CalAIM Program Lead (Temporary) in Los Angeles, California at United American Indian I Inc

United American Indian Involvement (UAII) is the only Urban Indian Organization in Los Angeles County, proudly serving as a home for American Indian and Alaska Native communities. Through our healthcare facility and culturally centered programs, we provide essential physical, behavioral, and spiritual health services—helping individuals stay connected to their Tribal heritage and traditions.

For over 50 years, UAII has grown to become the largest nonprofit provider of health and human services for American Indians and Alaska Natives in Los Angeles, home to the nation’s largest Urban Indian population. Our dedicated team delivers compassionate care that supports daily healing, resilience, and the continued strength of our communities. UAII is committed to uphold Indigenous values in all aspects of our work. It guides our actions, relationships, and responsibilities, ensuring that we serve our communities with integrity, respect, and accountability.

Core Principles

• Respect for Relatives – I will honor the dignity of all people, recognizing that every individual is a relative deserving of respect, compassion, and care.
• Community Responsibility – My work is not only for individual benefit but for the collective well-being of our communities, present and future.
• Cultural Integrity - I will safeguard and uplift Indigenous languages, traditions, and cultural practices, ensuring they remain central to our organizational life.
• Reciprocity - We give back in balance with what we receive, fostering mutual trust and accountability in all relationships.
• Stewardship – I will act as a caretaker of our communities, resources, and environment, mindful of the impact of our decisions on future generations.
• Truth and Transparency – I will communicate honestly and openly, ensuring clarity in our commitments and accountability in our actions

CalAIM Program Lead (Temporary) is a grant funded position.

Position Summary

The CalAIM Program Lead is a position responsible for the full implementation, management, and growth of United American Indian Involvement's (UAII) CalAIM Community Supports (CS) and Community Health Worker (CHW) programs under the California Advancing and Innovating Medi-Cal (CalAIM) initiative. This role operationalizes UAII's contractual obligations under multiple programs and ensures high-quality, culturally responsive, and contractually compliant service delivery to eligible Medi-Cal beneficiaries.

The CalAIM Program Lead develops and maintains policies, procedures, and standard operating procedures (SOPs), manages program budgets, ensures compliance with DHCS All Plan Letters (APLs) and program contract requirements, and leads strategic efforts to expand UAII's CalAIM service footprint. This position plays a critical role in positioning UAII as a leading Community Supports provider within the urban American Indian and broader Los Angeles County community.

Essential Functions

Program Implementation & Operations

• Lead the full implementation of UAII's CalAIM CS and CHW programs, from service delivery and continuous quality improvement.

• Establish and maintain operational workflows for member referral intake, 24-hour outreach response, service delivery, care coordination, and case closure.

• Ensure program readiness to meet all contractual timelines, including 24-hour outreach requirements and 24/7 phone line staffing.

• Monitor caseload capacity and staffing levels to ensure timely, high-quality service delivery per contract.

• Serve as the primary operational point of contact for CalAIM program matters.

Policy, Procedure & SOP Development

• Develop, implement, and maintain program-specific policies and procedures governing all CalAIM CS and CHW service lines.

• Author and maintain Standard Operating Procedures (SOPs) for member intake, outreach, service delivery, documentation, PHI/data sharing authorization, billing, and case closure.

• Ensure SOPs reflect current DHCS All Plan Letters (APLs), including APL 19-004 (Provider Credentialing), APL 22-016 (CHW Services), and any subsequent updates.

• Develop and maintain written care plan protocols for CHW services, including 6-month review procedures and 12-visit authorization thresholds.

• Create staff-facing reference materials, training guides, and decision trees to support consistent, compliant service delivery.

Budget Management & Financial Oversight

• Develop, manage, and monitor the CalAIM program budget, including personnel, operations, and direct service expenditures.

• Track program revenue against contracted rates and ensure billing targets are met to sustain program operations.

• Work with the finance team to ensure accurate and timely claims submission and payment reconciliation per contract.

• Monitor Housing Deposit expenditures against the $6,000 per-member lifetime maximum and maintain fiscal controls.

• Prepare budget projections, variance reports, and financial narratives for leadership and funder reporting.

Billing, Claims & Compliance

• Oversee submission of all CS and CHW claims and invoices to CalAIM provider using DHCS-required HCPCS codes and modifiers.

• Ensure claims are submitted in compliance with DHCS national standard specifications and code sets.

• Ensure CHWs obtain individual National Provider Identifier (NPI) numbers and that NPIs are included on all claims.

• Monitor claims payment timelines — 90% of clean claims within 30 days, 99% within 90 days, and escalate discrepancies to CalAIM provider as needed.

• Ensure prior authorization workflows are in place for all services requiring CalAIM provider approval.

• Oversee PHI data sharing authorization processes per HIPAA and contract requirements.

Care Coordination & Collaboration

• Ensure UAII program staff coordinate effectively with Members' care teams, including ECM Providers, Primary Care Providers (PCPs), and CalAIM provider care managers.

• Lead or facilitate care team meetings, case conferences, and partnership meetings as needed.

• Develop and maintain referral acceptance protocols and track program capacity to manage member assignments.

• Ensure transition planning protocols are in place when CS or CHW services are discontinued for any reason.

• Proactively identify opportunities to request additional CS services for members and coordinate authorization requests.

