Managed Care Policy Specialist

California Department of Health Care Services; Sacramento (CA); Hybrid; USD 81,000 - 102,000; Full time

Benefits offered by this job

Hybrid work

Job summary

The California Department of Health Care Services (DHCS) seeks a Health Program Specialist II to serve as SME on HR 1 cost sharing within the Medi-Cal managed care program. You will provide policy guidance and cross-divisional coordination for policy development.

Responsibilities include developing guidance documents, training materials, and monitoring policy adherence and reporting to meet federal obligations. Hybrid telework is available.

Qualifications

• SME for HR 1 member cost sharing within the Medi-Cal managed care program.
• Coordinate cross-divisional policy development and compliance processes.
• Provide policy consultation to departmental staff and MCPs; develop guidance documents.

Responsibilities

• Serve as SME on HR 1 cost sharing within Medi-Cal managed care.
• Collaborate with internal staff and external stakeholders.
• Develop All Plan Letters (APLs), FAQs, and training materials.
• Monitor MCP adherence and reporting to meet federal obligations.

Skills

Policy expertise

Stakeholder coordination

Policy analysis

Training materials

Job description

Work Location:

Sacramento County

Job Description And Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role.

You will find additional information about the job in the Duty Statement.

About this Role:

Under the general direction of the Supervisor II of the Policy and External Complaints Section, the Health Program Specialist II (HPS II) exercises a large degree of independence in serving as the subject matter expert (SME) on the H.R. 1 member cost sharing requirements within the Medi-Cal managed care program. This position is responsible for cross-divisional coordination, collaboration with internal staff and external stakeholders to develop and implement compliance processes and policy. The HPS II provides policy consultation and technical assistance to departmental staff and Medi-Cal Managed Care Plans (MCPs) and supports the development of guidance documents, including All Plan Letters (APLs), Frequently Asked Questions (FAQs), and training materials. The HPS II monitors MCP adherence with issued policy, identifying areas for improvement or clarification, and MCP compliance with any reporting requirements necessary to meet federal obligations. This a highly skilled program consultant in the area of policy development and interpretation and has a lead responsibility over developing and writing policy, procedural review tools, and reviewing MCP procedure submissions.

The HPS II performs functions that are sensitive and critical to the Department's mission, with responsibility to coordinate the development of broad policy that has multi-divisional, immediate, and long-range impacts, and where the level of expertise required is substantially greater than that of other nonsupervisory positions.

This position has been advertised as limited term and is expected to last 12 months. This limited term position may be extended up to 24 months if supported by workload or may become permanent if workload becomes permanent.

This is a re-advertisement of JC- 526071. If you previously applied under JC- 526071, you do not need to re-apply under this new Job Control.

Have questions and/or need assistance? Contact [e-mail], we are here to help walk you through the state hiring process.

Working Conditions

Please see the Telework and Salary Information section below for telework, reporting location, and temporary statewide salary reduction details.

Minimum Requirements

You will find the Minimum Requirements in the Class Specification.

• HEALTH PROGRAM SPECIALIST II

Additional Documents

• Job Application Package Checklist
• Duty Statement

Position Details

Job Code #: JC-531429

Position #(s): 805-147-8336-XXX

Working Title: Managed Care Policy Specialist

Classification: HEALTH PROGRAM SPECIALIST II

$7,276.00 - $9,107.00

New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.

# of Positions: Multiple

Work Location: Sacramento County

Telework: Hybrid

Job Type: 12 Month Limited Term - Full Time

DHCS’ purpose is to provide equitable access to quality health care leading to a healthy California for all.

DHCS is a dynamic organization with ambitious goals and talented, committed employees. We work hard every day to fulfill our vital responsibility to support the delivery of quality health care to Californians. DHCS is committed to addressing disparities within our organization and in our communities through efforts toward greater diversity, equity, and inclusion. This is accomplished, in part, by a commitment toward employing a diverse workforce that reflects the many communities we serve, and by promoting and enforcing equal employment opportunity.

Take a look at some of DHCS' recent projects and happenings that our Department has accomplished in the DHCS Newsroom.

Desirable Qualifications

• Maintain consistent and regular attendance
• Communicate effectively (orally and in writing if both appropriate) in dealing with the public, MCP representatives, stakeholders, legislative representatives, and/or other employees
• Develop, maintain, and enhance knowledge and skills related to specific tasks
• Research, methodologies, federal and state law, program policy, materials, tools, and equipment
• Complete assignments in a timely and efficient manner; and, adhere to departmental policies and procedures regarding attendance, leave, and conduct

Benefits

• Continuous and ongoing training
• Diversity, Equity, and Inclusion program activities
• Employee Assistance Program (EAP)
• Medical, including health, dental, and vision insurance.
• Paid Holidays and vacation/leave
• Defined retirement program
• Savings Plus Program (401(k), 457)
• Medical/Dependent Care Reimbursement Accounts

Full benefits information can be found on CalHR's California State Civil Service Employee Benefits Summary

Contact Information

Hiring Unit Contact: Emilie Correa
[phone]
[e-mail]

Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.

EEO Contact: EEO Officer
[phone]
[e-mail]

California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.

Telework and Salary Information

This position may be eligible for telework. The amount of telework is at the discretion of the Department and is subject to change consistent with DHCS’ Telework Program and Government Code sections 14200 – 14203. Telework is available to California residents, and proof of residency may be required.

Business travel may be required, and reimbursement considers an employee’s designated office and residence subject to regulations and bargaining unit contract provisions. All commute expenses to the reporting location will be the responsibility of the selected candidate.

The DHCS office location for this position is 1501 Capitol Ave, Sacramento, CA 95814.

Salary: Effective July 1, 2025, the California Department of Human Resources (CalHR) implemented the temporary Personal Leave Program 2025 (PLP 2025). PLP 2025 directs that each employee receive a temporary reduction in pay in exchange for PLP 2025 leave credits. The temporary salary reduction percentage and the number of PLP 2025 leave credits are based on the position’s associated bargaining unit. The salary range(s) included in this job advertisement do not include the temporary salary reduction. Please reach out to the hiring unit contact listed on this job advertisement for details.

Additional Information

Using the online application system as specified in the announcement is the preferred method of applying for civil service job opportunities; however, applicants may instead apply by way of U.S. mail, parcel delivery or courier service, or in person, as set forth in this announcement. Paper applications must include a signature. Dates printed on envelopes by mobile barcodes or equivalent mobile print technology are not acceptable proof of the date the application and any other required documents or materials were filed. Applicants must state their basis of eligibility (List Eligibility, Lateral Transfer, Reinstatement, T&D, or Surplus/SROA), and the Job Control (JC) number and/or position number in the “Examination(s) or Job Title(s), For Which You Are Applying” section on the STD. 678. Surplus/SROA candidates should submit a copy of their letter with their application. Please remove any confidential information (i.e., social security number, date of birth, etc.) as well as any information regarding your LEAP eligibility and/or exam scores from your documents prior to submission. All information on the Employment Application (STD 678) must be completed. Applicants should include all employment history on the Employment Application (STD 678), including detailed job descriptions, hours worked per week, and start/end dates (MM/DD/YYYY). Resumes or other documents may not be substituted for the Employment Application (STD 678). If applying electronically, please note that CalCareers no longer allows applicants to withdraw their applications. If you need assistance to withdraw your application, please contact the Recruitment Section at [e-mail] . For all other questions regarding your CalCareer account, please contact CalHR’s CalCareers Unit at [phone] or [e-mail] .

Equal Opportunity Employer

The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.

It is an objective of the State of California to achieve a drug‑free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.