Grievance & Appeals Nurse Specialist CalOptima Join Us in this Amazing Opportunity The Team You'll... Nurse Specialist will participate in managing CalOptima Health's medical appeals and state hearing reviews for all lines...
QI Nurse Specialist (RN) (PQI) CalOptima Join Us in this Amazing Opportunity The Team You'll... to this Role: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership...
Program Manager, Provider Data Operations CalOptima Join Us in this Amazing Opportunity The Team You'll... and market trends that may impact CalOptima Health's provider programs and/or mission. 10% - Other Completes...
Auditor, Provider Data CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission...) will be responsible for conducting ongoing data quality auditing of CalOptima Health's provider network data, which includes working...
Part-Time -Customer Service Representative Sr (OneCare) (Bilingual Required) CalOptima Join Us in this Amazing... of member's health care and social service needs both within and outside the medical group and CalOptima Health. Enters...
Contracts Manager Sr CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven... provider service delivery networks in support of CalOptima Health's Medi-Cal and Medicare programs, as assigned. Provides...
, authorization and/or referrals, eFax and records, abstracting charts and CalOptima billing. Pay Range Minimum $23.08 Midpoint...
EAP, Carelon/Anthem, IEHP, CalOptima, and any additional contracted payers. Submission must be completed before the client... EAP, Carelon/Anthem, and Medi-Cal managed care plans (including CalOptima and IEHP). Strong working knowledge of the...
, CalOPTIMA, MediCal, etc. Qualifications: Bilingual in Spanish Previous Medical Front Office experience Knowledge...
General knowledge of insurance payors: PPO, HMO, POS, EPO, Medicare, Medi-Cal, & CalOptima Bi-lingual (English/Spanish...