LIBERTY Dental Plan Jobs

Job Details Tustin - Corp - Tustin, CA Full Time DayDescription We normally recommend brushing regularly, but don't brush this one off! Opportunity is calling! is based out of our beautiful Headquarters in Tustin, CA! * * The Claims Payable Specialist will be responsible for daily and weekly processing of cash disbursements for multiple entities, daily provider payments, and transferring completed checks to fulfillment department. Job Summary Details Process daily Claim payment check run per assigned LDP Company and ASO Process capitation payments, commission payments, and reporting utilizing software data and Excel skills Process stale dated claim checks and research, as needed Process and audit 3rd Party check printing batches as needed Process Uniflow queue for check tracer status and resolution Process ASO client weekly registers for funding requests Application of Provider Refunds deposits, as needed Assist on 1099 annual reporting and Tax ID verification Excellent customer service skills to respond to Provider Payment email inquiries Backup support to Trade Payables team members Perform other duties as assigned and deemed appropriate by management Qualifications Education/Experience High School or GED required 1 Year Claims / Accounts Payable (AP) experience Specific Skills/Knowledge Strong working knowledge of MS applications; advanced Excel skills preferred Please be prepared to Complete Skills Assessments as part of the Interview process 10-key by touch; minimum typing speed of 40 wpm Must have the ability to multitask and function in a fast-paced environment with short deadlines and detail for accuracy Strong organizational skills Location Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States. * This is an in-office position. Hybrid/Remote is not available. All work will be performed at our Tustin, CA office. What Liberty Offers Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That's why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with: Competitive pay structure and savings options to help you reach your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines. Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan. 100% employer-paid dental coverage for employees and eligible dependents. Vision insurance with low-cost premiums for employee-only coverage and dependents. Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage. Flexible Spending Accounts for healthcare and dependent care expenses. Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. Long-term disability coverage. Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts. Employee Assistance Program (EAP) to support mental health and well-being. Generous vacation and sick leave policies, with the ability to roll over unused time. 10 paid company holidays. Tuition reimbursement for eligible educational expenses. Remote or hybrid work options available for various positions. Compensation In the spirit of pay transparency, the base hourly range for this position is $22.60 - $26.44, not including fringe benefits or potential bonuses. At Liberty, your final base pay will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions. Please note that the range listed represents the full base hourly range for this role. Typically, offers are not made at the top of the range to allow for future salary growth. Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.

Salary Range: $53,055 - $76,930 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status: Non-Exempt Department: Customer Service Reports To: Supervisor, Customer Service Employment Duration:Temporary GENERAL DESCRIPTION OF POSITION The Customer Service Representative I answers inbound calls and makes outbound calls to support Customer Service Department operations in a manner that maintains compliance with Medicare and Medi-Cal regulatory requirements and achieves Call Center service-level objectives. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Act as the primary point of contact and liaison for SCFHP members and providers contacting the plan regarding general inquiries, concerns or requests for information. Develop a general understanding of all member facing materials, communications and interactions and be prepared to respond appropriately to follow up calls. Answer inbound calls and/or place outbound calls in a high call volume environment and work directly with members and providers to accurately and completely answer inquiries involving SCFHP program services and benefits. Follow established guidelines and resources to respond to member and provider inquiries and resolve concerns in an accurate, timely, professional, and culturally competent manner. Intake, handle and coordinate member grievances, appeals and billing issues, escalating to the Grievance and Appeals department, when necessary. Educate members and providers on eligibility, and medical and pharmacy benefits and how to access services in a manner that achieves excellent service standards and maintains high customer satisfaction. Use listening skills and judgment to appropriately categorize and accurately document all contacts and follow-up actions regarding member and provider communications and activities in accordance with established guidelines. Appropriately handle member and provider requests through alternative channels such as e-mail, voicemail, fax, walk-in, etc. in accordance with established procedures. Triage member and provider requests or inquiries for other departments. Conduct member surveys as assigned in accordance with established guidelines. Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions. Identify member/provider issues and trends and report relevant information to management. Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. High School Diploma or GED. (R) Minimum one year of experience in Customer Service or Call Center role, preferably within a Health Care, Public Assistance or Human Services programs. (R) Prior experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations. (D) Ability to meet Key Performance Indicators by participating in and achieving the standards of the Customer Service Call Center Quality Program. (R) Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R) Ability to use a keyboard with moderate speed and a high level of accuracy. (R) Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP Plan members and providers over the telephone, in person or in writing. (R) Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) Ability to maintain confidentiality. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) EOE RequiredPreferredJob Industries Other

World Insurance Associates (“World”) is a unique financial services organization with a global network of brokers and specialists who empower people to make informed decisions to improve their risk management outcomes, modernize their benefits programs, and help them achieve their long-term financial goals. Founded in 2011, World is one of the fastest-growing, Top 25 insurance brokers in the U.S. with nearly 3,000 employees in more than 300 offices across North America and the U.K. World specializes in personal and commercial insurance, surety and fidelity bonding, employee and executive benefits, investment advisory and retirement plan services, and payroll & HR solutions. Insurance Sales Producer - Commercial Lines Client Advisor Position Overview World's Client Advisors bring risk management solutions to businesses and individuals. Your primary focus is identifying, prospecting, cultivating, and closing new commercial clients (small, medium, large) leveraging World's unique niche. While your focus is selling commercial lines risk solutions, you also are empowered to help clients with personal lines insurance, employee benefits, 401(k) and related retirement solutions, and payroll and human resources outsourcing solutions. World's investments in a broad range of solutions means you can prospect any company of any size to provide value to your client. Imagine the potential. Primary Responsibilities Identify, prospect, and cultivate new business, with a focus on commercial accounts. Engage in all sales and marketing tactics (with extensive corporate marketing support) to move prospects through your funnel to closing. Track all sales activities in HubSpot and leverage HubSpot to its fullest potential. Utilize World's broad platform to bring risk management solutions to individuals and business owners. At World, you will have access to resources to help any client solve any challenge, including traditional commercial lines insurance, high net worth / private client, employee benefits, human capital and payroll outsourcing, and retirement financial services. Qualifications Must have proven experience with a range of insurance solutions to bring value to clients. Must be willing to become each client's trusted risk management advisor and bring the entire World platform to each client (P&C, Employee Benefits, Retirement Plans, Wholesale, and Payroll and Human Resources outsourcing services). Must maintain all relevant insurance licenses from the first day of employment to be positioned to manage an existing book of business. It is meaningful, but not mandatory, if you have: Sold commercial insurance for a top broker. Based on your experience, World will enhance your expertise through the company's training program. Used an insurance agency management software platform, like AMS360 and Epic, and have experience with a sales CRM (World uses HubSpot). Built and presented client “pitch decks” / presentations. Compensation As a World Insurance Client Advisor, your compensation is tied to your effort and your performance. We offer a base salary plus commissions as well as a full suite of employee benefits, including a 401(k) match that is immediately fully vested. The base salary range for this role is $80,000 to $200,000+. The base salary depends on your experience and your ability to drive revenue. Your base salary grows as your book of business grows, with tremendous potential to significantly exceed the top of this range. Equal Employment Workforce and Workplace World celebrates and supports differences amongst its employees. World knows employing a team rich in diverse thoughts, experiences, and opinions allows World's employees and World's work environments to flourish. World is honored to be an equal opportunity workplace, dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, World makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of World's business. #J-18808-Ljbffr

