Policy and Network Adequacy Lead

Job Description and Duties

Why Join DHCS?

The Department of Health Care Services (DHCS) is the backbone of California’s health care safety net. Our success is made possible by the hard work of more than 4,800 DHCS team members and through collaboration with the federal government and other state agencies, counties, and partners for the care of low-income families, children, pregnant women, older adults, and persons with disabilities. This is an exciting opportunity to join our diverse team in the following role. If you are interested in joining our team, apply today!

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.

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You will find additional information about the job in the .

Working Conditions

Please see the Telework and Salary Information section below for telework, reporting location, and temporary statewide salary reduction details.

Special Requirements

Simple Application Steps

If you are interested in this position, complete the following simple steps:

1. Review the education and experience minimum qualifications (MQ’s) of the

. See the Minimum Requirements section above.

1. Complete the state application by clicking “Apply Now” above. See below for detailed application instructions.
2. Submit your application package with all required documents - see the "Required Application Package Documents" section below.
3. Once you have applied, take the Health Program Specialist II Examination.

Statement of Qualifications Requirement ? Section

Applicants must include a Statement of Qualifications (SOQ) for this recruitment. The SOQ is a narrative discussion, not a cover letter, prepared by the applicant describing how their skills, knowledge, abilities, education, training, and experience, qualify them for the position. The SOQ serves as documentation of the applicant’s ability to present information clearly and provide DHCS additional information about their experience and qualifications concisely in writing. 

The SOQ must be no more than two pages in length, double-spaced and using 12-point font. You must indicate your Full Name and Job Control Number at the top right corner. 

Candidates who fail to provide an SOQ with their application or do not follow SOQ instructions may be disqualified. Resumes do not take the place of the SOQ.

1. Describe a specific experience where you independently analyzed a complex dataset or identified a data gap/discrepancy, and then converted your findings into a policy recommendation, process change, or written guidance.

2. Describe a time you led or coordinated a complex, cross-functional initiative where requirements were evolving, details were still taking shape, and priorities had to be balanced.

Desirable Qualifications

In addition to evaluating each candidate's relative ability, as demonstrated by quality and breadth of experience, the following factors will provide the basis for competitively evaluating each candidate:

The ideal candidate will demonstrate:

-Strong analytical and research abilities related to evaluating delivery-system and benefit transitions, identifying continuity-of-care risks, provider network impacts, operational dependencies, and data gaps affecting visibility into provider availability and member access, synthesizing findings and providing well-reasoned recommendations.

- Expertise in health program administration, including familiarity with Medi-Cal managed care operations, provider enrollment processes, network adequacy standards, and State/Federal regulatory frameworks.

- Advanced policy development and interpretation skills, with the ability to translate complex analytical findings into clear, actionable, plain-language policy guidance.

- Exceptional communication skills, demonstrating the ability to clearly articulate complex information in writing and verbally to diverse audiences, including MCPs, internal divisions, and external stakeholders.

- Strong project management and organizational skills, including the ability to manage multiple priorities, meet deadlines, and coordinate cross-divisional efforts in a fast-paced environment.

- Demonstrated ability to work both independently and collaboratively, exercising a high degree of initiative, sound judgment, and professional discretion when handling sensitive or mission-critical program work.

- Comfort navigating ambiguity, with the ability to interpret evolving data, balance competing considerations, and make informed decisions amidst complex situations.

- Strong interpersonal skills, including the ability to build and maintain cooperative working relationships with MCP representatives, internal DHCS divisions, and external partners.

- Commitment to program integrity and professional standards, maintaining consistent attendance, adhering to departmental policies, and upholding the quality and accuracy of all program outputs.

Benefits

DHCS is dedicated to creating an innovative workplace for its team members that is inclusive, diverse, and interactive! Here are a few of the ways we stay engaged with our team:

• Continuous and ongoing training
• Diversity, Equity, and Inclusion program activities
• Employee Assistance Program (EAP)

Additionally, as a team member of the State of California, you may be eligible for many benefits, such as:

• Medical, including 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 

provides more information about our commitment to serving Californians and organizational excellence.

We need your help! Please let us know how you heard about our position by taking this brief optional survey: . This survey is not required to be considered for this position.

Telework and Salary Information

Telework: This position is currently eligible for telework. The amount of telework is at the discretion of the Department and is subject to change consistent with DHCS’ Telework Program and Government Code sections 14200 – 14203. Telework is available to California residents, and proof of residency may be required.

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.

The DHCS office location for this position is 1501 Capitol Ave, Sacramento, CA 95814.

Salary: 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. Please reach out to the hiring unit contact listed on this job advertisement for details.

Required Application Package Documents

The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:

• Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
• Resume is optional. It may be included, but is not required.
• Statement of Qualifications - Please see Statement of Qualifications section.