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29 jobs found
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  • Category:
    • Other (21)
    • Health Care (18)
    • Management (15)
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  • Company:
    CalOptima (off)
  • City:
    • Orange (29)
  • State:
    • California (29)
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QI NURSE SPECIALIST (PQI) (13010-042015) - View similar jobs
Job type: Full-Time
Participates in managing the organization's clinical grievance review process including investigation of all quality reviews for potential quality of...
CalOptima
CA - Orange
Today
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PROJECT MANAGER (HEDIS MEDICAL RECORD REVIEW) (13052-041615) - View similar jobs
Job type: Full-Time
This position is responsible for management of the HEDIS medical record review project from initiation through submission of HEDIS results to state...
CalOptima
CA - Orange
4 Days Ago
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Medical Case Manager (Ambulatory RN) (14192-041515) - View similar jobs
Job type: Full-Time
Care Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima members. The...
CalOptima
CA - Orange
5 Days Ago
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Grievance Resolution Specialist (15128-041515) - View similar jobs
Job type: Full-Time
Coordinate the overall process of complaint resolution, responding to all verbal and written complaints from members and/or providers relating to...
CalOptima
CA - Orange
5 Days Ago
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Medical Case Manager (Health Risk Assessment) (14269-14270-041415) - View similar jobs
Job type: Full-Time
This position will support the members in completing their health risk assessment (HRA) and development of an initial care plan. The HRA RN will meet...
CalOptima
CA - Orange
6 Days Ago
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Provider Relations Representative (06679-041415) - View similar jobs
Job type: Full-Time
Under the direction of the Manager, Member Outreach, Education, Provider Relations, this individual assists with the development and maintenance of...
CalOptima
CA - Orange
6 Days Ago
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TECHNICAL ANALYST, INT. (15090-041015) - View similar jobs
Job type: Full-Time
The role of this position is to provide technical analysis and support in the implementation of business applications and programs used at CalOptima...
CalOptima
CA - Orange
1 Week Ago
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TECHNICAL ANALYST, INT. (15082-041015) - View similar jobs
Job type: Full-Time
The role of this position is to provide technical analysis and support in the implementation of business applications and programs used at CalOptima...
CalOptima
CA - Orange
1 Week Ago
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SUPERVISOR, CUSTOMER SERVICE (MEMBER ENROLLMENT) (96142-041015) - View similar jobs
Job type: Full-Time
The Supervisor for Member Enrollment is responsible for daily operation of the Enrollment & Reconciliation (E&R) unit within customer service. The...
CalOptima
CA - Orange
1 Week Ago
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MEDICAL AUTHORIZATION ASSISTANT- PRIOR AUTH (14176-14177-14178-040815) - View similar jobs
Job type: Full-Time
The Medical Authorization Assistant (MA) provides office and referral management services. The MA serves as a contact between members, physicians...
CalOptima
CA - Orange
1 Week Ago
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Manager, Accounting (Payroll) (14139-040715) - View similar jobs
Job type: Full-Time
The Payroll Manager will be responsible to manage, direct, control and process the company’s payroll and all other payroll related duties. The Manager...
CalOptima
CA - Orange
1 Week Ago
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SR. CLAIMS EXAMINER (14255-14321-36-041514) - View similar jobs
Job type: Full-Time
The Senior Claims Examiner analyzes and processes claims. This position is responsible for following regulatory and internal guidelines in conjunction...
CalOptima
CA - Orange
2 Weeks Ago
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DIRECTOR, AUDIT AND OVERSIGHT (14327-040115) - View similar jobs
Job type: Full-Time
This position oversees and conducts independent performance audits of CalOptima operations, Pharmacy Benefits Manager (PBM) operations and Provider...
CalOptima
CA - Orange
2 Weeks Ago
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Executive Director, Compliance (13121-033115) - View similar jobs
Job type: Full-Time
The Executive Director of Compliance shall serve as the Compliance Officer for the organization. The Executive Director coordinates and communicates...
CalOptima
CA - Orange
2 Weeks Ago
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Health Network Liaison Specialist (14306-033115) - View similar jobs
Job type: Full-Time
The Health Network Liaison Specialist is a liaison between the networks or groups and CalOptima regarding coordination of care and / or service issues...
CalOptima
CA - Orange
2 Weeks Ago
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HR REPRESENTATIVE (ANALYST) (13032-033015) - View similar jobs
Job type: Full-Time
Under general supervision, provides technical support related to human resources information and business processes for the Human Resources Department...
CalOptima
CA - Orange
3 Weeks Ago
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ONECARE CONNECT CUSTOMER SERVICE REPRESENTATIVE (14224-14225-14226-14227-14228-14229-14230-032715) - View similar jobs
Job type: Full-Time
This position will provide telephonic customer service to potential and newly enrolled OneCare Connect members, facilitating the direction of each...
CalOptima
CA - Orange
3 Weeks Ago
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Social Worker (In Home Supportive Services Liaison) (15122-032615) - View similar jobs
Job type: Full-Time
This position provides care coordination between CalOptima, health networks, the Orange County Social Services Agency (SSA) In Home Supportive...
CalOptima
CA - Orange
3 Weeks Ago
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Supervisor, Health Education (96246-032615) - View similar jobs
Job type: Full-Time
The Supervisor of Health Education will be responsible for daily operation of health education activities and supervision of health education staff...
CalOptima
CA - Orange
3 Weeks Ago
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Supervisor, OneCare Connect Customer Service (14237-032615) - View similar jobs
Job type: Full-Time
The OneCare Connect Customer Service Supervisor (OCCCSS) is responsible for providing support in the daily operation of the OneCare Connect call...
CalOptima
CA - Orange
3 Weeks Ago
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Grievance and Appeals Nurse Specialist (08026-032515) - View similar jobs
Job type: Full-Time
The ideal candidate will manage the department work activities to ensure that service standards are met, and operations are consistent with the health...
CalOptima
CA - Orange
3 Weeks Ago
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Clinical Auditor (LVN) (14336-032515) - View similar jobs
Job type: Full-Time
The Clinical Auditor (LVN) will conduct routine oversight, monitoring and auditing, of all internal business functions within CalOptima, as well as...
CalOptima
CA - Orange
3 Weeks Ago