Caloptima jobs in Orange, CA

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Claims Resolution Specialist (PDR)
CalOptima - 21 reviews - Orange, CA
Effectively utilize computer and appropriate software and interact as needed with CalOptima Claim Processing Systems....
Claims QA Analyst
CalOptima - 21 reviews - Orange, CA
Effectively utilize computer and appropriate software and interact as needed with CalOptima claims processing system....

Staff Attorney

CalOptima - 21 reviews - Orange, CA
Investigate claims and complaints against CalOptima and recommend appropriate action. Effectively utilize computer and appropriate software and interact as...

Manager, Case Management

CalOptima - 21 reviews - Orange, CA
The Manager of Case Management provides shared responsibility for the daily operations, activities and projects for the Case Management Department. This

Supervisor, Therapy Services (PACE)

CalOptima - 21 reviews - Orange, CA
The incumbent will lead the CalOptima PACE Therapy Department, including the development of therapy-related policies and procedures for the CalOptima PACE...

Director, Long Term Support Services

CalOptima - 21 reviews - Orange, CA
Health Networks, including CalOptima Community Network providers, Physician Medical Groups). Serve as a resource for CalOptima and its entire medical groups (i...

Manager, Contracting

CalOptima - 21 reviews - Orange, CA
Responsible for leading the development and implementation of contracting strategies with physicians, facilities, ancillary providers and delegated entities as...

Sr Utiliz Mgt Asst

Heritage Healthcare (SJHH) - 12 reviews - Anaheim, CA 92805
Provides education to physicians and staff regarding HMO, PPO and Caloptima protocols and benefits. Responsible for sorting and distribution of Prior...

Registration Representative - Part-time, Nights

MemorialCare - 58 reviews - Fountain Valley, CA
PPO, HMO, POS, EPO, Medicare, Medi-Cal, & Caloptima Bilingual (English, Spanish, or Vietnamese) preferred Positive work ethic General computer skills required...

Clinical Auditor

CalOptima - 21 reviews - Orange, CA
Research regulations and inform various departments within CalOptima and delegates of CalOptima of any changes to regulatory requirements....

Manager, Audit & Oversight (Internal)

CalOptima - 21 reviews - Orange, CA
This position leads the routine oversight, monitoring and auditing of all internal business functions within CalOptima and its Pharmacy Benefits Manager (PBM)...

Registered Nurse (RN)

Decton Health Services - Orange, CA
$85,000 a year
CalOptima organizational operations. Prepares position statements and represents CalOptima at State Fair Hearings. $34.50/hr - $40.50/hr DOE....
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Claims Resolution Specialist (Customer Service)
CalOptima - 21 reviews - Orange, CA
The Claims Resolution Specialist (CRS) is the first line of contact for CalOptima providers. Effectively utilize computer and appropriate software and interact...
Licensed Vocational Nurse
Hurtt Family Health Clinic/Orange County Rescue Mission - Tustin, CA
$40,000 - $50,000 a year
Keeps clinic in compliance with Title-22, Cal-Optima, VFC program, CalOptima. The HURTT Family Health Clinic is a nonprofit health clinic that serves the needs...
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Customer Service Representative (CSR)
CalOptima - 21 reviews - Orange, CA
Understanding of the CalOptima program. This position will provide information regarding eligibility, enrollment, and benefits to CalOptima members and member...
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