasis on Medi-Cal and Medicare requirements in a managed care environment which included provider education responsibilities (an Associate's degree and an additional two years of experience may substitute for the Bachelor's degree); 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). Zone 1 (Monterey, San Benito and Santa Cruz)$70-$75 USDZone 2 (Mariposa and Merced)$67-$72 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 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. This position can be filled remotely for those residing in California or for those residing within the Pacific Standard Time zones. We have an opportunity to join the Alliance as a Risk Adjustment Program Manager in the Risk Adjustment Department. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Risk Adjustment Director, this position: Develops, manages, implements, and supports Risk Adjustment programs and manages Risk Adjustment Department activities Manages small- to large-scale projects that advance business outcomes to achieve strategic objectives Acts as a risk adjustment subject matter expert and resource ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strength in building, scaling, and managing risk adjustment programs within healthcare settings Skilled in provider education and engagement, from material creation to meeting facilitation, as well as addressing challenges to accurate clinical documentation Proven ability to build strong partnerships with internal stakeholders across clinical, operational and technical teams to achieve shared goals. Self-directed and proactive, with the ability to manage priorities and drive projects forward Excellent presentation and communications skills, delivering clear and compelling updates and training diverse audiences Strong commitment to compliance, clinical integrity and ethical risk capture practices Medicare and Medi-Cal experience a plus 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 Principles and practices of risk adjustment program management Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types Application and utilization of data and analytics to drive critical financial decisions Principles and practices of project management Ability to: Analyze and evaluate data and trends and apply the results to the development of risk adjustment strategies and tactics Act as a subject matter expert and provide guidance regarding the most complex risk adjustment activities to all levels of staff across the organization Manage the development and implementation of projects, systems, programs, policies, procedures, and workflows Manage multiple projects simultaneously, organize work, and achieve goals and timelines Provide leadership and facilitate meetings Education and Experience: Bachelor's Degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a related field A minimum of eight years of progressively responsible experience in healthcare finance or analytics, which included a minimum of three years of experience managing or supporting risk adjustment programs (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 USDZone 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.

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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 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 Fraud Waste Abuse (FWA) Specialist II (also known as a Program Integrity Specialist II) in the Compliance Department. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Program Integrity Manager, this position: Conducts medium- to high-complexity investigations into alleged fraud, waste, and abuse (FWA) referred to or identified by the Alliance FWA Prevention (FWAP) Program and/or Special Investigations Unit (SIU) Assists with the administration of medium- to high-complexity Program Integrity activities Supports the execution and oversight of moderate- to high-complexity privacy-related compliance activities Performs other duties as assigned ABOUT THE TEAM The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization's integrity and members' access to quality healthcare. We are the team that helps 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. We perform internal audits and monitoring to help us maintain a compliance program that is always up-to-date with ever-evolving compliance rules and obligations. We also handle and investigate internal concerns related to HIPAA, fraud, waste, and abuse, and conduct prevention and detection activities. THE IDEAL CANDIDATE Has experience conducting investigations into alleged fraud, waste and abuse (FWA)in a managed care or healthcare environment Is knowledgeable of HIPAA regulations and committed to maintaining data privacy and security Is proficient in Microsoft Office, especially Word and Excel 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 the ability to manage multiple projects at once in adeadline-driven environment Has knowledge of the Medi-Cal and Medicare Advantage 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 General health care compliance and privacy principles, quality improvement practices, and related audit techniques Proficiency with Windows-based PC systems and Microsoft Word, Outlook, PowerPoint and Excel (including pivot tables), and Adobe Acrobat Ability to: Quickly understand Alliance functions and roles and responsibilities related to oversight agencies and learn and apply policies, procedures, and guidelines, including Medi-Cal and Medicare guidelines Conduct thorough investigations and produce well-documented and accurate conclusions and recommendations Develop, implement, and monitor corrective action plans with guidance from the Program Integrity Specialist III or Program Integrity