Caloptima jobs in Orange, CA

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Credentialing Coordinator II

Orange, CA 92868
Credentialing Coordinator II We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care...
Desired Experience: NCQA Standards, Excel

Medical Case Manager (Pre Authorization Nurse Reviewer)

Orange, CA
Contacts the health networks and/or CalOptima Customer Service regarding health network enrollments. Under the direction of the Manager of Prior Authorizations...
Desired Experience: Case Manager Certification, Time Management, ICD-10, RN, CPT Coding, Managed Care
Easily apply

Medical Case Manager (NOA-RN)

Orange, CA
The position is responsible for providing Notice of Actions (NOA) coordination for CalOptima’s Utilization Management clinical determinations. The incumbent...
Desired Experience: Bilingual, RN, Managed Care
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RN (PACE) – Intake

Orange, CA
Coordinate with CalOptima Compliance Department to ensure requested documentation is complete. Effectively utilize computer and appropriate software and...
Desired Experience: Bilingual, Time Management, RN, Clean Driving Record, Supervising Experience, Driver's License
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Customer Service Representative (Bilingual Required)

Orange, CA
Understanding of the CalOptima program. Refer issues to health networks and/or make recommendations for further contacts within CalOptima....
Desired Experience: Bilingual, Call Center, Customer Service
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Data Warehouse Programmer/Analyst

Orange, CA
The Data Warehouse (DW) Programmer/Analyst works in conjunction with the Data Warehouse team to develop and support organization-wide reporting, Extract,...
Desired Experience: T-SQL, Business Intelligence, Microsoft SQL Server, Data Warehouse, SDLC, SQL, Microsoft Office, Tableau
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Business Analyst, Sr.

Orange, CA
Effectively utilize computer and appropriate software and interact with CalOptima IS as applicable. The incumbent will be responsible for initiating and...
Desired Experience: Microsoft Word, ICD-10, CPT Coding, Managed Care, ICD-9
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Technical Analyst, Sr.

Orange, CA
Effectively utilize computer and appropriate software and interact as needed with CalOptima staff. Upon hire - policies and procedures and maintenance of,...
Desired Experience: Microsoft Project, Microsoft Powerpoint, Software Troubleshooting, SQL, Microsoft Office, SharePoint, Troubleshooting, Application Support
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Supervisor, Behavioral Health (UM)

Orange, CA
Culture and needs of the socially and ethnically diverse population CalOptima serves. The incumbent will monitor and oversee the department’s UM work activities...
Desired Experience: Microsoft Powerpoint, RN, Social Work License, Applied Behavior Analysis, Behavioral Health, Microsoft Office, Supervising Experience, Managed Care
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Clinical Auditor

Orange, CA
$38 an hour
Participate in workgroups that address both clinical and non-clinical internal activities for which CalOptima must demonstrate improvement to meet its...
Desired Experience: Driver's License, Quality Management
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