CalOptima Health

Medical Case Manager, BHI Utilization Management - Covered California

CalOptima Health · Full Time · 15 days ago

CalOptima Health

🌎 United States 💵 $90820 - $145K per year ⭐ 2-5 yrs exp 💼 Healthcare

Responsible for reviewing and processing authorization requests for behavioral health services using established clinical protocols to determine medical necessity. The role involves coordinating care, documenting decisions in the utilization management system, and collaborating with providers and stakeholders.

APPLY

Program Manager, Provider Network - Covered California

CalOptima Health · Full Time · 16 days ago

CalOptima Health

🌎 United States 💵 $77863 - $124K per year ⭐ 2-5 yrs exp 💼 Product

The Program Manager designs and implements programs for the provider network, serving as a liaison between internal departments and health networks. They ensure regulatory compliance, monitor program progress, and develop operational workflows to optimize business decisions.

APPLY

Medical Authorization Assistant (Behavioral Health - Utilization Management) - Covered California

CalOptima Health · Full Time · 21 days ago

CalOptima Health

🌎 United States 💵 $49754 - $69655 per year ⭐ 2-5 yrs exp 💼 Healthcare

The role involves processing initial intake and managing authorizations for behavioral health services. It serves as a primary contact between physicians, providers, and staff to ensure compliance and complete referral information.

APPLY

Claims Resolution Specialist

CalOptima Health · Full Time · 21 days ago

CalOptima Health

🌎 United States 💵 $53813 - $80720 per year ⭐ 2-5 yrs exp 💼 Legal

The specialist serves as the primary contact for providers to resolve claims payment issues, denials, and contractual disputes. They are responsible for researching payment methodologies and ensuring accurate documentation of all inquiries within the Facets system.

APPLY

Program Manager, Community Health

CalOptima Health · Full Time · 22 days ago

CalOptima Health

🌎 United States 💵 $77863 - $124K per year ⭐ 2-5 yrs exp 💼 Product

Lead the design, implementation, and oversight of Equity and Community Health initiatives and pilots to reduce racial and ethnic disparities. Coordinate with internal departments and external stakeholders to ensure compliance with state and federal healthcare regulatory standards.

APPLY

Supervisor Behavioral Health

CalOptima Health · Full Time · 22 days ago

CalOptima Health

🌎 United States 💵 $90820 - $145K per year ⭐ 2-5 yrs exp 💼 Healthcare

Oversee daily operations of the Behavioral Health Call Center and Clinical teams to ensure members receive appropriate screenings and care management. Manage licensed clinicians, ensure regulatory compliance with agencies like NCQA and CMS, and coordinate with external community partners.

APPLY

Regulatory Affairs & Compliance Analyst, Policies & Procedures

CalOptima Health · Full Time · 22 days ago

CalOptima Health

🌎 United States 💵 $68015 - $108K per year ⭐ 2-5 yrs exp 💼 Legal

The analyst supports the development, communication, and implementation of organizational policies to ensure compliance with federal and state requirements. Key duties include performing technical reviews of policies, managing tracking tools, and supporting regulatory audits.

APPLY