HEALTH PROGRAM SPECIALIST II

About this Role: Under the direction of the Health Program Manager II, the Health Program Specialist II (HPS II) serves as the policy and network adequacy lead within the Managed Care Quality and Monitoring Division (MCQMD). The incumbent functions as a highly skilled technical consultant, responsible for the ongoing review, reconciliation, and monitoring of MCP 274 files and network data with the Open Data Portal and Provider Application and Validation for Enrollment (PAVE). The HPS II conducts continuous analysis to identify and resolve data gaps, ensuring the most current and accurate information for the Fee-For-Service (FFS) network. The position also performs complex analyses of delivery-system and benefit transitions affecting Medi-Cal managed care members, including changes related to Community Supports and other managed care services, identifying continuity-of-care issues, provider network impacts, operational dependencies, and reporting gaps. The HPS II collaborates with MCP network adequacy teams, Community Supports program staff, and internal DHCS divisions to assess provider and network information, reconcile enrollment, authorization, and service data, and support development of standardized monitoring approaches that improve visibility into provider availability, service transitions, and emerging access issues. The incumbent evaluates provider appointment availability and new patient acceptance through systematic data analysis; develops analytical reports, dashboards, and issue briefs that synthesize managed care information; and supports readiness and post-implementation monitoring for major program, benefit, network, or delivery-system changes. As the policy and network adequacy lead, the HPS II translates analytical findings into actionable, plain-language policy updates, refines guidance to maintain alignment with DHCS Unified Information Systems (UIS) policies, and leads cross-branch and cross-divisional projects involving managed care data, provider networks, member transitions, and Community Supports. The incumbent engages stakeholders to resolve data and directory discrepancies, supports coordinated implementation activities across DHCS programs, and exercises a high degree of independence and expertise while performing functions that are sensitive and critical to the Department's mission. The position requires established knowledge of managed care, health care services, and policy development, as well as strong analytical, communication, and collaborative skills. Have questions and/or need assistance? Contact recruit@dhcs.ca.gov, we are here to help walk you through the state hiring process! You will find additional information about the job in the Duty Statement.