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Auditor Sr (Non-Clinical) in 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.
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Sr Manager, Fraud, Waste and Abuse (Investigations) (Sr Manager I) in 505 City Parkway West
The Sr Manager I for Fraud, Waste and Abuse (FWA) will be responsible for leading the team of CalOptima Health investigators to detect, investigate and mitigate FWA issues.
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Program Manager Sr (Quality Analytics (CMS Stars)) in 505 City Parkway West
CalOptima Health is seeking an experienced Program Manager Sr to develop and implement enterprise-wide initiatives to improve Star and quality outcomes for Medicare members.
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Sr Manager, Quality Improvement (NCQA) (Sr. Manager II) in 505 City Parkway West
CalOptima Health is seeking a Sr. Manager in the Quality Improvement Department with NCQA accreditation experience to over see oversee the day-to-day operations of the National Committee for Quality Assurance (NCQA) Accreditation team and ensure CalOptima Health compliance with NCQA standards and submission processes. The position will also support the Quality Improvement Director in overseeing the Quality Improvement Health Equity Transformation Program (QIHETP) and the program structure.
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Program Specialist in 505 City Parkway West
Under general supervision, the Program Specialist (Medi-Cal and & CalAIM) will be responsible for supporting various projects related to Medi-Cal and the Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) initiatives and assisting in daily operations of services.
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