Salary Range: $95,729 - $143,594 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status: Exempt Department: Quality Improvement Reports To: Manager, Quality & Health Education GENERAL DESCRIPTION OF POSITION The Quality Improvement Program Manager is responsible for developing and executing a strategy to improve the quality performance for Santa Clara Family Health Plan. This role serves as a critical resource and subject matter expert in supporting, monitoring, managing, and driving strategic projects, interventions, and initiatives for the organization's Medicaid quality improvement program. This is a highly collaborative role that partners with internal teams across the company, external vendors, and healthcare providers to ensure our programs are achieving our goals. The role uses a variety of data sources to determine performance across current and emerging NCQA Healthcare Effectiveness Data Information Set (HEDIS) & Medi-Cal Accountability Set for Health Care Delivery System (MCAS) measures, identify insights and opportunities for performance improvements, and share these findings with stakeholders to drive continuous improvement. This position reviews and accurately interprets complex regulatory documents, including HEDIS & MCAS measure specifications from CMS and DHCS and measure stewards. This position will lead and present material at internal and external meetings, develop and conduct training on HEDIS & MCAS-related topics, assist in regulatory comment development, help drive goal setting, help prioritize interventions, and develop/implement Quality Improvement Health Equity Transformation Program (QIHETP) related documents and initiatives related quality. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Implement strategies and initiatives on the HEDIS & MCAS work plan, including managing projects of varying degrees of complexity (i.e., administration of DHCS surveys, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, multi-channel member outreach, provider education, off-cycle surveys, and prescription drug event reconciliation). Independently produce and manage prospective quality reports with analysis to manage program performance, support rating predictions, and support meetings with delegates, provider groups, and internal stakeholders. Interpret and organize information around current performance, historical trends, predicted performance, and opportunities for improvement (including opportunities relative to competing plans in the market). Provide comprehensive analysis of measures, barriers, and opportunities, and present results of improvement efforts and ongoing performance measures to management. Serve as a subject matter expert (SME) on HEDIS & MCAS measures, including the measures that apply to each contract and the organization's strategy for achieving the highest possible rating for each contract, and reviewing regulatory communications and staying abreast of changes to QI program rules, measures, and/or measure specifications Manage current quality initiatives, collaborate and educate SCFHP staff, provider network and community partners on how to improve SCFHP QIHET Program. Manage regulatory deliverables, including but not limited to: Population Needs Assessment, Quality Improvement Projects, Performance Improvement Projects, Strengths Weaknesses Opportunities & Threats, Plan Do Study Act. Implement and support NCQA Accreditation and DHCS Quality & Health Equity activities, including but not limited to: CalAIM, Population Health Management (PHM) initiatives, Health Equity, Social Determinants of Health(SDOH). Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Bachelor's Degree in Public Health, Healthcare, or a related field, or equivalent experience. (R) Minimum three years of experience with quality improvement in health related setting, including performing root cause analysis, Plan Do Study Act methodology and monitoring/analyzing improvement, program development. (R) Knowledge of Medicaid principles and practices with emphasis in quality improvement. (R) Proven ability to design and execute strategic plans for continuous improvement initiatives. (R) HEDIS experience. (R) Medicaid plan or ACOs experience. (D) Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) Experience leading cross-functional projects. (D) Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) Ability to form positive, professional relationships with internal and external stakeholders. (R) Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R) Ability to use a keyboard with moderate speed and a high level of accuracy. (R) Proficient in adapting to changing situations, working independently and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R) Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP members, providers and external stakeholders over the telephone, in person or in writing. (R) Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) Ability to maintain confidentiality. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

Work Schedule: Hybrid schedule with regular work onsite at the VIVA HEALTH corporate office and some work-from-home opportunities. Why VIVA HEALTH? VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys. VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare. Benefits Comprehensive Health, Vision, and Dental Coverage 401(k) Savings Plan with company match and immediate vesting Paid Time Off (PTO) 9 Paid Holidays annually plus a Floating Holiday to use as you choose Tuition Assistance Flexible Spending Accounts Healthcare Reimbursement Account Paid Parental Leave Community Service Time Off Life Insurance and Disability Coverage Employee Wellness Program Training and Development Programs to develop new skills and reach career goals See more about the benefits of working at Viva Health - ******************************************* Job Description The Commercial Complaint Coordinator is responsible for processing commercial complaints according to state and federal regulatory requirements, including intake, research of the complaint, and follow through to final disposition. This individual facilitates the Formal Complaint Committee meetings, including scheduling with the member and internal staff, distribution of materials and minutes, maintaining policies, and logging all complaints. In addition, this role will assist with reporting commercial complaints and pulling data as needed for both internal and external audits. This position assists the department with appeals and grievances for other lines of business, as needed and participates in an on-call rotation for weekend and holiday coverage. Key Responsibilities Process informal, formal, and expedited commercial member complaints in accordance with state and federal guidelines including coordinating investigations, drafting responses, and coordinating third party reviews as required. Coordinate Formal Complaint Committee meetings including scheduling with the member and internal staff and distribution of materials and minutes. Maintain policies and procedures, a log of all complaints (with disposition), and complaint files. Assist with reporting commercial appeals and grievances for internal and external audits. May provide analyses of data including trend reporting. Comply with federal, state, and local legal requirements by maintaining current knowledge of commercial regulatory guidance, enforcing adherence to requirements, and advising management on needed actions. Review and provide feedback on proposed coverage language changes to commercial coverage documents (e.g., Certificate of Coverage, Summary of Benefits, and drug riders). Provide additional support to the Appeals and Grievances Department by assisting with maintaining procedures and completing projects in support of plan audits. REQUIRED: Bachelor's Degree or equivalent experience 5 years' experience in specialized field such as health insurance customer service, or complaints and appeals Excellent written and verbal communication skills Good analytical ability High proficiency in the Microsoft Office suite of products including Excel, Word, and PowerPoint Ability to exercise sound independent judgement and discretion in decisions that affect business operations Excellent organizational and interpersonal skills, including the ability to work on and track multiple assignments on various timelines with minimal supervision PREFERRED: LPN/RN or comparable health care professional degree Advanced knowledge of a technical or specialized field such as insurance, public health policy, complaints and appeals, compliance, or government affairs 2 years of experience with a health plan Experience interpreting governmental regulations and applying them to business operations

