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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.
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.
Customer Service Representative, Sr. (General) 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.
Customer Service Representative (General) 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.
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.
Community Relations Specialist (Bilingual Spanish Required) 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.
Intern (Facilities) 505 City Parkway West
The Environmental Health & Safety (EH&S) Facilities department for building operations ensures that all physical infrastructure complies with safety, health, and environmental regulations. It manages building inspections, hazardous materials handling, emergency systems, and routine maintenance to minimize risks and ensure occupant safety. The team also supports sustainability efforts through energy efficiency, waste reduction, and environmentally responsible facility practices.
Provider Relations Rep 505 City Parkway West
The Provider Relations group is responsible for managing operations of the provider network to ensure timely access to care for our members.
Program Assistant (Credentialing) 505 City Parkway West
CalOptima Health's Quality Improvement (QI) department is responsible for the execution and coordination of quality assurance and improvement activities.
Executive Assistant 505 City Parkway West
The Executive Assistant will provide multi-faceted administrative support and assistance to the Chief and/or Executive Director (Executive).
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.
Administrative Assistant (PACE Clinic - Scheduler) 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.
Auditor Sr (Non-Clinical) 505 City Parkway West
The Auditor Sr (Non-Clinical) will conduct routine oversight, monitoring and auditing of all internal business functions within CalOptima Health (non-clinical) to ensure compliance with state, federal and accreditation standards.
Director, Premium Billing and Member Enrollment (Director II) 505 City Parkway West
CalOptima Health is looking for a strategic thinker with a proven track record of leading a high-performing team to establish and manage the Enrollment and Billing function related to Health Insurance Exchange/Marketplace/Covered California product operations.
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.

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