CalOptima Health

Member Liaison Specialist (Behavioral Health)

CalOptima Health · Full Time · 4 hours ago

CalOptima Health

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

Assist Medi-Cal and OneCare members with behavioral health care management and appointment securing in a call center environment. Act as a liaison between members, providers, and community agencies to coordinate behavioral health services and support integration initiatives.

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Supervisor Case Management

CalOptima Health · Full Time · a day ago

CalOptima Health

🌎 United States 💵 $109K - $175K per year ⭐ 2-5 yrs exp 💼 Others

Oversee daily case management operations, ensuring compliance with NCQA, CMS, and DHCS regulations. Lead and mentor a team of case managers while collaborating with providers and community partners to improve member health.

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(As-Needed) Clinical Pharmacist

CalOptima Health · Full Time · a day ago

CalOptima Health

🌎 Worldwide 💵 $120K - $193K per year ⭐ 2-5 yrs exp 💼 Healthcare

The role involves managing pharmacy operations, analyzing drug utilization reports, and developing clinical criteria for medication review. The pharmacist will also handle prior authorizations, appeals, and collaborate on disease management projects to improve member health outcomes.

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Covered California Claims and Billing Architect (ITS Architect III)

CalOptima Health · Full Time · 6 days ago

CalOptima Health

🌎 United States 💵 $120K - $193K per year ⭐ 10+ yrs exp 💼 Software Development

The architect will lead the design and delivery of scalable cloud-based claims and billing solutions to support digital transformation. They will collaborate with stakeholders to define enterprise technology blueprints and provide technical oversight for implementation.

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Covered California Architect (ITS Architect IV)

CalOptima Health · Full Time · 6 days ago

CalOptima Health

🌎 United States 💵 $132K - $212K per year ⭐ 10+ yrs exp 💼 Software Development

The architect is responsible for defining and implementing innovative technical solutions for the Covered California program within a health plan environment. This includes leading cross-functional initiatives, managing vendor consultants, and ensuring scalable integration with existing systems.

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IT Product Manager Sr (Digital Solutions)

CalOptima Health · Full Time · 21 days ago

CalOptima Health

🌎 United States 💵 $109K - $175K per year ⭐ 5-10 yrs exp 💼 Product

Lead the entire product lifecycle for digital solutions, including member and provider portals, to align business goals with customer needs. Collaborate with cross-functional teams to define product visions, manage backlogs, and ensure compliance with healthcare regulatory standards.

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Program Specialist (NCQA)

CalOptima Health · Full Time · 21 days ago

CalOptima Health

🌎 United States 💵 $55966 - $83949 per year ⭐ 0-2 yrs exp 💼 Others

Provide administrative and technical support for NCQA accreditation and regulatory quality requirements. Coordinate documentation, monitor standard updates, and collaborate with internal and external stakeholders to ensure audit readiness.

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Medical Case Manager

CalOptima Health · Full Time · 21 days ago

CalOptima Health

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

The Medical Case Manager provides intensive case management including assessment, planning, and coordination of services to ensure quality outcomes for members. This involves collaborating with providers and community partners to implement member-specific care plans and facilitate necessary referrals.

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Grievance Resolution Specialist (Provider Resolution)

CalOptima Health · Full Time · a month ago

CalOptima Health

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

Coordinate the resolution process for grievances and appeals from members and providers regarding eligibility, benefits, and claims. Collaborate with internal departments and external stakeholders to ensure timely case disposition and regulatory compliance.

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Data Analyst Sr, Clinical Operations

CalOptima Health · Full Time · a month ago

CalOptima Health

🌎 United States 💵 $84092 - $134K per year ⭐ 5-10 yrs exp 💼 Software Development

The role serves as the primary analytical resource for Clinical Operations, developing complex operational and programmatic reports using SQL and BI tools. Responsibilities include designing ETL processes, validating data quality, and interpreting findings to support healthcare decision-making.

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