Manager Understand and interpret provider contracts and provider payment system processes Identify and research relevant legal materials, analyze and interpret legal and contractual language Education and Experience: Bachelor's degree in Healthcare Administration, Public Health Administration, Criminal Justice, Finance, or a related field and a minimum of three years of program integrity, auditing, quality improvement, or compliance-related experience in the healthcare industry (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 USDZone 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 assignment is estimated to go through December 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 Risk Adjustment Director, this position: Acts as the clinical coding subject matter expert and lead coding resource across the organization Acts as a resource and provides education to providers on clinical coding standards Coordinates and leads the Alliance Coding Workgroup ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strong background in clinical coding and documentation education with current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) Demonstrated experience in supporting the development and implementation of clinical documentation improvement (CDI) programs Excellent communication skills with the ability to clearly explain complex regulatory or clinical coding concepts to diverse audiences Meticulous attention to detail with a strong foundation in auditing practices Experience leading cross functional workgroups WHAT YOU'LL NEED TO BE SUCCESSFUL Knowledge of: Medical coding languages, concepts, guidelines, methodologies, and regulations related to all sites of service, including knowledge of ICD-10, CPT, and HCPCS coding systems Principles and practices of training, including training content development for providers and staff The relationship between diagnosis documentation and risk adjustment payment models CMS Hierarchical Condition Categories (HCC) Risk Adjustment program, methodology, and impact to value-based contracts Principles and practices of internal data auditing Electronic Medical Record (EMR) coding standards Medicare and Medi-Cal coding policies The principles and practices of conducting and responding to audits The principles and practices of project management Ability to: Act as a subject matter expert and technical resource and explain policies, regulations, terms, and procedures related to area of responsibility Accurately assign clinical codes and act as the final decision maker regarding clinical code assignments Conduct research, gather and interpret information and data, identify issues of concern, make logical recommendations for action, and present findings in a clear and organized manner Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines Interpret and apply policies, standards, and guidelines Make presentations and facilitate and lead meetings and workgroups Develop training materials and conduct internal and external training Foster effective working relationships and communicate clearly and effectively with external and internal stakeholders and individuals at all levels of the organization Education and Experience: Current certification as a Certified Coding Specialist (CCS) issued by the American Health Information Management Association and as a Certified Risk Adjustment Coder (CRC) issued by the American Academy of Professional Coders Bachelor's degree in Health Care, Business, Nursing, or a related field A minimum of eight years of experience including a minimum of three years of clinical experience and a minimum of eight years of risk adjustment coding experience which included provider education responsibilities (an Associate's degree and an additional two years of experience may substitute for the Bachelor's degree); 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). Zone 1 (Monterey, San Benito and Santa Cruz) $67 - $72 USD Zone 2 (Mariposa and Merced) $62 - $67 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. *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 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration.That'swhy wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leadseverything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. ABOUT THIS TEMP POSITION This is a temporary position and the length of assignment is estimated to go through December 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 position can be filled remotely for those residing in California or for those residing within the Pacific Standard Time zones. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Risk Adjustment Director, this position: Acts as the clinical coding subject matter expert and lead coding resource across the organization Acts as a resource and provides education to providers on clinical coding standards Coordinates and leads the Alliance Coding Workgroup ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuringaccuratecoding,appropriate reimbursementand data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners tooptimizerisk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strong background in clinical coding and documentation education with current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) Demonstrated experience in supporting the development and implementation of clinical documentation improvement (CDI) programs Excellent communication skills with the ability to clearly explain complex regulatory or clinical coding concepts to diverse audiences Meticulous attention to detail with a strong foundation in auditing practices Experience leading cross functional workgroups WHAT YOU'LL NEED TO BE SUCCESSFUL To read the full position description