Medi-Cal & CalAIM Program Specialist

Medi-Cal & CalAIM Program Specialist

Cal Optima

The Team You’ll Join

We are a mission driven community‑based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

We are hoping you will join us as a Medi‑Cal & CalAIM Program Specialist and help shape the future of healthcare where you’ll be an integral part of our Medi‑Cal & CalAIM team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders.

This position has been approved to be Full Office
.

If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Program Specialist (Medi‑Cal & CalAIM) will provide comprehensive support for Cal Optima Health’s Street Medicine Program and Justice‑Involved (JI) Reentry Initiative while contributing to broader Medi‑Cal and CalAIM projects. You will be responsible for administrative responsibilities, service coordination and program monitoring to ensure effective operations and improved member outcomes. You will also work closely with internal teams, contracted providers and community partners to facilitate seamless care delivery and program success.

Together, we are building a stronger, more equitable health system.

• 80% – Program Support
  • Participates in a mission‑driven culture of high‑quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the department in carrying out department responsibilities and collaborates with others to support short‑ and long‑term goals/priorities for the department.
  • Works with cross‑functional teams to support the implementation, monitoring and evaluation of CalAIM services, activities and reports.
  • Assists in developing and updating program materials that support effective program implementation.
  • Assists with developing auditing tools, conducting audits of contracted providers and providing recommendations for compliance and quality improvement plans.
  • Collects and analyzes data related to the health outcomes and service utilization of JI members and prepares reports for management and stakeholders on the impact of programs and services.
  • Communicates with external partners, providers and stakeholders to ensure accurate program updates, reminders and relevant information are distributed in a timely manner.
  • Coordinates regulatory reporting for assigned programs and prepares memos, documents, reports and forms as needed.
  • Enters data into Cal Optima Connect portal and other Cal Optima Health information systems as needed.
  • Collaborates with Cal Optima Health’s Facilities and Information Technology departments to support the needs of the Street Medicine Program.
  • Prepares monthly and quarterly data related to the Street Medicine and JI initiatives.
  • Provides support for Care Traffic Control, including training new users, monitoring tickets, tracking weekly data uploads and auditing the system.
  • Supports correctional facilities, pre‑release care managers and enhanced care management (ECM) providers to coordinate care for members as needed.
  • Provides information on topics, including pre‑release care manager and ECM provider assignment, managed care plan (MCP) policy pertaining to the JI population of focus (POF), prior authorization, MCP services such as community supports and non‑emergency medical transportation, primary care provider (PCP) assignment and network providers.
  • Ensures smooth assignment of ECM providers to eligible JI members.
  • Supports the department in the training and monitoring of JI ECM providers.
  • Monitors activities of JI ECM providers to ensure compliance with policy guide.
  • Stays updated about Department of Health Care Services (DHCS) CalAIM program requirements and outcomes.
  • Supports the achievement of Cal Optima Health’s vision and goals for its Street Medicine Program as defined in the Street Medicine Operations Manual