Medical Survey Specialist

California Department of Managed Health Care; California (MO); Hybrid; USD 81,000 - 102,000; Full time

Job summary

California Department of Managed Health Care seeks a Medical Survey Specialist to advance statewide regulatory oversight of health plans. You will oversee medical surveys, review licenses, and develop recommendations on regulations and initiatives under the Knox-Keene Act.

Responsibilities include project management, leading teams, and responding to regulatory changes. Hybrid telework is available; some statewide travel will be required.

Qualifications

• Knowledge of health care regulation and survey processes.
• Strong analytical and problem-solving skills for complex regulatory tasks.
• Experience in project management and leading cross-functional teams.
• Ability to review licenses, conduct audits, and respond to regulatory changes.

Responsibilities

• Manage projects and formulate regulatory implementation recommendations.
• Plan, organize, and conduct medical surveys of health care service plans.
• Lead project teams to respond to changes in regulations and directives.
• Review license applications and amendments; conduct statutory surveys and investigations.

Skills

Analytical Skills

Project Management

Leadership

Self-Directed

Health Care Background

Communication Skills

Compliance/Audit

Microsoft Office

Time Management

Professionalism

Tools

Microsoft Office Suite

Job description

Job Description And Duties

Under the general direction of the Office of Plan Monitoring, (OPM), Division of Plan Surveys (DPS), Supervisor II, the incumbent performs high profile, sensitive and complex specialized assignments involving broad policy issues resulting in a statewide impact to health plans, providers and consumers in support of efficient and effective regulatory oversight of licensed health plans. The incumbent functions as a highly skilled independent program consultant who performs high profile, sensitive and complex, specialized duties to implement regulations which have significant statewide impact on the Department’s health plan medical survey efforts pursuant to the Knox-Keene Health Care Service Plan Act of 1975.

Responsibilities include project management; formulating recommendations for implementing new legislation and regulation, Department initiatives; planning, organizing, and conducting medical surveys of health care service plans; and organizing and leading project teams to respond to changes in regulations and Department directives as they impact DPS and other Offices. The incumbent reviews license applications and amendments, conducts statutorily mandated surveys (operational audits), as well as non-routine and investigative medical surveys, of licensed health care service plans.

This position includes Statewide travel up to 20% of the time.

Leave Program (PLP) 2025 agreement:
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.

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

Working Conditions

The DMHC has locations in Downtown Sacramento and Rancho Cordova. Both locations are located close to light-rail with various amenities. The incumbent will work in a climate-controlled cubicle and/or office environment with artificial lighting.

This position may be eligible for hybrid telework. The telework schedule is permitted at the operational needs of the Department and is subject to change, consistent with the State Telework Policy and the DMHC’s Telework Policy. All employees who telework are required to be California residents and maintain California residency in accordance with Government Code 14200.

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-533267

Position #(s): 409-571-8336-024

Working Title: Medical Survey Specialist

Classification: HEALTH PROGRAM SPECIALIST II

Salary: $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: 1

Work Location: Sacramento County

Telework: Hybrid

Job Type: Permanent, Full Time

Facility: DMHC Recruitment (Drop Off)

Department Information

The mission of the Department of Managed Health Care (DMHC) is to ensure health plan members have access to equitable, high-quality, timely, and affordable health care within a stable health care delivery system. The DMHC accomplishes its mission by ensuring the health care system works for members. The Department protects the health care rights of Californians by regulating health care service plans, assisting members through a member Help Center, educating members on their rights and responsibilities and preserving the financial stability of the managed health care system.

DMHC values diversity at all levels of the organization and is committed to fostering an environment in which employees from a variety of backgrounds, cultures, and personal experiences are welcomed and can thrive. DMHC believes the diversity of our employees and their unique ideas inspire innovative solutions to further our mission. Join DMHC and help us improve the lives of all Californians.

If you are interested in learning about the Department of Managed Health Care (DMHC) culture from the perspective of someone like yourself, contact our Someone Like Me program (please check your Spam or Junk folders for our email replies). Within five business days of your request to participate in the Someone Like Me program, you will be matched with a DMHC employee with a similar background to discuss the DMHC’s culture. This program is not part of, or in any way affiliated with the application or hiring process. Prospective employees must complete the application process on Cal Careers to be considered for hire at the DMHC. None of the information you provide through the Someone Like Me program will be relayed to the Hiring Unit.

Department Website: http://www.dmhc.ca.gov

Special Requirements

• The position(s) require(s) a Background Investigation be cleared prior to being hired.

Any documents you submit for a job vacancy such as your state application, resume, cover letter, educational transcripts, etc. SHOULD NOT include ANY confidential information. Confidential information that should be excluded or removed from these documents include, but is not limited to, your Social Security Number (SSN), birthday, driver’s license number (unless required), basis of eligibility, examination results, LEAP status, marital status, and age. Confidential information on the first page of applications submitted electronically online, such as Easy ID number, SSN, examination related information, and driver’s license number will automatically be redacted upon submission.

Possession of Minimum Qualifications will be verified prior to interview and/or appointment. If you are using education to meet the minimum qualifications for this position, you must submit a copy of your high school transcripts or college/university transcript(s). Unofficial transcripts may be accepted during the application process; however, submission of official transcripts may be required prior to appointment.

Desirable Qualifications

• Analytical Skills
• Project Management Experience
• Leadership Skills
• Self-Directed and takes initiative in accomplishing projects
• Health Care Operations and/or Health Care Industry Background
• Communication Skills (Verbal and written)
• Compliance and/or audit background
• Computer Skills (e.g. proficiency in Microsoft Office Suite Software)
• Excellent work habits, punctuality and attendance
• Time Management and organizational skills
• Demonstrates professionalism

Benefits

Benefit information can be found on the CalHR website and the CalPERS website.

Contact Information

The Human Resources Contact is available to answer questions regarding the application process. The Hiring Unit Contact is available to answer questions regarding the position.

Department Website: http://www.dmhc.ca.gov

Human Resources Contact:
DMHC Recruitment
[phone]
[e-mail]

Hiring Unit Contact:
Juan Ortega-Yanez
[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 Office
[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.

Statement of Qualifications Instructions

The Statement of Qualifications (SOQ) serves as documentation of each candidate’s ability to present information clearly and concisely in writing. In two typed pages or less, using Arial 12-point font, please answer each of the following questions individually:

• Describe key aspects of your education and experience that relate to the duty statement.
• Describe what interests you in this position.

Applicants that do not submit a SOQ with their application packet will automatically be disqualified from consideration for this position. Cover letters, resumes and applications will not take the place of the SOQ.

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.