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Collibra Administrator - Data Governance (Programmer Sr)
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505 City Parkway West
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| Information Technology provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve. |
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Supervisor Information Technology Services (Infrastructure)
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505 City Parkway West
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| The Supervisor Information Technology Services will assist the manager with overseeing technical assistance regarding hardware/software related requests through Information Technology Service Management (ITSM) elements such as incident management and request fulfillment. |
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Program/Policy Analyst Sr (Medi-Cal Compliance)
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505 City Parkway West
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| The Program/Policy Analyst Sr (Medi-Cal Compliance) will coordinate and maintain CalOptima Health’s relationship with regulatory agencies and ensure CalOptima Health and its First Tier, Downstream and Related Entities (FDRs) comply with all appropriate standards, regulations, contractual provisions, federal waivers and laws. |
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Buyer, Sr.
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505 City Parkway West
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| Vendor Management is responsible for obtaining goods and services needed by CalOptima, ensuring compliance with all statutes and regulations regarding public procurement. |
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Customer Service Representative Sr (OneCare) (Bilingual Required)
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505 City Parkway West
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| The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and providers with questions related to the OneCare Plan services. |
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Director, Medicare Program Development (Director III)
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505 City Parkway West
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| The Director III (Medicare Program Development) will be responsible for leadership, plan management and operations of CalOptima Health’s Medicare lines of business, including the Program of All Inclusive Care for the Elderly (PACE) health plan operations. |
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Director, Sales and Marketing (Director I)
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505 City Parkway West
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| The Director I (Sales and Marketing) will be responsible for strategizing and planning to maximize enrollment in CalOptima Health’s competitive lines of business including Medicare Advantage Special Needs Plan (OneCare), Program of All-Inclusive Care for the Elderly (PACE) and CalOptima Health’s insurance product offered in the California health care marketplace, Covered California. |
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Regulatory Affairs and Compliance Analyst (Medicare)
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505 City Parkway West
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| The Regulatory Affairs and Compliance Analyst (Medicare) will coordinate and maintain CalOptima Health’s relationships with regulatory agencies, including but not limited to supporting, enhancing and strengthening CalOptima Health’s policy infrastructure, platform and strategy at the state and federal level. |
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Data Analyst, Sr. (Quality Analytics)
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505 City Parkway West
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| Quality Analytics is responsible for working to improve performance on quality measures including clinical, access and member experience metrics. Quality Analytics works on priorities established with leadership, and collaborates with internal department business owners and external providers on strategy, reporting and interventions. |
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Customer Service Representative (OneCare) (Bilingual Required)
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505 City Parkway West
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| The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and providers with questions related to the OneCare Plan services. |
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Member Liaison Specialist (Behavioral Health)
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505 City Parkway West
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| The Behavioral Health Integration Department directly manages Behavioral Health Services for CalOptima Health Medi-Cal and OneCare Members. |
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Grievance & Appeals Nurse Specialist
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505 City Parkway West
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| The Grievance and Appeals Resolution Services (GARS) Department is responsible for coordinating thorough reviews to provide appropriate resolutions to verbal and written complaints, appeals and disputes for both members and providers. |
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Grievance Resolution Specialist
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505 City Parkway West
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| The Grievance and Appeals Resolution Services (GARS) Department is responsible for coordinating thorough reviews to provide appropriate resolutions to verbal and written complaints, appeals and disputes for both members and providers. |
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Quality Improvement Specialist (Equity & Practice Transformation Program)
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505 City Parkway West
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| CalOptima Health is seeking a quality specialist to develop training materials and educate providers on quality principles and methods to improve health outcomes and member satisfaction. |
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Sr Manager, Marketplace Program Development (Sr Manager II)
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505 City Parkway West
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| Strategic Development is responsible for oversight and facilitation of effective strategy planning and execution by developing, implementing, managing, and coordinating strategic priorities and key processes through organizational alignment, cross-collaboration, and operational improvement to achieve CalOptima Health goals and objectives. |
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LVN (PACE)
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PACE - Garden Grove
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| PACE is a health services plan designed for people of age 55 and older, who have ongoing health care needs. The services provided are all inclusive and authorized by the interdisciplinary team. |
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Customer Service Coordinator (OneCare Call Center) (Bilingual Required)
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505 City Parkway West
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| The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and providers with questions related to the OneCare Plan services. |
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Actuarial Analyst
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505 City Parkway West
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| The Financial Analysis Department is responsible for the development of various financial models used to forecast medical cost trends, provide support for provider contract negotiations, assess actuarial rate development studies, participate in annual budgeting functions. |
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Director, Quality Initiatives (Director III)
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505 City Parkway West
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| CalOptima Health is seeking a seasoned leader to oversee quality improvement initiatives to improve Medi-Cal and Medicare quality ratings. |
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Grievance Resolution Specialist (Provider Resolution)
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505 City Parkway West
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| The Grievance and Appeals Resolution Services (GARS) Department is responsible for coordinating thorough reviews to provide appropriate resolutions to verbal and written complaints, appeals and disputes for both members and providers. |