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Nurturing Care

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Director of CalAIM Operations

Los Angeles, CA · Remote

$95K - $110K/yr

Nurturing Care is seeking an experienced Director of CalAIM Operations to lead and oversee statewide operations for our Enhanced Care Management (ECM) and Community Supports (CS) programs under ...

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What are the key skills and qualifications needed to thrive as a California Advancing and Innovating Medi-Cal (CalAIM) Program Manager, and why are they important?

To thrive as a CalAIM Program Manager, you need expertise in Medi-Cal policy, program implementation, and healthcare administration, often supported by a degree in public health, healthcare management, or a related field. Familiarity with state healthcare systems, data analytics tools, project management software, and regulatory compliance is typically required. Outstanding organizational, leadership, and stakeholder communication skills help drive collaboration and effective program delivery. These skills are crucial for successfully managing complex healthcare initiatives that aim to improve care coordination and outcomes for Medi-Cal beneficiaries.

What is CalAIM and how does it work?

CalAIM (California Advancing and Innovating Medi-Cal) is a statewide initiative to improve Medi-Cal health care delivery by integrating services, expanding access, and promoting whole-person care. It involves new policies, care coordination, and data sharing to better serve Medi-Cal beneficiaries and reduce disparities.

What jobs pay 4000 a week without a degree?

Jobs that can pay $4,000 a week without a degree often include roles such as sales managers, real estate brokers, or skilled trades like electricians and plumbers, especially with experience and licensing. High-paying freelance or entrepreneurial work, such as consulting or online business, can also reach this income level, but typically require significant skills, effort, and client base development.

Who pays for CalAIM?

CalAIM is a statewide initiative funded by the California Department of Health Care Services, which allocates resources to improve health outcomes for Medi-Cal beneficiaries. Employment roles related to CalAIM may be funded through government budgets or grants, depending on the organization and project scope.

What are some common challenges faced by professionals working in CalAIM implementation roles, and how can they be addressed?

Professionals working in CalAIM (California Advancing and Innovating Medi-Cal) implementation often encounter challenges such as coordinating care across multiple providers, navigating evolving state guidelines, and managing complex member needs. Success in these roles requires strong communication and collaboration skills, as well as adaptability to policy changes and new workflows. Building effective relationships with community-based organizations and regularly participating in training or knowledge-sharing sessions can help address these challenges and ensure smooth program execution.

What is CalAIM?

CalAIM stands for California Advancing and Innovating Medi-Cal. It is a multi-year initiative by the California Department of Health Care Services (DHCS) to improve and transform the Medi-Cal program. CalAIM aims to streamline services, better coordinate care for individuals with complex needs, and address social determinants of health such as housing and behavioral health. The initiative focuses on whole-person care and integrating healthcare delivery across physical, behavioral, and social services.

What jobs make $3,000 a day?

High-earning jobs such as specialized surgeons, anesthesiologists, and certain corporate executives can earn $3,000 or more per day, often due to high skill levels, certifications, and demanding schedules. Freelance consultants, top-tier lawyers, and successful entrepreneurs may also reach this level of daily income depending on their industry and client base.

What is the difference between Calaim vs Claims Adjuster?

AspectCalaimClaims Adjuster
Required CredentialsCertification in insurance claims processing, relevant licensesInsurance license, certification in claims adjusting often preferred
Work EnvironmentInsurance companies, third-party claims firmsInsurance companies, independent adjusting firms
Industry UsageUsed mainly in insurance claim processing rolesCommonly used in insurance claim assessment and settlement

Both Calaim and Claims Adjuster roles involve evaluating insurance claims, but Calaim typically refers to a specialized certification or platform, whereas Claims Adjuster is a broader job title for professionals assessing and settling claims. Understanding these differences helps job seekers target the right roles and certifications in the insurance industry.

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What states have the most Calaim jobs? States with the most job openings for Calaim jobs include:
What job categories do people searching Calaim jobs look for? The top searched job categories for Calaim jobs are:
Calaim jobs near you
CalAIM Billing Specialist

