Teams at Central California Alliance for Health

Supports the Alliance grievance function by assisting with low-complexity case administration and resolution. Tracks, organizes, monitors, and follows up on casework; participates in training, workgroups, and operational improvement activities. Requires knowledge of managed healthcare, benefit structures, medical billing, grievance regulations, conflict resolution, and Medi-Cal member needs. The role also drafts correspondence and communicates with members, providers, and internal departments.

Manages individualized pediatric care plans for complex case management members, coordinating with families, providers, agencies, and internal teams. Educates stakeholders, evaluates medical records and healthcare data, applies clinical and regulatory guidelines, and supports quality improvement initiatives. Requires a California RN license, nursing education, pediatric patient-care experience, and case management experience. This is a full-time temporary hybrid position.

Designs and validates managed care payer models, performs financial and scenario analysis to evaluate payer reimbursement methodologies, and collaborates with internal and external stakeholders to achieve payer reimbursement objectives.