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Social Worker (PACE) PACE - Garden Grove
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.
Covered California Architect (ITS Architect 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.
Covered California Claims and Billing Architect (ITS Architect III) 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 Manager, Communications - Covered California (Sr Manager I) 505 City Parkway West
The Sr Manager, Communications will oversee the day-to-day development and production of communications and marketing related to CalOptima Health Covered and collaborate with the director on strategy and execution.
Lead Customer Service Rep - Covered CA Call Center 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and providers with questions related to Covered California.
Financial Analyst II (Budgeting) 505 City Parkway West
The Budget Department is responsible for planning, developing and managing the financial resources of the organization. The main responsibilities include developing and managing annual operating budgets and providing insights and recommendations to support strategic decision-making.
Manager Utilization Management Oversight and Clinical Administration 505 City Parkway West
The Utilization Management Department processes authorization requests for medically necessary services and care and ensures the member receives appropriate care while in an inpatient setting.
Medical Case Manager 505 City Parkway West
The Case Management Department oversees CalOptima Health Case Management needs for Medi-Cal and OneCare Members and Case Management regulatory requirements.
Supervisor Accounting 505 City Parkway West
The Accounting area monitors the plan’s financial condition through external audits of financial data and ensures compliance with federal and state regulations and tax filing requirements.
Program Specialist (NCQA) 505 City Parkway West
CalOptima Health's Quality Improvement (QI) department is responsible for the execution and coordination of quality assurance and improvement activities.
Accountant I 505 City Parkway West
The Accounting area monitors the plan’s financial condition through external audits of financial data and ensures compliance with federal and state regulations and tax filing requirements.
IT Product Manager Sr (Digital Solutions) 505 City Parkway West
IT provides best-in-class technology solutions that enhance the health outcomes of our members and the community we serve.
Director, Community Relations (Director III) 505 City Parkway West
The Community Relations Department strives to strengthen partnerships by enhancing communications, understanding, and mutual support between CalOptima Health and community organizations.
Data Analyst Sr, Clinical Operations 505 City Parkway West
The Clinical Operations department provides support and operational alignment between Case Management, Long-Term Support Services, Utilization Management and peers operating in a similar capacity outside of Clinical Operations.
Grievance Resolution Specialist (Provider Resolution) 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.
Sr Manager, Contracting (Sr. Manager I) 505 City Parkway West
Under the leadership and guidance of the Director of Contracting, the Sr Manager of Contracting will be responsible for the daily management and oversight of contract negotiations, contract implementation, and contract effectiveness and staff performance.
Director, Quality Analytics - Risk Adjustment (Director II) 505 City Parkway West
CalOptima Health is seeking an independent and experienced leader to oversee end-to-end risk adjustment programs for Medicare Advantage, Exchange, and Medicaid products. The Director Quality Analytics/Risk Adjustment will develop, implement, and evaluate enterprise-wide risk adjustment and interface with key stakeholders.
Part-Time - Customer Service Representative Sr (OneCare) (Bilingual Required) 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and providers with questions related to the OneCare Plan services.
Manager Quality Improvement (PQI) 505 City Parkway West
CalOptima Health's Quality Improvement (QI) department is responsible for the execution and coordination of quality assurance and improvement activities.
Customer Service Rep, Covered California 505 City Parkway West
The Customer Service Rep (Covered CA) will be the first line of contact for CalOptima Health’s members and providers.

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