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Project Manager, Strategic Planning & Growth Advisor (Project Manager IV) in 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.
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Sr. Program Manager, Behavioral Health (Program Manager Sr.) in 505 City Parkway West
The Behavioral Health Integration Department directly manages Behavioral Health Services for CalOptima Health Medi-Cal and OneCare Members.
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Grievance & Appeals Nurse Specialist in 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.
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Claims Examiner in 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.
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Program Specialist Int in 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.
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