Salary Range: $83,243 - $124,864 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. This posting is for one position and will be filled as either a Business Systems Analyst I or Business Systems Analyst II or a Business Systems Analyst III depending on the candidate qualifications and experience. FLSA Status: Exempt Department: Information Technology Reports To:Manager, Business Systems Location: San Jose, CA Salary: Business Systems Analyst I - $83,243 - 124,864 Business Systems Analyst II - $95,729 - 143,594 Business Systems Analyst III - $107,930 - 167,292 Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521. GENERAL DESCRIPTION OF POSITION We are looking for a BSA candidate who possesses strong technical skills with a focus on reporting and data analysis. The candidate should be skilled in SQL and have an understanding of programming languages to support code review and interpretation. The position will require adept critical thinking and problem-solving skills. The position will be responsible for developing and maintaining regulatory reports related to Case Management, Utilization Management, Claims, Members, Grievances, and Appeals. Business Systems Analyst I- The Business Systems Analyst I acts as a liaison between the business units, internal and external, including software development, production support teams, vendors and trading partners; develops and reviews small scale, basic business requirements, functional specifications, and business processes; participates in basic validation and testing of applications and reports, and provides support in the maintenance and improvement of SCFHP information management systems in support of SCFHP objectives and regulatory compliance. Business Systems Analyst II- The Business Systems Analyst II acts as a liaison between the business units, internal and external, including software development, production support teams, vendors and trading partners; develops and reviews small to medium scale, basic to moderate business requirements, functional specifications, and business processes; participates in basic to moderate validation and testing of applications and reports, and provides support in the maintenance and improvement of SCFHP information management systems in support of SCFHP objectives and regulatory compliance. Business Systems Analyst III - The Business Systems Analyst III acts as a liaison between the business units, internal and external, including software development, production support teams, vendors and trading partners; develops and reviews small to large scale, basic to complex business requirements, functional specifications, and business processes; participates in basic to complex validation and testing of applications and reports, and provides support in the maintenance and improvement of SCFHP information management systems in support of SCFHP objectives and regulatory compliance. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Business Systems Analyst I -Project and task management for small scale projects including: facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identified risks.Business Systems Analyst II- Project and task management for small to medium scale projects including: facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identified risks. Business Systems Analyst III - Project and task management for small to large scale projects including: facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identified risks. Business Systems Analyst I- Troubleshoot small scale, basic production system issues, including: thoroughly reviewing the initial service request, efficiently gathering additional information as needed from the service requester and subject matter experts, performing comprehensive critical thinking to identify root cause, documenting findings and resolution, and working with manager to determine appropriate escalation path, if applicable.Business Systems Analyst II- Troubleshoot small to medium scale, basic to moderate production system issues, including: thoroughly reviewing the initial service request, efficiently gathering additional information as needed from the service requester and subject matter experts, performing comprehensive critical thinking to identify root cause, documenting findings and resolution, and working with manager to determine appropriate escalation path, if applicable. Business Systems Analyst III - Troubleshoot small to large scale, basic to complex production system issues, including: thoroughly reviewing the initial service request, efficiently gathering additional information as needed from the service requester and subject matter experts, performing comprehensive critical thinking to identify root cause, documenting findings and resolution, and working with manager to determine appropriate escalation path, if applicable. Business Systems Analyst I- Process improvement and documentation for small scale, basic projects and components of medium scale projects; writing formal requirements and functional specifications following industry standards and departmental templates; creating process flow diagrams; overseeing implemented changes; communicating impact to affected business areas.Business Systems Analyst II- Process improvement and documentation for small to medium scale, basic to moderate projects and components of large scale projects; writing formal requirements and functional specifications following industry standards and departmental templates; creating process flow diagrams; overseeing implemented changes; communicating impact to affected business areas. Business Systems Analyst III - Process improvement and documentation for small to large scale, basic to complex projects; writing formal requirements and functional specifications following industry standards and departmental templates; creating process flow diagrams; overseeing implemented changes; communicating impact to affected business areas. Responsible for following the SCFHP Project Life Cycle, Software Development Coding Standards, and Change Control Management policies and procedures. Perform data validation on both inbound and outbound data sources. Document test cases and results. Act as a resource for IT staff and business units ensuring quality, testing, and documentation. Create and maintain basic to moderate SQL based reports to support business processes and initiatives. Business Systems Analyst III - Train, mentor and educate business systems analyst staff as needed on IT or healthcare topics. Generate basic to complex source to target mapping documentation that clearly defines the data mapping and business rules applied between two systems. Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Bachelor's Degree in Healthcare, Information Systems, or related field, or equivalent experience, training, or coursework. (R) Business Systems Analyst I- Experience in healthcare. (D) Business Systems Analyst II- Minimum two years of experience as a business analyst. (R) Business Systems Analyst III - Minimum four years of experience, training, or coursework. (R) Business Systems Analyst I- Knowledge of healthcare management information systems. (D) Business Systems Analyst II- Minimum one year of experience with healthcare management information systems. (R) Business Systems Analyst III - Minimum of three years of experience with healthcare management information systems. (R) Business Systems Analyst I- Ability to identify, troubleshoot, and resolve small-scale, basic business and systems issues. (R) Business Systems Analyst II- Ability to identify, troubleshoot, and resolve small to medium scale, basic to moderate business and systems issues. (R) Business Systems Analyst III - Ability to identify, troubleshoot, and resolve small to large scale, basic to complex business and system issues. (R) Ability to organize work and present results in a professional manner. (R) Business Systems Analyst I- Knowledge of healthcare business processes. (D) Business Systems Analyst II- Minimum one year of experience working with healthcare business processes. (R) Business Systems Analyst III - Minimum three years of experience working with healthcare business processes. (R) Business Systems Analyst I- Knowledge of healthcare analytics and standard reporting measures. (D) Business Systems Analyst II- Minimum one year of experience working with healthcare analytics and standard reporting measures. (R) Business Systems Analyst III - Minimum three years of experience working with healthcare analytics and standard reporting measures. (R) Business Systems Analyst I- Knowledge of project management standards and functions. (R) Business Systems Analyst II- Minimum two years of experience utilizing project management guidelines and best practice. (R) Business Systems Analyst III - Minimum four years of experience utilizing project management standards and functions. (R) Business Systems Analyst I- Ability to analyze data for the purpose of informing business decisions. (D) Business Systems Analyst II- Minimum two years of experience analyzing data for the purpose of informing business decisions. (R) Business Systems Analyst III - Minimum four years of experience analyzing data for the purpose of informing business decisions. (R) Business Systems Analyst I- Ability to document business requirements and processes following industry guidelines and best practice. (R) Business Systems Analyst II- Minimum two years of experience creating industry standard business requirements and process documentation. (R) Business Systems Analyst III - Minimum four years of experience creating industry standard business requirement and process documentation. (R) Working knowledge of and the ability to efficiently operate all applicable computer software including a working knowledge of computer applications such as Outlook, Word and Excel. (R) Ability to use a keyboard with moderate speed and a high level of accuracy. (R) Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R) Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) Ability to maintain confidentiality. (R) Ability to comply with SCFHP's policies and procedures. (R) Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) EOE RequiredPreferredJob Industries Other

Salary Range: $171,721 - $274,753 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status: Exempt Department: Health Services Reports To: Vice President, Health Services GENERAL DESCRIPTION OF POSITION The Director of Utilization Management (UM) is responsible for the clinical and operational management of the Utilization Management Department activities including utilization management, concurrent review, prior authorization, care coordination, discharge planning, retrospective review, and claims support, including staff management to ensure that all administrative utilization management (UM) processes are performed in accordance with applicable state and federal regulatory requirements, SCFHP policies and procedures and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Manage and perform utilization management activates to ensure regulations, compliance, criteria, standards, and metrics as established by the Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), and Healthcare Effectiveness Data and Information set (HEDIS) for Medi-Cal and Medicare lines of business. Responsible for the development, design, implementation, and evaluation of the strategic plan for the UM department including the UM program, work plan, evaluation, and oversight of delegated UM functions. Maintain accountability for utilization management functions to achieve business and clinical outcomes, meeting contract requirements, and supporting cross departmental initiatives with providers and members. Manage effectiveness of UM coordinators and nurse's review, coordination, and processing of prior authorization, concurrent review, discharge planning, and transitions of care activities including appeals, claims, provider disputes in accordance with established policy and standardized guidelines. Monitor and evaluation of under-/over utilization medical services and durable medical equipment for health outcomes analysis including but not limited to identifying gaps in care, cost effectiveness, vendor administration, and quality improvement opportunities through claims, encounter data, and prior authorization data. Produce and submit regular reports and data analytics as required for, but not limited to, all medical services, compliance dashboard, regulatory requirements, productivity, clinical operations, benefit changes, implementation, and service quality monitoring. Direct and participates in various meetings including the Utilization Management Committee, UM delegation oversight meetings, and additional interface with providers, delegates, vendors, hospitals, skilled nursing facilities, and community partners. Assist Health Services Leadership and Medical Directors with activities to meet departmental and organization objectives and implementing action plans to address issues and improve key performance indicators and selected utilization/cost and quality outcomes. Work cross functionally across departments to ensure timely implementation of benefit changes, regulatory requirements, and member and provider satisfaction. Responsible for overseeing and maintaining UM contracts and Letter of Agreements (LOA). Develop, coordinate and approve all departmental budget for the UM department. Assist with education of managers on the budget process and ensure appropriate monitoring of these areas is actionable. Perform all job functions with integrity. Provide timely internal and external customer service in cooperative, professional, and respectful manner. Responsible for staffing ratios and projecting changes in staffing with new programs and member ratios. Assist with system-wide initiatives as it relates to utilization of medical services and coordination of medical care including UM software/application implementations. Attend off-site meetings or events as necessary. Perform other related duties as required or assigned. SUPERVISORY/MANAGEMENT RESPONSBILITIES Carries out supervisory/management responsibilities in accordance with the organization's policies, procedures, applicable regulations and laws. Responsibilities include: Recruiting, interviewing, and hiring. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees' needs, ensuring they have the necessary resources to do their work. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews. REQUIREMENTS - Required (R) Desired (D) Current unrestricted California Registered Nurse (RN) license or qualified health care professional. (R) Bachelor's Degree from an accredited four-year institution. (R) Master's Degree in Nursing or related field. (D) Minimum five years of experience in Managed Care, Utilization Management, Quality Improvement, or equivalent. (R) Minimum five years of experience in a supervisory capacity in a managed care setting. (R) Comprehensive understanding of applicable standards and regulations pertaining to utilization management programs for DHCS, DHMC, NCQA, CMS and NCQA. (R) Knowledge of medical cording practices. (R) Knowledge of MCG guidelines, InterQual criteria, Medi-Cal Provider Manual, or CMS Guidelines. (R) Current working knowledge of Medicare and Medi-Cal rules and regulations. (R) Ability to consistently meet accuracy and timeline requirements to maintain regulatory requirements (R) Familiarity with Health Maintenance Organization (HMO), Independent Practice Association (IPA), and medical group contracting concepts, principles and practices. (D) Strong attention to detail and able to concentrate without distraction in a fast paced environment. Able to adapt to a rapidly changing environment and to keep supervisor informed of any delays which could disrupt delivery of health care services or the internal operations. (R) Self-directed with proven ability to work independently under general direction and minimal supervision; able to assume responsibility, take initiative, follow up on assignments, make appropriate decisions within the scope of the position, handle multiple projects simultaneously and assume accountability for own errors. (R) Strong working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R) Ability to use a keyboard with moderate speed and high level of accuracy. (R) Excellent written, verbal, and interpersonal communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to think and work under pressure and effectively prioritize and complete tasks within established timeframes. (R) Ability to assume responsibility and exercise sound judgment when making decisions within the scope of this position. (R) Maintenance of a valid California Driver's License and acceptable driving record in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) Ability to perform the job safely and with respect to others, to property and to individual safety. (R) PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies; and sit or stand for extended periods of time. (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less. (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment. (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone. (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

