DEPARTMENT(S): Health Network Relations REPORTS TO: Director Network Management FLSA STATUS: Non-Exempt SALARY GRADE: I - $29.3269 - $40.8654 ($61,000 - $85,000)

JOB SUMMARY

The Program/Policy Analyst supports CalOptima’s Health Network Relations (HNR) department and related organizational projects, by working with other departments for data requests, conducting research and reporting on program requirements and regulations, and reviewing department policies and procedures. Under general supervision, the incumbent will assist in the review and development of complex communications for internal and external stakeholders. The incumbent will interface and work collaboratively with various levels of internal staff at CalOptima and external stakeholders, such as health network executives as required.

POSITION RESPONSIBILITIES:

• Supports the department in various projects and initiatives by conducting research and reporting any impact to the department and CalOptima’s delegated entities.
• Identifies opportunities for process improvement and helps drive changes that support and improve the department and its operational relationship with CalOptima’s delegated entities.
• Partners with departments across the organization on department data management and reporting needs.
• Research CalOptima’s policies and pertinent regulations impacting the department and CalOptima’s delegated entities, reports findings from complex policy and regulatory research in a digestible manner for the appropriate level of staff.
• Collaborates with internal departments to clarify and disseminate regulatory guidance that may impact the department or CalOptima’s delegated entities.
• Maintains the department’s policy review schedule and assists in the development and review of policies and procedures.
• Assists in the review and development of high-profile communications for internal and external stakeholders, including the development of requests for legal services directed to CalOptima’s Legal Affairs Department.
• Works with internal staff and delegated entities to ensure compliance with contract and regulatory requirements.
• Represents CalOptima at external events, as required.
• Other projects and duties as assigned.

POSSESSES THE ABILITY TO:

• Formulate strategies for conducting research and report findings to various levels of staff.
• Work independently on assigned projects and manage expectations from different stakeholders.
• Communicate clearly and concisely, both verbally and in writing.
• Maintain a high degree of credibility, confidentiality, and integrity.
• Analyze, problem solve, and have strong project management skills.
• Prioritize tasks according to internal and external deadlines.
• Establish and maintain effective working relationships with CalOptima leadership and staff.
• 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.

EXPERIENCE & EDUCATION:

• Bachelor’s degree in Business Administration, Healthcare Administration, or related field or an equivalent combination of education and relevant experience required.
• 2 years of experience in a healthcare or Managed Care setting with related experience in health plan regulatory requirements and/or government affairs required.
• Have access to a means of transportation for work away from the primary office approximately 5% of the time required.

PREFERRED QUALIFICATIONS:

• 2 years of project management and process improvement experience strongly preferred.
• 2 years of experience working with healthcare data preferred.

KNOWLEDGE OF:

• Principles and practices of Medi-Cal and/or Medicare, healthcare, and Managed Care.
• Healthcare data, such as encounters, claims, provider data, and grievances.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima 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 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.

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Required Skills Required Experience