Program Growth & Strategic Development

• Develop and execute a CalAIM program growth strategy to expand UAII's contracted CS service lines with other Medi-Cal managed care plans.

• Monitor DHCS policy developments, new CalAIM APLs, and emerging CS service categories and position UAII to adopt new service lines as they become available.

• Build and maintain relationships with referral partners, ECM providers, housing agencies, and community-based organizations to grow the member pipeline.

• Develop program metrics, dashboards, and outcome reports to demonstrate program impact and support contract renewals and expansions.

• Represent UAII in external CalAIM stakeholder meetings, coalitions, and funder convenings.

Quality Assurance & Compliance

• Implement a quality assurance framework to monitor service timeliness, documentation accuracy, member outcomes, and billing integrity.

• Prepare for and support CalAIM programs quality oversight activities, including audits, required reporting, and corrective action plans.

• Conduct internal audits of member files, claims, and care plans to ensure ongoing compliance with program requirements.

• Ensure all staff comply with cultural competency, linguistic access, and non-discrimination requirements under federal, State, and local law.

Cultural Competency & Equity

• Deliver services in a culturally and linguistically competent manner consistent with the needs of the urban American Indian and Indigenous population, and all other communities served.

• Comply with cultural competency and linguistic requirements under Federal, State, and Local laws.

• Comply with non-discrimination requirements set forth in State and Federal law and program agreements.

You may perform all elements of this position or identified components, other duties as assigned or required for the purpose of the position or for organizational efficiency and effective client service

• Bachelor's degree in Public Health, Social Work, Health Administration, Business Administration, or a related field required. A comparable combination of education, professional experience, and/or relevant lived experience will be considered.

• Minimum three (3) years of progressively responsible experience in program management, health care administration, or community-based services.

• Minimum one (1) year of supervisory experience managing direct service staff.

• Knowledge of CalAIM, Medi-Cal managed care, and/or DHCS Community Supports programs required.

• Demonstrated experience developing policies, procedures, and/or SOPs for health or social service programs.

• Experience managing program budgets, including tracking expenditures, projecting revenue, and preparing financial reports.

• Familiarity with Medi-Cal billing, HCPCS coding, and managed care claims processes.

• Strong written and verbal communication skills, including the ability to produce professional reports, SOPs, and correspondence.

Preferred Qualifications (Education & Experience)

• Master's degree strongly preferred.

• Experience working within an American Indian/Alaska Native or urban Indigenous serving organization.

• Lived experience that reflects the communities served (housing instability, behavioral health, homelessness, etc.) is valued.

• Experience managing contracts with Medi-Cal managed care plans (Health Net, LA Care, Molina).

• Knowledge of Enhanced Care Management (ECM) and its intersection with Community Supports.

• Bilingual/bicultural capacity; fluency in Spanish or an Indigenous language is a plus.

• Experience with electronic health records (EHR) and/or care management platforms.

Knowledge, Skills, Abilities, and Competencies

• Strategic Leadership — Ability to set program direction, build team capacity, and drive growth in a complex regulatory environment.

• Systems Thinking — Understands how clinical, operational, financial, and compliance functions intersect in a managed care setting.

• Cultural Humility — Deep commitment to equity and culturally responsive service delivery for urban Indigenous and other underserved communities. Ability to interact professionally, compassionately, and respectfully with individuals experiencing crisis, housing instability, mental health challenges, or other complex barriers, while maintaining appropriate boundaries and a participant-centered approach.

• Operational Rigor — Skilled at building and managing systems, workflows, SOPs, and accountability structures.

• Financial Acumen — Comfortable managing budgets, analyzing billing data, and driving revenue performance.

• Relationship Building — Effective at cultivating partnerships with managed care plans, ECM providers, and community stakeholders.

• Communication — Communicates clearly and professionally in writing and verbally, including with executive leadership, funders, and health plan partners.

Conditions of Hire

• Eligibility to work in the U.S.
• Fingerprint clearance and post-offer drug test.
• Proof of hepatitis B vaccination and TB screening.
• UAII strongly encourages COVID-19 and Influenza vaccinations; in the absence of the recommended vaccinations, employees are advised to wear a mask while on company premises.
• If applicable, if driving for company business, a valid driver license is required.

Benefits

· Medical, Dental, and Vision Coverage

· Voluntary Accident, Critical Illness, and Hospital Indemnity Insurance Plans

· Company-paid Short-Term & Long-Term Disability

· Company-paid Basic Life Insurance and AD&D

· HSA, FSA

· 403(b) Retirement Plan with 4% Employer Match

· Employee Assistance Program

· Bereavement and Jury Duty Paid Leave

· Employee Wellness Program

· Paid Vacation

Working Conditions

The work environment characteristics described here represent those employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to stand and/or sit. The employee is occasionally required to walk, sit and climb or balance. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, peripheral vision and depth perception.

United American Indian Involvement, Inc. (UAII) provides equal employment opportunities (EEO) to all employees and applicants for employment. All qualified applicants will receive consideration for employment without regard to any protected status under federal, state, or local law. UAII is a drug-free workplace and complies with ADA regulations. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

UAII is committed to providing reasonable accommodations for qualified individuals with disabilities and for sincerely held religious beliefs, in accordance with applicable law.