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Program Specialist (Clinical Support (GARS))

CalOptima
Orange, CA
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Program Specialist (Clinical Support (GARS)) CalOptima CalOptima Health is ...
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Summary
About the job:
seeking a highly motivated an experienced Program Specialist to join our team. The Program Specialist will provide administrative clinical support services to the Grievance and Appeals Nurse Specialists in the investigation and preparation of cases for review based on clinical information, benefits, applicable regulations related to member or provider dispute of decisions. The incumbent will collect additional medical information from CalOptima Health members, and/or providers to complete appeal case reviews. The...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Certified Medical Assistant
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Sr. Manager, Strategic Development (Sr. Manager II)

CalOptima
Orange, CA
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Sr. Manager, Strategic Development (Sr. Manager II) CalOptima CalOptima ...
Details
Summary
About the job:
Health is seeking a highly motivated an experienced Sr. Manager, Strategic Development (Sr. Manager II) to join our team. The Sr Manager II (Strategic Development) will be responsible for overall management and oversight of the grants management lifecycle, including grant program development and approval, grant application and award and grants monitoring and close-out. The incumbent will work across all program areas, including collaborating with business owners, finance, compliance and senior leadership to ensure...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Managers, All Other
Career Level / Education:
High school diploma or equivalent
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Petroleum Safety Training
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Manager, Accounting

CalOptima
Orange, CA
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Manager, Accounting CalOptima CalOptima Health is seeking a highly motivated ...
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Summary
About the job:
an experienced Manager, Accounting to join our team. The Manager, Accounting will be responsible for the direct supervision of accounting operatings and/or general ledger division of the department. The incumbent will also provide explanations and make recommendations for developing and maintaining accounting principles, practices and procedures to ensure accurate and timely closing and financial reporting, and financial variance analysis. Position Information: Department: Accounting Salary Grade: 316 - $120,881 -...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Public Accountant
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

Manager, Clinical Pharmacists (Medicare)

CalOptima
Orange, CA
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Manager, Clinical Pharmacists (Medicare) CalOptima CalOptima Health is ...
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Summary
About the job:
seeking a highly motivated an experienced Manager, Clinical Pharmacists (Medicare) to join our team. The Manager, Clinical Pharmacists (Medicare) will assist the Pharmacy Director and pharmacy staff with the ongoing development and implementation of Medicare Part D requirements for members enrolled in CalOptima Health's PACE and OneCare plans. The incumbent will supervise the pharmacists with Medicare-related responsibilities, including Medication Therapy Management (MTM), interdisciplinary care teams, formulary...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Pharmacists
Career Level / Education:
Doctoral or professional degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
6
Graphic Literacy
6
Workplace Documents
7
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Detailed Job Information

Care Manager

CalOptima
Orange, CA
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Care Manager CalOptima CalOptima Health is seeking a highly motivated an ...
Details
Summary
About the job:
experienced Care Manager to join our team. The Care Manager will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes. The incumbent will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member's needs. Position Information: Department: Case Management Salary Grade: 310 - $72,096 - $115,353...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Personal Care Aides
Career Level / Education:
Associate's degree
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
Driver's License
Licensed Vocational Nurse
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Clinical Auditor, Sr. (Internal Audit)

CalOptima
Orange, CA
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Clinical Auditor, Sr. (Internal Audit) CalOptima CalOptima Health is seeking ...
Details
Summary
About the job:
a highly motivated an experienced Clinical Auditor, Sr. (Internal Audit) to join our team. The Clinical Auditor Sr will conduct routine oversight, monitoring and auditing of all internal clinical business functions within CalOptima Health to ensure compliance with state, federal and accreditation standards. The incumbent will serve as a subject matter expert in multiple business areas of health care with Centers for Medicare & Medicaid Services (CMS), California Department of Health Care Services (DHCS), National...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Accountants and Auditors
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
National Committee for Quality Assurance
Licensed Vocational Nurse
Certified Registered Nurse
Workkeys
Applied Math
4
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

Claims Resolution Specialist (Claims)

CalOptima
Orange, CA
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Claims Resolution Specialist (Claims) CalOptima CalOptima Health is seeking ...
Details
Summary
About the job:
a highly motivated an experienced Claims Resolution Specialist (Claims) to join our team. The Claims Resolution Specialist (Claims) will be responsible for overseeing and managing the claims resolution process. The incumbent will follow regulatory and internal guidelines in conjunction with CalOptima Health's policies and procedures that apply to claims adjudication and adjustment of claims. The incumbent will work closely with claims management and trainers to identify training opportunities from trend reports. The...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Claims Adjusters, Examiners, and Investigators
Career Level / Education:
High school diploma or equivalent
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
LPIC-3 304: Virtualization and High Availability
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Auditor (Claims)

CalOptima
Orange, CA
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Auditor (Claims) CalOptima CalOptima Health is seeking a highly motivated an ...
Details
Summary
About the job:
experienced Auditor (Claims) to join our team. The Auditor (Claims) will be responsible for conducting routine oversight monitoring and auditing of all business functions within CalOptima Health to ensure compliance with federal, state, regulatory and internal guidelines. The incumbent will ensure the Claims department is adhering to regulatory and internal guidelines in conjunction with CalOptima Health's policies and procedures as they apply to claims processing. Position Information: • Department: Claims...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Insurance Claims and Policy Processing Clerks
Career Level / Education:
Postsecondary nondegree award
Salary:
Middle Income Jobs ($30K-$49K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Financial Analyst II (Budgeting)

CalOptima
Orange, CA
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Financial Analyst II (Budgeting) CalOptima CalOptima Health is seeking a ...
Details
Summary
About the job:
highly motivated an experienced Financial Analyst II (Budgeting) to join our team. The Financial Analyst II (Budgeting) will be responsible for supporting the Budget department in developing, monitoring, and analyzing CalOptima Health's administrative, medical management, and capital budgets. This role involves close collaboration with various departments to ensure accurate and comprehensive budgets and alignment with organizational objectives. The incumbent will possess strong analytical skills and a good understanding...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Budget Analysts
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
4
apply
Detailed Job Information

Medical Case Manager (Whole Child Model) (Case Management)

CalOptima
Orange, CA
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Medical Case Manager (Whole Child Model) (Case Management) CalOptima ...
Details
Summary
About the job:
CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (Whole Child Model) (Case Management) to join our team. Case Management is an advanced specialty collaborative practice, responsible for providing ongoing case management services for CalOptima Health's members. The Medical Case Manager will facilitate communication and coordination among all participants of the health care team and the member to ensure the services provided promote quality and cost-effective outcomes for all members along...
Location:
Orange, CA
Job Type:
Full-Time
Permanent
Occupation:
Healthcare Social Workers
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Registered Nurse
Certified Case Manager
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information
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