Salary Range: $107,930 - $167,292 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status:Exempt Department:Health Services Reports To:Health Services Management Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 GENERAL DESCRIPTION OF POSITION The RN Case Manager is responsible for providing on-going case management services for Santa Clara Family Health Plan (SCFHP) members. As a SCFHP member advocate, the RN Case Manager facilitates communication and coordination among all participants of the care team to ensure member identified goals and needed services are provided to promote quality cost-effective outcomes. Through the development and implementation of member individualized care plans, the RN Case Manager provides medical and psychosocial case management support to help coordinate resources and services for individuals across the healthcare and social services continuum, and facilitate the use of available healthcare benefits in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Conduct, review and document comprehensive clinical and/or psychosocial assessments and on-going follow-up interventions to measure progress towards meeting goals as they relate to a member's physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs. Maintain case files by assuring that they are documented in accordance with SCFHP policies and procedures, state and federal requirements and organized in a manner that adheres to standards for audit requirements. Facilitate involvement of the member and/or family/responsible party for development and implementation of a member specific care plan which includes individualized prioritized goals. Coordinate member's care with PCP, Specialists, Behavioral Health and Long Term Services and Supports providers to assist member to achieve or maintain a level of functional independence which allows them to remain at home or in the community. Facilitate and coordinate communication with member's interdisciplinary care team including SCFHP internal staff, as well as the member's physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services. Facilitate successful transition of care for members who move between care settings by coordinating services for medical appointments, pharmacy assistance and by facilitating utilization review. If assigned to MLTSS, support the transition of long-term care members residing in nursing facilities to a lower level of care, or community setting in partnership with MLTSS providers and programs. If assigned to Community Based Adult Services (CBAS): Conduct face-to-face, on-site eligibility determinations for CBAS services with members using the standardized California Department of Health Services approved tool - CBAS Eligibility Determination Tool (CEDT) & Patient Health Record Quick Guide; Review and approve Individual Plan of Care for CBAS members; and Provide care coordination to targeted CBAS members including assessment, care plan implementation and care transitions. Conduct telephonic and/or visits/assessments, as needed in the home, facility or community setting. Collaborate with team members on cross-departmental improvement efforts, quality improvement projects, optimization of utilization management, and improvement of member satisfaction. Attend and actively participate in Health Services meetings, operational meetings, training and coaching sessions, including off-site meetings as needed. Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Active California RN License without restriction. (R) Minimum three years of experience in case management, discharge planning, or education or certifications, or equivalent experience. (R) Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R) Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan. (R) Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D) Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children). (D) Ability to work within an interdisciplinary team structure. (R) Ability to conduct home, facility and other community-based visits. (R) Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R) Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R ) Ability to use a keyboard with moderate speed and a high level of accuracy. (R) Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by nursing scope of practice. (R) Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) Ability to maintain confidentiality. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

Salary Range: $107,930 - $167,292 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status:Exempt Department:Finance Reports To:Director, Health Care Economics Employee Unit:Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521. GENERAL DESCRIPTION OF POSITION The Analytics Developer designs, develops, implements and supports small to large scale, basic to complex in-house and vendor applications and interfaces, including the accurate data exchange between SCFHP and trading partners in support of SCFHP objectives and regulatory compliance. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. 1. Maintain existing and develop new applications to support organizational business needs. 2. Utilize data analysis techniques and queries to support internal business functions through the generation of reports and development and maintenance of the data warehouse. 3. Review existing basic to complex processes and recommend new or improved solutions that increase efficiency and accuracy and implement those solutions. 4. Assess and troubleshoot small to large scale production issues related to performance, data errors, and process failures by reviewing error logs, source code, and applicable data to identify, recommend and implement solutions. 5. Collaborate with business analysts, other developers and business users through the project life cycle to gather and understand requirements, determine best solutions, test solutions and demonstrate functionality to end users. 6. Actively participate in design reviews and provide input to other Application Developers and Business Systems Analysts to ensure quality solutions are developed, working with the Application Developer Lead and Manager as needed. 7. Responsible for following the SCFHP Project Life Cycle, Software Development Coding Standards, and Change Control Management policies and procedures. 8. Create technical requirements based on review and analysis of requirement specifications supplied by Business Systems Analysts and/or business users. 9. Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. 1. Bachelor's Degree in Computer Science, or related field, or equivalent experience, training or coursework. (R) 2. Minimum four years of experience in application development. (R) 3. Applicable software development certifications. (D) 4. Minimum three years of experience with SQL programming, MS SQL database development, and T-SQL query generation. (R) 5. Minimum three years of experience with MS SQL Business Intelligence tools (SSRS, SSIS, SSAS) or other enterprise business intelligence software. (R) 6. Minimum three years of experience with any of the following applicable languages/platforms: .NET, PERL, Java, SAS, VB, C++, or other modern programming language or related software. (R) 7. Minimum three years of experience with healthcare management information systems. (R) 8. Experience with the design and development of EDI solutions that meet HIPAA X12 standards. (D) 9. Knowledge of database concepts and data processes in order to understand, develop, analyze and support various new projects and make recommendations for improvements to existing processes. (R) 10. Ability to document code and processes. (R) 11. Ability to create and follow technical specifications. (R) 12. Ability to analyze data. (R) 13. Knowledge of BizTalk, Sharepoint, ActiveBatch and other core integration tools and services (D) 14. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word and Excel. (R) 15. Ability to use a keyboard with moderate speed and a high level of accuracy. (R) 16. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R) 17. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) 18. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) 19. Ability to maintain confidentiality. (R) 20. Ability to comply with SCFHP's policies and procedures. (R) 21. Ability to perform the job safely with respect to others, to property, and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

