Managed Care Policy Specialist

About the role

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.

Responsibilities

• 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.
• Maintains cross-divisional coordination and collaboration with internal staff and external stakeholders to develop and implement compliance processes and policy.
• Provides policy consultation and technical assistance to departmental staff and MCPs.
• Serves as a lead responsibility over developing and writing policy, procedural review tools, and reviewing MCP procedure submissions.
• Monitors MCP adherence with issued policy, identifying areas for improvement or clarification, and MCP compliance with any reporting requirements necessary to meet federal obligations.

Requirements

This is 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.

Qualifications

The Health Program Specialist II (HPS II) position requires a bachelor's degree in a relevant field and three years of progressively responsible experience in health care policy, program development, or management. Alternatively, an equivalent combination of education and experience may be substituted. Must have a valid California driver's license and reliable transportation.

Skills

Strong communication skills, including the ability to communicate effectively (orally and in writing if both appropriate) in dealing with the public, MCP representatives, stakeholders, legislative representatives, and/or other employees. Knowledge of federal and state law, program policy, materials, tools, and equipment. Ability to research, methodologies, federal and state law, program policy, materials, tools, and equipment. Ability to complete assignments in a timely and efficient manner; and, adhere to departmental policies and procedures regarding attendance, leave, and conduct.

Benefits

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.

Pay

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.

Schedule

Beginning July 1, 2026, pursuant to Executive Order N-22-25 issued March 3, 2025, and California Department of Human Resources (CalHR) Statewide Guidance issued March 13, 2025, DHCS team members generally will be required to report in-person a minimum of four days per week unless exempted/excepted. 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.