Program/Policy Analyst Sr (Medi-Cal Compliance)

Company: CalOptima
Location: Orange
Posted on: June 29, 2025

Job Description:

Program/Policy Analyst Sr (Medi-Cal Compliance)CalOptima CalOptima Health is seeking a highly motivated Program/Policy Analyst Sr (Medi-Cal Compliance) to join our team. The Program/Policy Analyst Sr (Medi-Cal Compliance) will coordinate and maintain CalOptima Health's relationship with regulatory agencies and ensure CalOptima Health and its First Tier, Downstream and Related Entities (FDRs) comply with all appropriate standards, regulations, contractual provisions, federal waivers and laws. Specifically, the incumbent works to enhance and strengthen CalOptima Health's policy infrastructure, platform and strategies at the state level, including contract compliance, statutory and regulatory obligations with the Department of Health Care Services (DHCS). The incumbent requires the ability to complete a variety of independent detailed analyses, including the development, review and response to corrective action plans. The incumbent will be responsible implementing Corrective Action Plans (CAPs), supporting regulatory audits, validating regulatory guidance and developing regulatory communications for CalOptima Health stakeholders. The incumbent will interact with CalOptima Health's executives and department management, FDR's management, legal counsel and state and federal regulatory agencies. The incumbent will also support other key CalOptima Health staff on related projects.Position Information: Department: OOC - MediCal Regulatory Affairs & Compliance Salary Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947) Work Arrangement: Full TeleworkThis position is eligible for telework in California. Duties & Responsibilities: 85% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Works with all of CalOptima Health's departments in response to inquiries, problem-solving and promoting CalOptima Health's mission and message. Assists in the management of CalOptima Health's daily relationship with the DHCS for CalOptima Health's Medi-Cal program. Maintains open lines of communication to ensure the ongoing trust and confidence of regulators in the program and management. Researches, analyzes and makes recommendations regarding the policy implications of major initiatives for CalOptima Health's Medi-Cal program, e.g., integration of new benefits and populations. Works with business areas at all levels of leadership to validate regulatory communications from regulators impacting CalOptima Health's Medi-Cal program. Supports process improvements for the Office of Compliance department. Serves as a Medi-Cal regulatory subject matter expert and lead for CalOptima Health's compliance issues and investigations. Supports management in the readiness, coordination, oversight and remediation of regulatory audits, including but not limited to validating business area submissions, additional audit requests and written daily reports. Researches and responds in a professional manner to questions pertaining to the Medi-Cal program. Works with the director and manager with interactions and responses to regulatory representatives on compliance-related issues as needed. Reviews and retains working knowledge of Medi-Cal policies and procedures related to assigned programs and projects. Assists in the creation of communications and strategic alliances with regulators. Researches and keeps current on the local, state and federal health care environment and health policy, identifying issues that may impact CalOptima Health's Medi-Cal program. Coordinates the maintenance of public program benefit updates for accurate and consistent application by CalOptima Health and its provider community. Participates and represents CalOptima Health in meetings and calls with regulators and associations and summarizes key points and impact to CalOptima Health's Medi-Cal program as needed. 10% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Initiates, facilitates and promotes activities to foster compliance awareness and encourages the reporting of compliance issues within the organization and related entities. 5% - Other Completes other projects and duties as assigned. Minimum Qualifications: Bachelor's degree in health services administration, public health, public policy or a related field PLUS 4 years of experience in government, public or government affairs role in health care compliance or health plan requirements required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. Preferred Qualifications: Master's degree. Experience working with regulatory agencies in California. Experience with Medi-Cal regulatory requirements and/or compliance in the areas of Customer Service, Grievance & Appeals, Quality Improvement, Case Management, Claims Administration and/or Utilization Management. Certification in Healthcare Compliance (CHC) or other compliance related certifications such as Certified Compliance and Ethics Professional. Required Licensure / Certifications: n/a Knowledge & Abilities: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Work Environment:If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. About CalOptima Health:CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!About our Benefits & Wellness options:At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2025 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONSApplications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is June 25, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.The selection process may include, but is not limited to, a skills assessment, phone screen and interview.The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.To apply, please visit: https://jobs.caloptima.org/jobs/program-policy-analyst-sr-medi-cal-compliance-505-city-parkway-west-california-united-statesCopyright ©2025 Jobelephant.com Inc. All rights reserved.Posted by the FREE value-added recruitment advertising agencyjeid-43fc317f2b58de478297d644681066da Salary: . Date posted: 06/16/2025

Keywords: CalOptima, South Whittier , Program/Policy Analyst Sr (Medi-Cal Compliance), Healthcare , Orange, California