Salary Range: $72,385 - $108,578 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status:Non-Exempt Department:Health Services Reports To:Health Services Management GENERAL DESCRIPTION OF POSITION Under the guidance and direction of the UM department RN Manager or Director, the Utilization Management Review Nurse (LVN) performs prospective and retrospective clinical review for inpatient and outpatient authorization requests in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and applicable business requirements. Following regulatory or evidence-based guidelines, assesses for medical necessity of services and/or benefit coverage which result in approved determination for services or the need to collaborate with Medical Directors for potential denial considerations. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Conduct clinical review to ensure effective and appropriate utilization of benefits and services for prospective, concurrent and retrospective/claims review organization determination authorization requests within regulatory turnaround requirements for all SCFHP lines of business. Process authorization reviews by applying the appropriate clinical criteria/guidelines, policies and procedures. Draft and process timely notification of action (NOA) letters for authorization determinations to providers and to members, in member specific language preferences as identified within member demographic information. Coordinate referrals to appropriate departments or programs for member identified continuity of care needs, such as Case Management, Behavioral Health, Managed Long Term Services and Supports (MLTSS), community resources, Pharmacy and Quality. Maintain adherence with CMS (Medicare) and DHCS (Medi-Cal) regulatory requirements. Facilitate appropriate processing of Letters of Agreement with non-contracted Providers for approved medically necessary services. Perform other duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Active California Board of Nursing Licensed Vocational Nurse License (LVN) without restriction. (R) Minimum one year of licensed related health care experience. (R) One year of experience within a Managed Care Health Plan. (D) Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management. (R) Knowledge of MediCal and/or Medicare guidelines and regulations. (D) Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards. (D) Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance. (R) Ability to pass random quarterly case file reviews in accordance with departmental monitoring standards. Ability to successfully pass departmental bi-annual inter-rater reliability testing. (R) Ability to work within an interdisciplinary team structure. (R) Proficient in adapting to changing situations and efficiently alternating focus between tasks to support the operations as dictated by business needs. (R) Working knowledge of and the ability to efficiently operate all applicable computer software including applications such as Outlook, Word, Excel, and specific case management programs. (R) Ability to use a keyboard with moderate speed and accuracy. (R) Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing as mandated by nursing scope of practice. (R) Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) Ability to maintain confidentiality. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to perform the job safely and with respect to others, to property and to individual safety. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

Salary Range: $72,385 - $108,578 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status:Non-exempt Department:Long Term Services and Supports (LTSS) Reports To:Manager, SDOH or Manager, Community Based Case Management Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 GENERAL DESCRIPTION OF POSITION The Community Based Services Specialist serves as the lead, primary contact, and liaison for developing, supporting and monitoring the network of public and community based providers and vendors delivering Enhanced Care Management (ECM), Community Supports (CS), and/or other activities, programs or special projects addressing social determinants of health. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Develop and maintain updated knowledge of community based services, and capacity across Santa Clara County and support identification and assessment of ECM and/or CS provider network gaps. Recommend for initial and ongoing needs to support ECM and/or CS delivery system and operational infrastructure including data exchange, workforce training and capacity building. Support ECM and/or CS authorization and delivery process in accordance with DHCS-developed service definitions, eligibility criteria and reporting requirements. Oversee the development and management of the ECM, SDOH and/or CS provider network including: Serve as a knowledge and resource expert for ECM, CS and/or SDOH provider network operations. Establish and manage positive and productive working relationships with all public and community-based providers and vendors delivering services to members under ECM, CS or SDOH projects. Receive, research and respond to inquiries and issues that are raised by or impacting providers in a timely fashion and in collaboration with appropriate business units. Proactively communicate and collaborate with providers to identify problem patterns, track and trend issues, prepare recommendations for potential service improvement opportunities and develop tools and processes to improve communication and other processes Oversee collaboration with internal business units, particularly Provider Network Operations, Health Services Department, Finance and Claims, regarding provider communication, training and support and to ensure payments are made in accordance with vendor agreement terms. Schedule, conduct and report on regular site visits with each provider as required and coordinate and host at least one annual meeting with providers. Conduct orientation and ongoing training and education to community service providers and office staff including technical assistance, development of presentations and other written guidance or materials, in-person sessions, webinars and/or calls as needed. Assist in the preparation of promotional materials for the public, website or newsletters. Oversee provider compliance with required ECM and/or CS trainings and technical assistance including in-person sessions, webinars, and/or calls as necessary. Establish and oversee a program for communicating and tracking ECM and/or CS provider compliance with vendor agreement scope of work, key operational and financial objectives, and quality and performance metrics. Maintain accurate and timely documentation of provider contacts in compliance with NCQA standards, DHCS, DMHC and CMS regulatory requirements. Contribute to the development of ECM and/or CS pricing including recommending changes in pricing subsystems. Support the Department Manager in generating reports and performing special projects. Troubleshoot with providers to address issues related to submission of claims and encounter data for ECM and/or CS services. Understand and track applicable regulatory and reporting requirements. Ensure accuracy and regulatory compliance for all materials or documents. Attend off-site meeting or events as necessary. Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Bachelor's Degree in public health, social welfare or related field; or equivalent experience, training, or coursework. (R) Minimum two years of progressively responsible and direct work experience working with the essential duties and responsibilities described above. (R) Demonstrated experience leading/managing projects, initiatives, and/or leading or directing the work of others. (R) Knowledgeable in the field of home and community-based services and community resource networks and a particular interest in working to address health disparities and addressing the needs of low-income communities. A deep understanding of SDOH that impact Santa Clara County and community members. (R) Ability to think creatively and work strategically, to help develop and implement innovative solutions yielding measurable results to the organization. (R) Ability to think creatively and strategically, gather and analyze data, organize and write reports, organize work efficiently. (R) Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities. (R) Advanced working knowledge and proficient with Microsoft Suite applications, and the ability to operate all applicable software. (R) Excellent oral and written communication skills, including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments and outside entities over the telephone, in person or in writing.(R) Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff (R). Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to perform the job safely with respect to others, to property, and to individual safety. (R) Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) Knowledge of the community-based delivery system and managed care. (D) Project Management Professional (PMP) certification (D) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors, in person, by telephone, and via work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements:ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically, throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

Salary Range: $126,818 - $196,568 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. TEMPORARY PART-TIME POSITION FLSA Status:Non-Exempt Department:Health Services Reports To:Director of Medical Management GENERAL DESCRIPTION OF POSITION The Manager of Utilization Management (UM) is responsible for the direct oversight of internal and external delegated UM functions including the development and implementation of policies, procedures and program development and related quality monitoring. In addition, the Manager of UM is responsible for supervising the Supervisor of UM to ensure that all administrative UM processes are performed in accordance with all applicable state and federal regulatory requirements, SCFHP policies and procedures and business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Develop, implement and manage all UM processes for continuous and sustained compliance with all applicable state, federal and NCQA regulatory requirements, SCFHP policies and procedures and general business requirements for all lines of business. Develop and implement continuous analysis and quality monitoring of all policies and procedures to evaluate UM staff performance and ensure regulatory compliance, including the development and implementation of effective, measurable corrective action plans to meet targeted strategic outcomes. Ensure the integration of UM operations into other internal and external teams/departments including Quality, Long Term Services and Support (LTSS) and Behavioral Health (BH). Establish and maintain effective interpersonal relationships with all SCFHP staff, members and/or their authorized representatives, providers and other program or agency representatives. Ensure UM Committee preparedness. Attend off-site meetings. Perform other related duties as required or assigned. SUPERVISORY/MANAGEMENT RESPONSIBILITIES Carries out supervisory/management responsibilities in accordance with the organization's policies, procedures, applicable regulations and laws. Responsibilities include: Recruiting, interviewing, and hiring. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees' needs, ensuring they have the necessary resources to do their work. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Unrestricted professional RN licensure in the state of California. (R) Minimum two years of experience in a supervisory capacity in a managed care setting. (R) Understanding and/or experience with Utilization Management. (R) Must be knowledgeable of DHCS, CMS, DMHC regulations and NCQA regulatory Population Health standards. (R) Ability to consistently meet accuracy and timeline requirements to maintain regulatory requirements. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word, Excel, and specific case management programs. (R) Ability to use a keyboard with moderate speed and high level of accuracy. (R) Excellent written, verbal, and interpersonal communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, members, providers and outside entities over the telephone, in person or in writing. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to think and work under pressure and effectively prioritize and complete tasks within established timeframes. (R) Ability to assume responsibility and exercise sound judgment when making decisions within the scope of this position. (R) Maintenance of a valid California Driver's License and acceptable driving record in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. Frequent computer screen exposure. EOE RequiredPreferredJob Industries Other