and list of requirements, click here. Knowledge of: Medical coding languages, concepts, guidelines, methodologies, and regulations related to all sites of service, including knowledge of ICD-10, CPT, and HCPCS coding systems The relationship between diagnosis documentation and risk adjustment payment models CMS Hierarchical Condition Categories (HCC) Risk Adjustment program, methodology, and impact to value-based contracts Principles and practices of internal data auditing Medicare and Medi-Cal coding policies Ability to: Act as a subject matter expert and technical resource and explain policies, regulations, terms, and procedures related to area of responsibility Accurately assign clinical codes and act as the final decision maker regarding clinical code assignments Conduct research, gather and interpret information and data, identify issues of concern, make logical recommendations for action, and present findings in a clear and organized manner Organize work, manage multiple tasks, establish priorities, adjust to changing priorities, and meet deadlines Make presentations and facilitate and lead meetings and workgroups Education and Experience: Current unrestricted license as a Registered Nurse or Licensed Vocational Nurse issued by the State of California Current certification as a Registered Health Information Administrator (RHIA) and Certified Coding Specialist (CCS) issued by the American Health Information Management Association Bachelor's degree in Nursing, Health Care, or a related field A minimum of eight years of experience including a minimum of three years of clinical experience and a minimum of five years of CDI (clinical documentation integrity) experience with emphasis on Medi-Cal and Medicare requirements in a managed care environment which included provider education responsibilities (an Associate's degree and an additional two years of experience may substitute for the Bachelor's degree); 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). Zone 1 (Monterey, San Benito and Santa Cruz)$70-$75 USDZone 2 (Mariposa and Merced)$67-$72 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.

OUR COMMITMENT TO A HUMAN HIRING PROCESS We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully. SERVICE AREA PREFERENCE While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment. 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. This position can be filled remotely for those residing in California or for those residing within the Pacific Standard Time zones. We have an opportunity to join the Alliance as a Risk Adjustment Program Manager in the Risk Adjustment Department. WHAT YOU'LL BE RESPONSIBLE FOR Reporting to the Risk Adjustment Director, this position: Develops, manages, implements, and supports Risk Adjustment programs and manages Risk Adjustment Department activities Manages small- to large-scale projects that advance business outcomes to achieve strategic objectives Acts as a risk adjustment subject matter expert and resource ABOUT THE TEAM Risk Adjustment is a growing, specialized team that plays a critical role in ensuring accurate coding, appropriate reimbursement and data-driven insights that support the broader organizational goals of our health plan. Our team collaborates closely with internal and external partners to optimize risk adjustment performance across our future Medicare and current Medi-Cal programs. We are passionate about using data to improve our members' health outcomes, support the success of our provider partners, and ensure regulatory alignment. THE IDEAL CANDIDATE Strength in building, scaling, and managing risk adjustment programs within healthcare settings Skilled in provider education and engagement, from material creation to meeting facilitation, as well as addressing challenges to accurate clinical documentation Proven ability to build strong partnerships with internal stakeholders across clinical, operational and technical teams to achieve shared goals. Self-directed and proactive, with the ability to manage priorities and drive projects forward Excellent presentation and communications skills, delivering clear and compelling updates and training diverse audiences Strong commitment to compliance, clinical integrity and ethical risk capture practices Medicare and Medi-Cal experience a plus 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 Principles and practices of risk adjustment program management Healthcare industry specific terms and healthcare related data types and structures, including member, claims, clinical, and provider types Application and utilization of data and analytics to drive critical financial decisions Principles and practices of project management Ability to: Analyze and evaluate data and trends and apply the results to the development of risk adjustment strategies and tactics Act as a subject matter expert and provide guidance regarding the most complex risk adjustment activities to all levels of staff across the organization Manage the development and implementation of projects, systems, programs, policies, procedures, and workflows Manage multiple projects simultaneously, organize work, and achieve goals and timelines Provide leadership and facilitate meetings Education and Experience: Bachelor's Degree in Finance, Business, Healthcare Administration, Mathematics, Statistics, or a related field A minimum of eight years of progressively responsible experience in healthcare finance or analytics, which included a minimum of three years of experience managing or supporting risk adjustment programs (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 USDZone 2 (Mariposa and Merced)$100,246-$160,410 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.