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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.
Member Liaison Specialist (Behavioral Health) 505 City Parkway West
The Behavioral Health Integration Department directly manages Behavioral Health Services for CalOptima Health Medi-Cal and OneCare Members.
Clinician Sr (Behavioral Health)(Clinical/Care Management) 505 City Parkway West
The Behavioral Health Integration Department directly manages Behavioral Health Services for CalOptima Health Medi-Cal and OneCare Members.
Financial Analyst II (Decision Support) 505 City Parkway West
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, and participate in annual budgeting functions.
Y AS-NEEDED - Clinical Pharmacist 505 City Parkway West
Pharmacy Management provides strategic leadership and operational oversight for all aspects of pharmacy services within a managed care organization.
Y AS-NEEDED - Pharmacy Services Specialist 505 City Parkway West
Pharmacy Management provides strategic leadership and operational oversight for all aspects of pharmacy services within a managed care organization.
Claims Examiner 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.
Project Manager II 505 City Parkway West
CalOptima Health Enterprise Project Management Office (EPMO) is recruiting for a Project Manager II.
Business Analyst Sr (Covered California) 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.
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.
Care Manager (OneCare) 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.
Customer Service Rep Sr (Behavioral Health) 505 City Parkway West
The Customer Service team provides information regarding eligibility, enrollment, benefits and assists members and provider with questions related to the Medi-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.
Social Worker (MSSP) 505 City Parkway West
This Social Worker (MSSP) will assess prospective members for the various programs available and will be responsible for developing, implementing, monitoring, modifying and documenting care plans.
Provider Data Management Services Coordinator Sr 505 City Parkway West
The Provider Data Management Services department is responsible for managing operations of the provider network to ensure timely access to care for our members.
Facilities Coordinator 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.
Manager Community Relations 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.
Program Manager, Medicare Insights and Operations 505 City Parkway West
The Program Manager for Medicare Insights and Operations will play a vital role in the program design, development, implementation and support of department initiatives and programs for the Medicare line of business.
Claims Resolution Specialist (Customer Service) 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.
Manager Customer Service, Enrollment & Premium Billing (Covered California) 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.

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