We are so glad you are interested in joining Sutter Health! Organization: SOPS-Sutter Outpatient Services - Valley Accountable for the assessment, planning, treatment and evaluation during the pre operative, intra operative and post operative phases of nursing care. Assists the physician during surgery and procedures by functioning in the circulating role. Develops, implements, manages/coordinates an optimal interdisciplinary plan of care that incorporates psychological, sociocultural, spiritual, economic, and life-style factors. Fosters and maintains collaborative relationships between patients, their family/support group, physicians, and other healthcare providers through timely and effective communications. Adheres to polices, industry standards, best practices, and applicable laws/regulations and codes to promote a quality, highly reliable patient experience. Engages in continuous growth and development in professional nursing practice. Job Description: EDUCATION Graduate of an accredited school of nursing. CERTIFICATION & LICENSURE RN-Registered Nurse of California BLS-Basic Life Support Healthcare Provider ACLS-Advanced Cardiac Life Support TYPICAL EXPERIENCE: 2 years recent relevant experience SKILLS AND KNOWLEDGE Demonstrated knowledge and competence with regard to nursing theories, concepts and practices; medical terminology; anatomy; and physiology. Working knowledge of the healthcare industry, safety precaution policies, best practices regarding patient care and privacy, and changes in local/state/federal regulations. Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people. Basic knowledge of computer applications, such as Microsoft Office Suite (Word and Outlook), Electronic Health Record. Ability to prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions. Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options. Ensure the privacy of each patient's protected health information (PHI). Build collaborate relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Job Shift: Days Schedule: Part Time Shift Hours: 8 Days of the Week: Monday - Friday Weekend Requirements: As Needed Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 20 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $62.84 to $82.32 / hour The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Salary Range: $83,243 - $124,864 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status:Exempt Department:Quality Improvement Reports To:Manager, Quality Improvement and Health Education Manager Employee Unit:Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521 GENERAL DESCRIPTION OF POSITION The Health Educator manages Quality Improvement Programs, Health Education Program, and the Group Needs Assessment area of the Cultural and Linguistic Services Program to ensure members have resources, knowledge, and confidence to achieve optimal health and wellness in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and SCFHP business requirements, to achieve Department performance objectives. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Develop and manage the Health Education program, create Health Education Work Plan and report Health Education annual evaluation. Manage current health education resources, train SCFHP staff and provider network on how to initiate health education referrals. Follow up on health education external and internal referrals. Collaborate, develop and maintain relationships with external stakeholders to develop and support health education programs and quality improvement initiatives. Collaborate with SCFHP departments to disseminate health education information to SCFHP members and the community. Develop and maintain health education vendor relationships. Track and trend health education activities to monitor utilization of health education resources. Audit delegates and vendors to ensure health education policies and procedures are in compliance with SCFHP's policies and regulatory requirements and vendor/delegate contracts. Manage Group Needs Assessment reporting for the Cultural and Linguistic Services Program. Manage Performance Improvement Projects (PIP) design and implementation. Ensure member incentive programs are reviewed and approved by DHCS prior to implementation. Perform other related duties as required or assigned. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Master's Degree in Public Health or Certified Health Education Specialist (CHES) credentials, Registered Dietitian or Registered Nurse. (R) Minimum one year of experience as a health educator. (R) Prior experience with managed care plans, Medi-Cal and Medicare programs, and working with the underserved populations. (R) Ability to pay attention to detail and work accurately. (R) Ability to form positive, professional relationships with internal and external stakeholders. (R) Ability to analyze data. (R) Critical thinking with the ability to look for gaps, identify opportunities and initiate improvements in the Health Education Programs. (R) Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R) Ability to use a keyboard with moderate speed and a high level of accuracy. (R) Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP members, providers and external stakeholders over the telephone, in person or in writing. (R) Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R) Must be able to adapt to a changing environment, work independently, and manage multi-task responsibilities. (R) Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) Ability to maintain confidentiality. (R) Ability to comply with all SCFHP policies and procedures. (R) Ability to perform the job safely with respect to others, to property, and to individual WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

