Policy and Network Adequacy Lead

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

Benefits offered by this job

Hybrid work

Telework eligible

Medical, dental, and vision insurance

Paid holidays and vacation

Job summary

California Department of Health Care Services seeks a Health Program Specialist II to lead policy and network adequacy efforts within the MCQMD. The role analyzes provider data, reconciles enrollment and service information, and develops dashboards and briefs to guide program decisions.

The incumbent translates findings into policy updates, partners across divisions, and supports implementation and monitoring of major system changes to safeguard access for Medi‑Cal members.

Qualifications

• Knowledge of managed care and health care services.
• Experience in policy development and implementation.
• Strong analytical, communication, and collaborative skills.
• Ability to translate analysis into actionable policy updates.

Responsibilities

• Review, reconcile, and monitor MCP 274 files and network data.
• Develop analytical reports, dashboards, and issue briefs.
• Collaborate with MCP network adequacy teams and program staff.
• Support readiness and monitoring for major program, benefit, or delivery-system changes.

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.

About this Role

Under the direction of the Health Program Manager II, the Health Program Specialist II (HPS II) serves as the policy and network adequacy lead within the Managed Care Quality and Monitoring Division (MCQMD). The incumbent functions as a highly skilled technical consultant, responsible for the ongoing review, reconciliation, and monitoring of MCP 274 files and network data with the Open Data Portal and Provider Application and Validation for Enrollment (PAVE). The HPS II conducts continuous analysis to identify and resolve data gaps, ensuring the most current and accurate information for the Fee-For-Service (FFS) network. The position also performs complex analyses of delivery-system and benefit transitions affecting Medi-Cal managed care members, including changes related to Community Supports and other managed care services, identifying continuity-of-care issues, provider network impacts, operational dependencies, and reporting gaps. The HPS II collaborates with MCP network adequacy teams, Community Supports program staff, and internal DHCS divisions to assess provider and network information, reconcile enrollment, authorization, and service data, and support development of standardized monitoring approaches that improve visibility into provider availability, service transitions, and emerging access issues. The incumbent evaluates provider appointment availability and new patient acceptance through systematic data analysis; develops analytical reports, dashboards, and issue briefs that synthesize managed care information; and supports readiness and post-implementation monitoring for major program, benefit, network, or delivery-system changes.

As the policy and network adequacy lead, the HPS II translates analytical findings into actionable, plain-language policy updates, refines guidance to maintain alignment with DHCS Unified Information Systems (UIS) policies, and leads cross-branch and cross-divisional projects involving managed care data, provider networks, member transitions, and Community Supports. The incumbent engages stakeholders to resolve data and directory discrepancies, supports coordinated implementation activities across DHCS programs, and exercises a high degree of independence and expertise while performing functions that are sensitive and critical to the Department’s mission. The position requires established knowledge of managed care, health care services, and policy development, as well as strong analytical, communication, and collaborative skills.

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

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-534114

Position #(s): 805-149-8336-XXX

Working Title: Policy and Network Adequacy Lead

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: Permanent, Full Time

Department Information 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.

Telework and Salary Information

Telework: This position is currently 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.

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

DHCS 2023-2027 Strategic Plan provides more information about our commitment to serving Californians and organizational excellence.

We need your help! Please let us know how you heard about our position by taking this brief optional survey: SurveyMonkey link . This survey is not required to be considered for this position.

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.