Director, Information Technology (Claims, Membership, Benefits, Provider and Contact Center) (Director IV)
CalOptima
CalOptima Health is seeking a highly motivated Director, Information Technology (Claims, Membership, Benefits, Provider and Contact Center) (Director IV) to join our team. The Director will be accountable for the Information Technology (IT) strategy and execution for Claims, Membership, Benefits, Provider and Contact Center applications. This position will work closely with business leadership and the department staff to find solutions and deliver the technology required to support existing and new applications and technology. The incumbent will be responsible for the effective and efficient management and delivery of all third-party and internal IT resources to implement new systems and enhancements and ensure ongoing support.
As a member of the department's leadership team, the incumbent will contribute to the development and execution of the organizational technology strategy, ensure its alignment with the organization's business strategy and ensure the delivery of capabilities required to achieve business success. The incumbent will have extensive health plan technology experience, strong project management acumen, excellent vendor management skills, financial management expertise, and a superior, service-oriented approach to IT.
Position Information:
- Department: IT - Applications Management
- Salary Grade: 323 - $204,199 - $326,717 ($98.17 - $157.0756)
- Work Arrangement: Partial Telework
**This position is eligible for telework in California.**
Duties & Responsibilities:
- 50% - Leadership Functions
- Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
- Leads the development of IT strategy and technical roadmap and ensures its integration with overall IT and CalOptima Health strategies.
- Works with the department's leadership team on the project portfolio and governance required to prioritize resources, including budget.
- Acts as a trusted advisor and builds and maintains relationships with other internal and external IT and business leaders to develop a clear understanding of business needs. Ensures cost-effective delivery of IT services to meet those needs and can respond with the agility required to address changing business priorities.
- Develops and adheres to the annual operating and capital budgets and expenditures for infrastructure to ensure consistency with the departmental and organizational strategic objectives and remain within budget. Manages labor forecasting in support of project cost accounting.
- Champions innovative efforts in experimenting with new solutions to take advantage of business opportunities.
- Stays abreast of leading-edge and innovative solutions to the recruitment, development and retention of the IT workforce.
- Drives the adoption and commitment to continual service improvement.
- 45% - Program Oversight
- Provides strategic direction and oversight for the design, development, operation and support of systems that fulfill the needs of the business, including a deep understanding of the marketplace and technology's role in supporting the assigned systems.
- Defines, develops, and manages a comprehensive and integrated architecture for assigned systems based on best-practice processes, disciplines and toolsets.
- Operates within the established governance process to ensure that services can continue to be delivered in line with the agreed-upon business outcomes and timelines.
- Delivers effective service management through the definition and adoption of a governance practice that uses key performance indicators (KPIs) and metrics to track and measure the quality of service. Continually monitors metrics and the integration of them with key accountabilities to ensure consistency of approach and continual service improvement.
- Participates in the assessment of external and internal technology capabilities required to achieve desired competitive positioning.
- Maintains knowledge of new technologies and platforms and provides direction on what emerging technologies should be assimilated, integrated, and introduced, ensuring that technology capabilities respond to and support the needs of the business.
- Negotiates with vendor and supplier partners to enable cost-effective and innovative contracts and solutions to achieve business goals and ensure receipt of full support in line with service agreements.
- 5% - Other
- Completes other projects and duties as assigned.
Minimum Qualifications:
- Bachelor's degree in computer science, information systems or other related field PLUS 7 years of experience within information technology leadership required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- 7 years of experience in an IT senior leader roles at large health plans required.
- 7 years of experience influencing business management and key stakeholders effectively across the organization required.
- Experience with technology and business processes required to support Claims, Membership, Benefits, Provider, and Contact Center required.
- Experience in leading IT transformational initiatives in dynamic environments required.
- Experience managing staff of 30+ required.
- Experience managing large-scale consulting/contracting engagements required.
- Experience managing operational and project budgets (including project cost accounting) required.
- Extensive experience with the technology implications of a delegated provider model required.
- Extensive experience leading the implementation of best-in-class processes supported by technology for claims, membership, benefits, provider, and contact center functions.
- Demonstrated ability to manage health plan technology operations delivering consistently to best-in-class SLAs required.
- Comprehensive knowledge of the health plan core system and contact center vendor marketplace specifically for health plans and the ability to compare and contrast vendors and benefits delivered.
- Experience crafting business cases including meticulous cost estimates and quantifiable benefits.
- Extensive experience working closely with sophisticated business partners to craft a roadmap and deliver on commitments.
- Experience delivering innovative contact center solutions that improve member experience and staff productivity.
Preferred Qualifications:
- Experience leading a team responsible for Facets (claims, membership, benefits, provider) and Salesforce (CRM).
Required Licensure / Certifications:
Knowledge & Abilities:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Physical Requirements (With or Without Accommodations):
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Work Environment:
If located at the 500, 505 Building or a remote work location:
- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- There are no harmful environmental conditions present for this job.
- The noise level in this work environment is usually moderate.
If located at PACE:
- Work is typically indoors in a clinical setting serving the frail and elderly.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
If located in the Community:
- Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
- Employee will occasionally work outdoors in varied temperatures.
- There may be harmful or hazardous environmental conditions present for this job.
- The noise level in this work environment is usually moderate to loud.
About CalOptima Health:
CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!
About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the 2025 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.
IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is August 7, 2025 at 9:00 PM (PST). Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.
Communication regarding your application will be sent to the email address listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
To apply, please visit: https://jobs.caloptima.org/jobs/director-information-technology-claims-membership-benefits-provider-and-contact-center-director-iv-505-city-parkway-west-california-united-states
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