Salary Range: $171,721 - $274,753 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change. FLSA Status: Exempt Department: Information Technology Reports To: Chief Information Officer GENERAL DESCRIPTION OF POSITION The Director of Infrastructure and System Support is responsible for providing vision and problem solving leadership on a company-wide level for infrastructure, desktop, and application system support. The primary management focus is on the implementation and usage of SCFHP network and hardware infrastructure, telecom infrastructure, as well as computer operations strategy. An emphasis of this position is to anticipate future directions in the Information Technology industry, and then relate those changes to current and future infrastructure needs and projects of the organization. The Director of Infrastructure and System Support is responsible for safeguarding and treating all data, information, and communications with uncompromising confidentiality and have knowledge of cybersecurity protocols and network security. ESSENTIAL DUTIES AND RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Oversee all network and telecom security configuration and monitoring security reports daily. Provide project management for single and multiple projects across several channels. Oversee management of the data center, technical services, production scheduling, help desk, communication networks (voice and data), and computer systems operations. Understand and track applicable regulatory and reporting requirements. Conduct periodic audits (based on policies and procedures) to ensure compliance with regulatory, enterprise security, and HIPAA requirements. Direct the maintenance and support of all electronic and computerized systems; information processing equipment, and software for the acquisition, storage, and retrieval of information. Set the direction for all information processing and communication systems and operations. Work with CIO and senior management to determine network architecture strategies and standards. Develop relationships with professional organizations, peer groups, and industry trade groups to stay current with technology and attend conferences as necessary. Understand and track business, technical, architecture, and infrastructure issues, and act as consultant for improving the design and management of the information systems department operations. Identify issues, trends, and opportunities to improve efficiency, cost effectiveness and/or quality; develop recommendations and implement same relative to identified issues, trends, and opportunities. Analyze trends and develop a long-range plan designed to resolve problems and prevent them from recurring while maintaining high service levels for the user community. Ensure a stable performance environment by monitoring and analyzing problems, ensuring problems are identified and solved as rapidly and efficiently as possible. Apply best practices for enterprise infrastructure and network security to ensure compliance with Office of Inspector General (OIG) and HIPPA standards. Recommend appropriate courses of action to developers, technicians, and management on technical and infrastructure issues. Apply best practices and methodologies to work with departments, teams, and individuals across the organization to facilitate controls over IT operations. Oversee the status and monitoring of IT operations improvement efforts. Facilitate training of appropriate individuals using SCFHP's enterprise managed care information system. Provide and manage on-call responsibilities for the infrastructure. Provide and manage utilization and capacity monitoring of networks, data storage, servers, and phones for management reporting and planning. Prepare, deploy, and monitor necessary policies and procedures related to infrastructure security, compliance and audits; to include desktop encryption and data privacy policies. Work with the Compliance Department on enterprise risk management with a focus on security and disaster recovery. Create departmental and capital budgets, in conjunction with the CIO. Facilitate/consult with operational personnel to develop or resolve performance issues, upgrades, design reviews, and system set up/implementation. Oversee the testing and quality assurance of all telecom, system, and network applications. Define the direction and infrastructure for the enterprise, oversee all projects, and identify major areas of development, technical standards and procedures. Apply organizational vision to all infrastructure projects. Participate in various IT projects intended to continually improve/upgrade the infrastructure, such as evaluation of new software and hardware required to meet a business need or to make a process more cost effective, without compromising network security Attend off site meetings/events as necessary. Perform any other duties as required or assigned SUPERVISORY/MANAGEMENT RESPONSBILITIES Carries out supervisory/management responsibilities in accordance with the organization's policies, procedures, applicable regulations and laws. Responsibilities include: Recruiting, interviewing, and hiring. Developing a high performing department culture and staff. This includes setting the standard for staff/peers and motivating employees to maximize organizational goals and objectives. Effectively assimilating, training and mentoring staff and (when appropriate), cross training existing staff and initiating retraining. This includes coaching to help increase skills, knowledge and (if applicable) improve performance. Setting goals and planning, assigning, and directing work consistent with said goals. This includes responding to employees' needs, ensuring they have the necessary resources to do their work. Appraising performance, rewarding and disciplining employees, addressing complaints and resolving issues. This includes providing regular and effective feedback to employees and completing timely and objective performance reviews. REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Bachelor's Degree in Computer Science or related field; or equivalent experience, training, or coursework. (R) Minimum ten years of progressively responsible and direct work experience with the duties and responsibilities above, including demonstrated leadership skills with executing the supervisory/management responsibilities above. (R) Certification in hardware (e.g. A+) or Microsoft Certified Professional Certification. (R) Cybersecurity Certification. (R) Minimum eight years of related experience with firewall concepts and deployment, DMZ layout, telephony, infrastructure, network environments, performing network engineering, designing, planning, and implementing LANs/WANs using the latest technology. (R) Demonstrated experience making project decisions, monitoring progress, and reporting results to executive leadership. (R) Demonstrated experience with scripting and automation. (R) Knowledge of applicable regulatory requirements for healthcare plans. (R) Ability to think creatively and work strategically, to help drive innovative solutions yielding measurable results to the organization. (R) Self-directed with ability to assume responsibility, work independently, organize, prioritize, and effectively manage competing initiatives in a fast paced, dynamic environment with a high level of ambiguity. (R) Ability to direct and manage large-scale, complex, cross-functional, multi-departmental projects to completion with minimum supervision. (R) Excellent data analysis skills, including the ability to gather and analyze data, organize and write reports, and organize work efficiently. (R) Knowledge of, and experience with, healthcare management information systems. (R) Working knowledge of, and the ability to, efficiently operate all applicable computer software including a working knowledge of computer applications such as Outlook, Word, Excel, and other Microsoft Office applications. (R) Ability to use a keyboard with moderate speed and a high level of accuracy. (R) Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments, providers and outside entities over the telephone, in person or in writing. (R) Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff. (R) Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R) Ability to maintain confidentiality. (R) Ability to comply with SCFHP's policies and procedures. (R) Ability to perform the job safely with respect to others, to property, and to individual safety. (R) Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R) WORKING CONDITIONS Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors in person, by telephone and via work-related electronic communications. PHYSICAL REQUIREMENTS Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation: Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time. (R) Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (R) Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less. (R) Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment. (R) Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone. (R) Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R) ENVIRONMENTAL CONDITIONS General office conditions. May be exposed to moderate noise levels. EOE RequiredPreferredJob Industries Other

World Insurance Associates (“World”) is a unique financial services organization with a global network of brokers and specialists who empower people to make informed decisions to improve their risk management outcomes, modernize their benefits programs, and help them achieve their long-term financial goals. Founded in 2011, World is one of the fastest-growing, Top 25 insurance brokers in the U.S. with nearly 3,000 employees in more than 300 offices across North America and the U.K. World specializes in personal and commercial insurance, surety and fidelity bonding, employee and executive benefits, investment advisory and retirement plan services, and payroll & HR solutions. Position Summary We are seeking a dynamic and personable Outbound Deal Sourcer to join our World class M&A team specializing in the independent Insurance Retail and Specialty Distribution vertical markets. The ideal candidate will be self-motivated, credible, organized, and personable. Your mission will be to proactively source acquisition targets by identifying independent retail, specialty, and retirement/wealth related businesses, consistently building relationships with business owners, leadership teams, and key industry stakeholders, and further expanding World's ecosystem. You'll play a key role in impacting our deal pipeline and fostering relationships with potential partners who may lead you onto your next acquisition deal with less effort. Responsibilities Industry Research and Deal Sourcing Conduct research to identify businesses that meet World's deal criteria in the Insurance Retail, Specialty Brokerage, and Financial Services sector. Develop a thorough understanding of industry trends, competitive dynamics, and emerging technologies while conducting preliminary outreach. Maintain and expand a qualified list of proprietary acquisition suspects and interested targets to present the opportunity to join World. Relationship Building Build relationships with founders, owners, executives, and other key decision-makers in target companies. Develop credibility and trust by demonstrating industry knowledge and professionalism. Stay top-of-mind with potential clients through regular, meaningful touchpoints. Pipeline Development Proactively use an omnichannel approach to promote the World within the industry. Develop a high-level marketing strategy that includes the preparation and use of prospecting assets, such as phone, texting, email, LinkedIn, HubSpot, etc. to build pipeline. Generate qualified leads for potential acquisitions through outbound efforts such as cold outreach, warm introductions, and referral networks. Arrange early introduction meetings with the target's key decision-maker and the Corporate Development's senior team. Maintain detailed records of outreach and progress in Salesforce. Strategic Collaboration Work closely with internal M&A deal teams to align sourcing efforts with World's broader strategy and criteria. Provide feedback on market trends, company needs, and potential opportunities. Experience 2-5 years of professional experience in insurance M&A, Private Equity, or Corporate Development, preferred. Experience in origination, deal sourcing, inside sales, business development, or pipeline generation, preferred. Strong interpersonal and communication skills, both written and verbal. A strong interest to remain educated on innovations, disruptions, and valuations in the insurance and financial services sectors. Proficiency in CRM software and tools to manage pipeline activity. Equal Employment Opportunity At World Insurance Associates (WIA), we celebrate and support our differences. We know employing a team rich in diverse thoughts, experiences, and opinions allows our employees, our products, and our community to flourish. WIA is honored to be an equal opportunity workplace. We are dedicated to equal employment opportunities regardless of race, color, ancestry, religion, sex, national orientation, age, citizenship, marital status, disability, gender identity, sexual orientation, or Veteran status. In addition, WIA makes reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant or employee with a disability, unless the accommodation would impose an undue hardship on the operation of our business. To Executive Search Firms and Staffing Agencies World does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered World's property, and World will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting World's Human Resources Talent Department. #LI-CM1

