Expression of interest

Loading...

Current opportunities

Position Location Closes
Supervisor Facilities 505 City Parkway West
The Facilities Department is responsible for maintaining the functionality, safety, and efficiency of our buildings to support the company’s operations, employee well-being and services to our members.
Pharmacy Resident 505 City Parkway West
Pharmacy Management provides strategic leadership and operational oversight for all aspects of pharmacy services within a managed care organization.
Project Manager, Strategic Planning & Growth Advisor (Project Manager IV) 505 City Parkway West
The Strategic Planning & Growth Advisor will be responsible for strategic alignment and integration across programs and projects in support of Strategic Development department’s process and administrative efficiency.
Sr. Program Manager, Behavioral Health (Program Manager Sr.) 505 City Parkway West
The Behavioral Health Integration Department directly manages Behavioral Health Services for CalOptima Health Medi-Cal and OneCare Members.
Grievance & Appeals Nurse Specialist 505 City Parkway West
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.
Claims Examiner 505 City Parkway West
The Claims Examiner analyzes, and processes claims.  This position is responsible for following regulatory and internal guidelines in conjunction with CalOptima policies and procedures as they apply to claims adjudication.   The Claims Examiner is responsible to adjudicate claims that require minimal research and problem solving. 1 - 2 years of health claims processing background.  Knowledge of Medicare or Medi-Cal processing line of business preferred.   Examiner is expected to adjudicate tier one claim types with attention to detail in order that high quality standards are met. The challenge of consistently and accurately processing an increased volume of claims in a production environment is attainable with appropriate staffing levels. The return on the investment is that approval of this position will allow us to continue meeting regulatory compliance and timeliness requirements.
Program Specialist Int 505 City Parkway West
The Provider Data Operations department is responsible for managing operations of the provider network to ensure timely access to care for our members.
Intern (Communications) 505 City Parkway West
The Communications department is here to create, support, implement and direct CalOptima’s internal and external communications in a manner that promotes and preserves CalOptima, its mission, and strategic goals and objectives.
Sr. Program Manager, Strategic Initiatives 505 City Parkway West
The Program Manager Sr for Strategic Initiatives plays a vital role in the program design, development, implementation and overall support of strategic initiatives, pilots and programs related to the department’s priorities.
Program Manager, Real Estate and Construction Management 505 City Parkway West
The Facilities Department is responsible for maintaining the functionality, safety, and efficiency of our buildings to support the company’s operations, employee well-being and services to our members.
Program Specialist, Customer Service 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and provider with questions related to the Med-Cal programs.
Director, Information Technology – Clinical, (Utilization Management, Care Management, and Grievance & Appeals) (Director IV) 505 City Parkway West
IT provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve.
Sr. Program Manager, Public Policy (Program Manager Sr) 505 City Parkway West
The Program Manager Sr for Public Policy will play a vital role in the design, development, implementation and overall support of public policy priorities and initiatives to further the goals of CalOptima Health.
Sr Manager, Individual and Family Plans (Sr Manager II) 505 City Parkway West
The Sr Manager for Individual and Family Plans will be responsible for supporting the development of new programs and initiatives related to the implementation and ongoing management of new product lines, including commercial.
ITS Architect IV (Release Train Engineer/SDLC Architect) 505 City Parkway West
The ITS Architect IV (Release Train Engineer/Agile Software Development Life Cycle (SDLC)) will define the enterprise Agile Release Trains (ARTs) and SDLC methodology for CalOptima Health to enhance team collaboration, cross-functionality and delivery efficiency.
Communications Specialist, Sr. 505 City Parkway West
The Communications Specialist Sr will write, create, edit and produce materials to ensure effective internal and external communication for CalOptima Health’s programs and activities.
Member Liaison Specialist (Customer Service) - Bilingual 505 City Parkway West
The Member Liaison Specialist (Customer Service) will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program.
Lead Decision Support Analyst (Principal Financial Analyst) 505 City Parkway West
The Principal Financial Analyst (Decision Support) will be responsible for providing highly complex analysis, guidance and expert knowledge on health care finance for various departments within CalOptima Health.
Claims Examiner Sr 505 City Parkway West
The Claims Examiner Sr. analyzes and processes claims. This position is responsible for following regulatory and internal guidance in conjunction with CalOptima policies and procedures as they apply to claims adjudication. The Claims Examiner is responsible to adjudicate claims that require minimal research and problem solving. 3-4 years of health claims processing background. Knowledge of Medicare and Medi-Cal processing preferred. Examiner is expected to adjudicate tier one claim type with attention to detail in order that high quality standards are met. The challenge of consistently and accurately processing an increased volume of claims in a production environment is attainable with appropriate staffing levels. The return on the investments is that the approval of this position will allow us to continue meeting regulatory compliance and timeliness requirements.
Sr Manager, Operation and Business Configuration (Sr Manager I) 505 City Parkway West
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.

More Jobs 1