CalAIM Billing Specialist

Volunteers of America

Los Angeles, CA • On-site

$23.75 - $25/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 4 days ago

Volunteers Of America rating

7.0

Company rating: 7.0 out of 10

Based on 124 frontline employees who took The Breakroom Quiz

321st of 707 rated non-profit organizations

Job description

About Us:
VOALA
Helping Our Most Vulnerable Change Their Life Stories
Volunteers of America is a non-profit human services organization committed to serving people in need, strengthening families, and building communities. VOALA provides a variety of social services to Los Angeles area communities such as Head Start programs, Upward Bound college prep programs, veterans' services, homeless shelters, low-income housing program as well as drug and alcohol rehabilitation. Learn more at www.voala.org.
PAY RATE: $23.75 - $25.00 Per Hour
BENEFITS: VOALA offers competitive medical, dental, vision and retirement benefits.
Continuous Quality Improvement (CQI)- Corporate
Serving those who serve others. The Continuous Quality Improvement (CQI) Department supports the programs of VOALA through data collection and validation, identifying, describing, and analyzing strengths and problems and then supporting the organization and Programs as they implement and update best practices. The CQI Department works with all VOALA programs to ensure their hard copy records and electronic databases meet legal and funder requirements, and reviews selected program procedures for compliance with funder requirements and goals. The CQI Department strives to ensure that all VOALA programs are "audit-ready".
JOB SUMMARY AND PURPOSE
Under direct supervision of CQI leadership and guidance of the CQI Billing and Records team, the CalAIM Billing Specialist I will be responsible for reviewing, submitting, and tracking claims for VOALA's Health Supportive Services division, consisting of Community Supports (CS) Housing (Housing Tenancy, Housing Deposit, Housing Navigation, and/or Recuperative Care) and Enhanced Care Management (ECM) programs, with the potential of additional CalAIM program inclusion. The role will monitor assigned CS and ECM program claims for errors and flag appropriate parties for billing corrections. The CalAIM Billing Specialist will track payments and ensure they are posted in the billing portal and accounting systems. This position will work closely with the CQI team, CalAIM Program Leadership, and accounting in order to ensure billing accuracy and timeliness. While they work within the CQI Department, this role is expected to work collaboratively with the CalAIM programs on an ongoing basis by providing support, mentorship and training. This role is responsible for maintaining member confidentiality and information security at all times.
DUTIES AND RESPONSIBILITIES
  • The CalAIM Billing Specialist will ensure clean CS Housing and ECM claims are submitted through the billing portal and clearinghouse.
  • Monitor billing errors that could involve issues around data entry for services in queue (i.e. units of services, time start and end time, etc.) and notify responsible parties to make timely corrections.
  • Monitor and review denied claims and resubmit with corrected billing errors.
  • Track all payments and ensure they are posted in the billing portal and all accounting systems.
  • Support, coach, and train CalAIM program staff and team members in billing processes.
  • Maintain and store all billing supportive documentation in designated Information System, as required by State guidelines.
  • Assist in maintaining confidential records of members served.
  • Maintain active accounts in all billing-related and Insurer portals.
  • Conduct program site visits, as assigned by need.
  • Develop, record, and distribute monthly reports, and/or general information, as needed.
  • Support, as needed, with generating CalAIM services in billing portal and submit to designated Program Leadership.
  • Assist leadership in reconciling data, as needed.
  • Interact with accounting to ensure accuracy in billing and payments received.
  • Remain current in updates made by Insurers, the state, and other regulatory bodies to ensure ongoing compliances and upholding best billing practices.
  • Other duties as may be assigned by CQI Leadership.

ESSENTIAL DUTIES
  • An essential function of this position requires incumbents to report to the office.
  • Submit clean claims in billing portals
  • Monitor and support in correcting billing errors
  • Resubmit denied claims with necessary corrections
  • Track and document claims payments
  • Train and coach CalAIM team members
  • Other duties as required and is subject to change at any time.

MANDATED REPORTER
As service providers to the underprivileged and vulnerable in our community, all employees are considered Mandated Reporters, and must report any instance of physical or sexual abuse to proper authorities.
Qualifications
REQUIREMENTS:
  • Must be able to pass a fingerprint clearance, background check, including criminal history, personal references, employment and education verifications
  • Ability to perform under circumstances of possible emotional stress and conflicts dealing with difficult, uncooperative, and potentially aggressive clients as VOALA serves the neediest of the needy in our programs which may include clients with homelessness, mental-illness, substance abuse, recently released from incarceration and other challenges.

EDUCATION:
  • Associate Degree or equivalent combination of education and work experience (2 years of relevant experience / coursework)

EXPERIENCE:
  • 1 year of experience with billing.
  • 1 years of experience in Electronic Health Record database operations and/or billing submissions.

PREFFERED QUALIFICATIONS:
  • Bachelor Degree
  • Medi-Cal billing certificate
  • Medi-Cal billing experience
  • Experience with CalAIM

Volunteers of America is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.
This employer participates in E-Verify as required by the federal government and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.
If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment.

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