Braces yourself, the job you've been searching for is just a click away! This position supports our Southern California market and regular travel within the region is required. The Provider Network Manager is responsible for developing and maintaining a strong provider network, recruiting and retaining General Dentists and Specialists, and training providers to ensure compliance with Liberty's policies and procedures. The role involves building strategic relationships, analyzing market needs, and supporting providers with contractual and operational guidance. Regular travel is required to support recruitment efforts and conduct provider audits. Job Summary Details * Recruit General Dentists and Specialists for various networks to meet objectives at department and corporate levels. * Review competitor information and propose strategies to meet recruitment needs. * Analyze existing network providers and determine if additional recruitment of providers is necessary to meet access standards. * Research and analyze fee schedules within assigned territory to determine cost effectiveness of contracting providers. * Manage and service network providers within assigned territory according to established guidelines. * Counsel providers with aberrant utilization or questionable billing patterns to ensure compliance. * Educate and train providers on policies and procedures when necessary. * Collect necessary contract documents from providers and follow up on outstanding paperwork. * Conduct on-site structural audit and orientation according to established guidelines. * Process and submit facility changes promptly to update internal systems. * Establish and maintain strong relationships with providers to assure stable networks. * Complete monthly activity reports and provide updates on various recruitment projects. * Resolves more complex issues related to claims, grievances, and provider compliance. * Performs other related duties as assigned. Qualifications Education/Experience * 4 Year / Bachelor Degree or equivalent combination of education and relevant work experience. * 4 Years' prior network management experience, dental office management, managed healthcare, and/or related sales, including prior experience working with Dental PPO or DHMO network. Specific Skills/Knowledge * Knowledge of dental terminology. * Strong presentation and public speaking abilities. * Strong verbal and written communication skill sin English language; bilingual a plus. * Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook, and SharePoint). * Please be prepared to complete online skills assessments as part of the application process. * Ability to negotiate fee schedules with providers. * Must be detail oriented, strong customer service skills, strong organizational and time management skills. * Ability to identify problems, research issues and follow through until resolved. * Medicaid or Medicare experience preferred. * Able to process provider contracts. * Strong organizational and time management skills. * Availability for occasional night and weekend travel for special events. * Valid driver's license, reliable transportation, and proof of insurance with a minimum liability of $100,000. Location Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States. Candidates for this position must currently reside in Southern California and be able to travel regularly within the assigned market. What Liberty Offers Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That's why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with: * Competitive pay structure and savings options to help you reach your financial goals. * Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines. * Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan. * 100% employer-paid dental coverage for employees and eligible dependents. * Vision insurance with low-cost premiums for employee-only coverage and dependents. * Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage. * Flexible Spending Accounts for healthcare and dependent care expenses. * Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. * Long-term disability coverage. * Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts. * Employee Assistance Program (EAP) to support mental health and well-being. * Generous vacation and sick leave policies, with the ability to roll over unused time. * 10 paid company holidays. * Tuition reimbursement for eligible educational expenses. * Remote or hybrid work options available for various positions. Compensation In the spirit of pay transparency, the base salary range for this position is $68,640 - $80,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions. Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth. Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.

We are so glad you are interested in joining Sutter Health! Organization: SOPS-Sutter Outpatient Services - Valley Competently performs routine and specialized radiology procedures to produce quality images to physicians and other health care providers for the diagnosis, treatment, monitoring and prevention of injury or disease. Works independently, exercising sound judgment, and developed clinical skills to execute safe and precise procedures to deliver accurate results in a timely manner. Gains confidence and cooperation from the patient, their family/support group, and other healthcare providers through competent patient assessment, attentive monitoring, and effective communication. Adheres to all local/state/federal regulations, codes, policies and procedures to ensure privacy and safety while delivering optimal patient care. May also be responsible for performing specific procedures and/or may help orient other staff to the department. Job Description: EDUCATION: Graduate of an accredited Radiologic Technologist Program CERTIFICATION & LICENSURE: ARRT-American Register of Radiologic Technologist and evidence of application for CRT (may not begin work until the CRT is verified online) ARRT-American Register of Radiologic Technologist BLS-Basic Life Support Healthcare Provider Upon Hire RHF-Radiology Fluoroscopy within 180 Days of hire if required at the affiliate TYPICAL EXPERIENCE: 2 years recent relevant experience SKILLS AND KNOWLEDGE: General knowledge of diagnostic radiology principles, procedures, views, and equipment, including some experience responding to traumas and various hospital emergencies.' Capable of performing routine radiographic examinations as well as a basic understanding of human anatomy, physiology, pathology, and medical terminology. Possess written and verbal communications skills to explain sensitive information clearly and professionally to diverse audiences, including non-medical people. Well-developed time management and organizational skills, including the ability to prioritize assignments and work within standardized operating procedures and scientific methods to achieve objectives and meet deadline General knowledge of computer applications, such as Microsoft Office Suite (Word, Excel and Outlook) and related information systems (Radiology (RIS), laboratory (LIS), electronic health records (EHR), EPIC, and picture archive and communication system (PACS). Prioritize assignments and work within standardized policies, procedures, and scientific methods to achieve objectives and meet deadlines. Work independently, as well as be part of the team, including accomplishing multiple tasks in an environment with interruptions. Identify, evaluate and resolve standard problems by selecting appropriate solutions from established options. Ensure the privacy of each patient's protected health information (PHI). Build collaborate relationships with peers and other healthcare providers to achieve departmental and corporate objectives. Job Shift: Varied Schedule: Per Diem/Casual Shift Hours: 8 Days of the Week: Monday - Friday Weekend Requirements: None Benefits: No Unions: No Position Status: Non-Exempt Weekly Hours: 0 Employee Status: Per Diem/Casual Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $46.24 to $57.79 / hour The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Job Details Tustin - Corp - Tustin, CA Hybrid Full Time DayDescription Join the Liberty Dental Plan Team, Where Every Smile Counts! The Legal Secretary is responsible for providing administrative support to Liberty's Legal Department daily, as well as working closely with clients and other team members to ensure effective and timely attention to important legal matters. This position is HYBRID and will work from our Corporate Office in Tustin, CA 3 days per week. Job Summary Details Report directly to the Deputy General Counsel to assist on all matters that flow through Legal Department Corporate entity management and statutory filings for all subsidiaries in all jurisdictions, including annual and all other reports, certificates, and assumed business names; create, convert, and withdraw or dissolve entities as necessary Schedule, organize, and assist in the preparation for board of director and shareholder meetings Support corporate secretarial function, including maintenance of corporate minute books for all entities and the drafting and finalization of minutes Manage the agreement execution process; prepare standard agreements, such as nondisclosure agreements and business associate agreements; handle early stage negotiation of standard agreements and coordinate with appropriate business units to ensure timely and complete review of business terms Coordinate workflow processes in document management system; manage all Legal Department files and projects within document management system Manage legal calendar and legal projects; coordinate with business units to determine reasonable target deadlines and to provide status updates and notification of changes in target completion dates; follow up with business units regarding information needed by counsel Perform due diligence and legal research Manage and prepare responses to subpoenas and records requests; prepare legal hold notices and manage record collection process Draft correspondence on behalf of counsel; attend meetings as representative for Legal Department where appropriate Respond to RFP and audit-related requests pertaining to Legal Department Manage departmental online and paper subscriptions, memberships and registrations, legal reference resources, and professional affiliations Track expenditures and outside counsel spend; support departmental budget preparation Draft and revise Organizational charts in response to RFP and audits Performs other duties as assigned or determined appropriate Qualifications Education/Experience 4 Year / Bachelors Degree or equivalent combination of education and experience. 2+ Years' experience in a corporate legal department preferred. Notary Public preferred. Specific Skills/Knowledge Excellent organizational skills and the ability to prioritize and manage multiple deadlines in a fast-paced environment Exceptional writing and analytical abilities Proactive and industrious nature Meticulous attention to detail Advanced knowledge of MS Word, Excel, PowerPoint, and Outlook Please be prepared to complete an online skills assessment as part of the application process. Location Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States. This position is HYBRID and will work from our Corporate Office in Tustin, CA 3 days per week. What Liberty Offers Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That's why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with: Competitive pay structure and savings options to help you reach your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines. Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan. 100% employer-paid dental coverage for employees and eligible dependents. Vision insurance with low-cost premiums for employee-only coverage and dependents. Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage. Flexible Spending Accounts for healthcare and dependent care expenses. Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. Long-term disability coverage. Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts. Employee Assistance Program (EAP) to support mental health and well-being. Generous vacation and sick leave policies, with the ability to roll over unused time. 10 paid company holidays. Tuition reimbursement for eligible educational expenses. Remote or hybrid work options available for various positions. Compensation In the spirit of pay transparency, the base salary range for this position is $70,000 - $95,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions. Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth. Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.