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Intern (Community Relations)
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505 City Parkway West
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| The Community Relations Department strives to strengthen partnerships by enhancing communications, understanding, and mutual support between CalOptima Health and community organizations. |
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Auditor Sr (Non-Clinical)
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505 City Parkway West
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| The Claims Administration Department is responsible for managing and processing of all medical claims in accordance with industry standards and regulations, ensuring accuracy and timely reimbursement to healthcare providers. |
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Manager Grievance & Appeals (Provider Services)
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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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Sr Manager, Fraud, Waste and Abuse (Investigations) (Sr Manager I)
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505 City Parkway West
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| The Sr Manager I for Fraud, Waste and Abuse (FWA) will be responsible for leading the team of CalOptima Health investigators to detect, investigate and mitigate FWA issues. |
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Program Manager Sr (Quality Analytics (CMS Stars))
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505 City Parkway West
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| CalOptima Health is seeking an experienced Program Manager Sr to develop and implement enterprise-wide initiatives to improve Star and quality outcomes for Medicare members. |
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Sr Manager, Quality Improvement (NCQA) (Sr. Manager II)
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505 City Parkway West
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| CalOptima Health is seeking a Sr. Manager in the Quality Improvement Department with NCQA accreditation experience to over see oversee the day-to-day operations of the National Committee for Quality Assurance (NCQA) Accreditation team and ensure CalOptima Health compliance with NCQA standards and submission processes. The position will also support the Quality Improvement Director in overseeing the Quality Improvement Health Equity Transformation Program (QIHETP) and the program structure. |
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Program Specialist
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505 City Parkway West
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| Under general supervision, the Program Specialist (Medi-Cal and & CalAIM) will be responsible for supporting various projects related to Medi-Cal and the Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiatives and assisting in daily operations of services. |